Differential Diagnosis for 8-month-old Baby with Inspiration Wheezing while Breastfeeding

• Single most likely diagnosis:
  • Gastroesophageal reflux disease (GERD): This condition is common in infants and can cause wheezing or other respiratory symptoms, especially during feeding, due to the reflux of stomach contents into the esophagus which can irritate the airways.
• Other Likely diagnoses:
  • Laryngomalacia: A condition where the soft tissues of the larynx are floppy, leading to partial airway obstruction, which can cause inspiratory wheezing or stridor, especially noticeable during feeding or when the baby is on their back.
  • Milk allergy or intolerance: An allergic reaction or intolerance to milk proteins can lead to respiratory symptoms, including wheezing, particularly during breastfeeding.
  • Upper airway obstruction: Conditions such as nasal congestion or anatomic abnormalities can cause inspiratory wheezing, especially if the obstruction worsens during feeding.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed):
  • Foreign body aspiration: Although less common in a breastfeeding scenario, aspiration of a foreign body can cause sudden onset of respiratory distress, including wheezing.
  • Congenital heart disease: Certain congenital heart defects can present with respiratory symptoms, including wheezing, due to pulmonary congestion or other mechanisms.
  • Tracheoesophageal fistula or esophageal atresia: These congenital anomalies can lead to respiratory symptoms during feeding due to the abnormal connection between the trachea and esophagus or due to esophageal obstruction.
• Rare diagnoses:
  • Vascular ring or sling: Abnormal formation of the aortic arch can compress the trachea or esophagus, leading to respiratory and feeding difficulties.
  • Bronchomalacia: Weakening of the bronchial walls can cause airway obstruction and wheezing, particularly during feeding or when the baby is in certain positions.