Wheezing in Children: Model Clinical Case and Viva Q&A

Clinical Case of Wheezing in Children

Acute Wheezing in a 3-Year-Old

Patient Information

• Name: Emily
• Age: 3 years
• Sex: Female

Presenting Complaint

Emily is brought to the emergency department by her parents with complaints of difficulty breathing and a "whistling" sound when exhaling. The symptoms started about 6 hours ago and have been progressively worsening.

History of Present Illness

• Onset: Symptoms began suddenly this morning
• Progression: Gradually worsening over the day
• Associated symptoms: Cough, mild fever (38°C), decreased appetite
• Recent history: Had a mild cold for the past 2 days
• No history of similar episodes in the past

Past Medical History

• Full-term birth, normal development
• Up-to-date on vaccinations
• No known allergies
• No previous hospitalizations or surgeries

Family History

• Father has asthma
• Maternal grandmother has allergies

Physical Examination

• General: Alert but in mild respiratory distress
• Vital Signs:
  • Temperature: 38.2°C
  • Heart Rate: 130 bpm
  • Respiratory Rate: 40 breaths/min
  • Blood Pressure: 100/60 mmHg
  • SpO2: 92% on room air
• Respiratory:
  • Visible intercostal retractions
  • Audible wheezing on expiration
  • Prolonged expiratory phase
  • Decreased air entry bilaterally
• Cardiovascular: Regular rhythm, no murmurs
• ENT: Mildly erythematous pharynx, no tonsillar exudates
• Skin: No rashes or cyanosis

Initial Management

1. Oxygen therapy via nasal cannula to maintain SpO2 > 94%
2. Nebulized albuterol (2.5 mg) with ipratropium bromide (0.5 mg)
3. Oral prednisolone (1 mg/kg)
4. Reassessment after 20 minutes

Outcome

After two rounds of nebulized bronchodilators and systemic corticosteroids, Emily's respiratory status improved significantly. Her wheezing decreased, respiratory rate normalized, and SpO2 increased to 98% on room air. She was observed for 4 hours and then discharged home with a short course of oral prednisolone, an inhaled corticosteroid, and a rescue inhaler. Follow-up with a pediatrician was scheduled for 48 hours later.

Discussion

This case illustrates a typical presentation of acute wheezing in a young child, likely due to viral-induced bronchospasm or early asthma. The management demonstrates the standard approach of bronchodilators and corticosteroids, with close monitoring and follow-up. It highlights the importance of prompt recognition and treatment of respiratory distress in children, as well as the need for ongoing management and education for potential recurrences.

Clinical Presentations of Wheezing in Children

Various Clinical Presentations of Wheezing in Children

1. Acute Viral Bronchiolitis

   • Typically affects infants < 2 years old
   • Preceded by upper respiratory tract infection symptoms
   • Rapid onset of wheezing, cough, and increased work of breathing
   • Often associated with RSV or other respiratory viruses
   • May lead to feeding difficulties and dehydration
   • Characteristic crackles on auscultation

2. Asthma Exacerbation

   • Recurrent episodes of wheezing, coughing, and shortness of breath
   • Often triggered by viral infections, allergens, or exercise
   • May have nocturnal symptoms or early morning worsening
   • Family history of asthma or atopy is common
   • Response to bronchodilators is typically good
   • May have associated atopic conditions (eczema, allergic rhinitis)

3. Foreign Body Aspiration

   • Sudden onset of cough and wheezing in a previously healthy child
   • May have a history of choking episode
   • Unilateral wheezing or decreased breath sounds
   • Can present with recurrent pneumonia in the same location
   • May have intermittent symptoms if foreign body is mobile
   • Chest X-ray may show hyperinflation or atelectasis

4. Allergic Reaction / Anaphylaxis

   • Rapid onset of wheezing along with other systemic symptoms
   • May have associated urticaria, angioedema, or gastrointestinal symptoms
   • Often has a history of exposure to a known allergen
   • Can progress rapidly to respiratory failure and shock
   • May have concurrent cardiovascular symptoms (tachycardia, hypotension)

5. Cystic Fibrosis Exacerbation

   • Chronic or recurrent wheezing in a child with known CF
   • Associated with increased cough and sputum production
   • May have weight loss or failure to thrive
   • Often accompanied by recurrent respiratory infections
   • Characteristic upper lobe bronchiectasis on imaging

6. Gastroesophageal Reflux Disease (GERD)

   • Wheezing associated with feeding or when lying down
   • May have concurrent symptoms of reflux (regurgitation, heartburn)
   • Can present with chronic cough, especially at night
   • May not respond well to typical asthma treatments
   • Often improves with anti-reflux measures and medications

7. Tracheomalacia or Bronchomalacia

   • Inspiratory or expiratory stridor that may be mistaken for wheezing
   • Symptoms worsen with agitation or crying
   • Often improves when the child is calm or sleeping
   • May be associated with other congenital anomalies
   • Diagnosis often requires bronchoscopy

8. Vocal Cord Dysfunction

   • Wheezing-like sound, often more prominent on inspiration
   • May be triggered by exercise or stress
   • Often mistaken for treatment-resistant asthma
   • Symptoms may resolve quickly without intervention
   • Diagnosis confirmed by laryngoscopy during an episode

Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30

Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.