Table of Contents
Page created on February 9, 2022. Last updated on December 18, 2024 at 16:58
Differential diagnosis of stridor
A stridor is a low-pitched sound on inspiration due to upper airway obstruction.
| Etiology | Typical findings |
| Croup | Preceded by URTI, symptoms worsen at night, barking cough |
| Foreign body | Unattended small child, choking, onset after playing or eating |
| Anaphylaxis (laryngeal oedema) | Urticaria, swollen face, known allergy |
| Epiglottitis | Very ill-looking, high fever, drooling saliva, “sniffing” posture |
Differential diagnosis of wheezing
A wheeze is a high-pitched whistle-like sound on expiration due to lower airway obstruction.
| Time of symptoms | Etiology | Typical findings |
| Acute | Foreign body | Unattended small child, choking, onset after playing or eating |
| Viral infection (bronchiolitis or tracheitis. Usually RSV) | Preceded by or coexistent URTI symptoms | |
| Chronic or recurrent | Asthma | Symptoms worse at night and morning, episodes of worse symptoms, family history of atopy |
| Tracheomalacia/bronchomalacia | Onset in first months | |
| Cystic fibrosis | Persistent lung infection, pancreatic insufficiency, elevated sweat chloride |
Differential diagnosis of tachypnoea
Tachypnoea is the most sensitive sign of respiratory disease in children. It’s usually defined as respiratory rate as >60 in neonates, >40 – 50 in young children, and >30 in adolescents.
| Etiology | Typical findings |
| Pneumonia | Fever, cough, SOB. Preceded by URTI |
| Viral infection (bronchiolitis or tracheitis. Usually RSV) | Preceded by or coexistent URTI symptoms |
| Heart failure | Tachycardia, SOB, poor weight gain |
| Dehydration/shock | Decreased turgor, hypotension, altered mental status |
Differential diagnosis of respiratory distress in neonates
| Etiology | Typical findings |
| Transient tachypnoea of the newborn | Begins within 2 hours, not severe, negative x-ray |
| Neonatal respiratory distress syndrome | Very premature infant, begins within minutes or hours |
| Meconium aspiration syndrome | Postterm infant, meconium stained |
| Pneumonia | Symptoms of infection/sepsis |
| Congenital cyanotic heart disease | Cyanosis |
| Pulmonary air leak syndrome | Circulatory collapse |
| Choanal atresia | Cyanosis which improves when crying |
| Congenital diaphragmatic hernia | Bowel sounds but no breathing sounds on left side |