An 11-Month-Old Boy With Cough, Wheezing, and Fever

Watch this video taken during examination of the child. Listen as he cries. Is there a clue to the diagnosis?

An 11-month-old boy was seen after approximately 3 days of fever, cough, wheezing, otitis, and trouble sleeping. His mother describes the child’s cough as “seal-like” barking and says it is worse in the evening and overnight than during the day. The mother denies exposure to passive smoke in the home. The child had been and is otherwise healthy. His weight is 21.6 lb and height, 30 in. Vital signs: temperature, 37.7°C (99.9°F [ax]); heart rate, 147 beats/min; SpO2: 99% on room air.

Review the video of the examination and select your diagnosis from this differential: