What is the cause of a 5-year-old child's failure to thrive, with symptoms of diurnal and nocturnal enuresis, and hypoxemia during sleep with oxygen saturation levels decreasing to 80%?

Differential Diagnosis for a 5-year-old not meeting weight milestones, wheezing during day and night, and oxygenation in sleep to 80%

• Single most likely diagnosis:

  • Asthma: This is a common condition in children that can cause wheezing, coughing, and shortness of breath, which may lead to poor weight gain due to increased energy expenditure and potential feeding difficulties. The nocturnal wheezing and desaturation to 80% during sleep further support this diagnosis, as asthma symptoms can worsen at night.

• Other Likely diagnoses:

  • Chronic lung disease of infancy (if the child was premature): This condition can lead to long-term respiratory issues, including wheezing and oxygen desaturation, affecting growth.
  • Cystic Fibrosis: A genetic disorder that affects the lungs and digestive system, leading to malnutrition and poor growth due to malabsorption, and respiratory symptoms like wheezing.
  • Gastroesophageal reflux disease (GERD): Can cause wheezing and coughing, especially at night, due to acid reflux into the lungs, and may lead to feeding difficulties and poor weight gain.

• Do Not Miss diagnoses:

  • Congenital heart disease: Conditions like tetralogy of Fallot can cause cyanosis and poor weight gain due to increased metabolic demand and decreased oxygenation.
  • Foreign body aspiration: Especially if the onset of symptoms was acute, a foreign body in the airway can cause sudden wheezing and respiratory distress.
  • Pneumonia or other infections: Recurrent or chronic infections can lead to failure to thrive and respiratory symptoms.

• Rare diagnoses:

  • Primary ciliary dyskinesia (Kartagener syndrome): A rare genetic disorder affecting the cilia, leading to chronic respiratory infections, bronchiectasis, and poor growth.
  • Interstitial lung disease: A group of rare disorders that affect the lung tissue, leading to chronic respiratory symptoms and potential failure to thrive.
  • Immunodeficiency: Certain immunodeficiencies can increase the risk of recurrent infections, leading to poor growth and chronic respiratory symptoms.