Differential Diagnosis for a 6-year-old with Shortness of Breath (SOB)

Single Most Likely Diagnosis

• Asthma exacerbation: This is a common condition in children that can cause shortness of breath, wheezing, and coughing. The child's age and presentation with SOB make asthma a likely diagnosis.

Other Likely Diagnoses

• Viral upper respiratory infection (URI): URIs are common in children and can cause SOB, especially if the infection has progressed to involve the lower respiratory tract.
• Pneumonia: Bacterial or viral pneumonia can cause SOB, fever, and cough in children.
• Foreign body aspiration: Children often put objects in their mouths, which can lead to aspiration and subsequent respiratory distress.

Do Not Miss Diagnoses

• Epiglottitis: Although rare, epiglottitis is a life-threatening condition that requires prompt recognition and treatment. It can cause severe SOB, stridor, and drooling.
• Pneumothorax: A spontaneous pneumothorax can occur in children and cause sudden onset of SOB and chest pain.
• Anaphylaxis: A severe allergic reaction can cause SOB, wheezing, and potentially life-threatening respiratory distress.

Rare Diagnoses

• Cystic fibrosis: A genetic disorder that affects the respiratory and digestive systems, causing chronic respiratory infections and SOB.
• Congenital heart disease: Certain congenital heart defects can cause SOB, especially during periods of increased respiratory demand.
• Interstitial lung disease: A group of rare disorders that affect the lung tissue and can cause SOB, cough, and fatigue.

Plan of Care

1. Initial Assessment: Quickly assess the child's airway, breathing, and circulation (ABCs) and provide oxygen if necessary.
2. History and Physical: Take a detailed history, including the onset and duration of symptoms, and perform a thorough physical examination.
3. Diagnostic Tests: Order diagnostic tests, such as a chest X-ray, complete blood count (CBC), and blood cultures, as indicated by the child's presentation and suspected diagnosis.
4. Treatment: Initiate treatment based on the suspected diagnosis, such as bronchodilators for asthma or antibiotics for pneumonia.
5. Monitoring: Continuously monitor the child's respiratory status and adjust the treatment plan as needed.