Differential Diagnosis for 14-Month-Old with Retraction Breathing, Cough, and Fussiness without Fever
- Single Most Likely Diagnosis
- Bronchiolitis: This is a common respiratory illness in infants, typically caused by a viral infection, leading to symptoms such as cough, retraction breathing, and fussiness. The absence of fever does not rule out this diagnosis, as not all cases present with fever.
- Other Likely Diagnoses
- Asthma: Although less common in infants, asthma can present with cough and respiratory distress. The diagnosis might be considered, especially if there's a family history or if the infant has had similar episodes before.
- Pneumonia: While the absence of fever makes this less likely, pneumonia cannot be ruled out without further investigation, such as a chest X-ray. Viral pneumonias, in particular, might not always present with high fever.
- Foreign Body Aspiration: This is a critical consideration in any infant presenting with sudden onset of respiratory symptoms, as it can lead to severe complications if not promptly addressed.
- Do Not Miss Diagnoses
- Epiglottitis: Although rare and more commonly associated with fever, epiglottitis is a life-threatening condition that requires immediate recognition and treatment. The absence of fever does not exclude this diagnosis.
- Congenital Heart Disease: Infants with undiagnosed congenital heart disease can present with respiratory symptoms due to pulmonary congestion or other complications. This diagnosis is critical to consider, especially if the infant has not had a recent cardiac evaluation.
- Rare Diagnoses
- Cystic Fibrosis: This genetic disorder can lead to recurrent respiratory infections and symptoms such as cough and respiratory distress. It's less likely to be the cause of acute symptoms in a previously healthy infant but should be considered in the differential for chronic or recurrent respiratory issues.
- Pulmonary Lymphangiectasia: A rare condition characterized by abnormal lymphatic vessels in the lungs, leading to respiratory distress. It's a diagnosis that would typically be considered after other more common causes have been ruled out.