Article Text

Download PDFPDF
Cough and you’ll miss it
  1. Seana Molloy1,
  2. Gemma Batchelor2,
  3. Luke McCadden3,
  4. Rebecca Moore2,
  5. Thomas Bourke1,4,
  6. Andrew Thompson1
  1. 1 Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2 General Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  3. 3 ENT, Royal Victoria Hospital, Belfast, UK
  4. 4 Department of Medical Education, Centre for Medical Education, Queen's University, Belfast, UK
  1. Correspondence to Dr Seana Molloy, Paediatrics, Royal Belfast Hospital for Sick Children, Belfast BT12 6BA, UK; seana.molloy{at}


­A 9-month-old boy presented to the emergency department with acute wheeze. He had a background of cleft lip repair at 4 months and was awaiting palatoplasty. He had mild eczema but had never had a previous wheezy episode, and was awaiting cardiology follow-up for a small patent ductus arteriosus (PDA). He had been at the child minder when symptoms began abruptly with no witnessed event. On assessment, the wheeze had resolved, saturations were 98% breathing air, respiratory rate was 34 breaths per minute and he was afebrile. He was discharged home with safety net advice.

He represented 2 days later with cough, wheeze and shortness of breath. On examination, he had subcostal recession and there was reduced air entry on the right. There was no wheeze, crepitations or obvious organomegaly. Oxygen saturations were 98% breathing air, respiratory rate was 38 breaths per minute and he was afebrile. Oral amoxicillin was given.


  1. Given the history what is the likely diagnosis?

    1. Bronchiolitis

    2. Congestive heart failure

    3. Foreign body aspiration

    4. Pneumonia

    5. Reactive airways disease

  2. Which investigation would be most useful at this stage?

    1. Bronchoscopy

    2. Chest X-ray

    3. CT chest

    4. Echocardiogram

    5. Point-of-care respiratory strip

  3. What is the next step in the management?

    1. Intravenous ceftriaxone/clarithromycin

    2. Intravenous diuretics

    3. Needle thoracocentesis

    4. Oral steroids and inhaled bronchodilator

    5. Rigid bronchoscopy

  4. What are the long term complications of an undiagnosed foreign body?

Questions Answers can be found on page 2.

  • paediatric
  • foreign body aspiration
  • cough
  • wheeze

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Twitter @No twitter

  • Correction notice This paper has been corrected since it was published online. The abstract should not have been included in the published version and this has been removed.

  • Contributors SM wrote the first draft. All other authors reviewed the manuscript and agreed on the final version for submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.