A 30-month-old child has a fever of 102 F, cough, and shortness of breath with increased work of breathing; auscultation shows diffuse wheezes and crackles. What should you suspect?

• A. Bronchiolitis
• B. Croup
• C. Asthma
• D. Epiglottis

Answer: (A)

This scenario points to a viral infection causing inflammation of the small airways in a young child. The combination of fever, cough, increased work of breathing, and diffuse wheezes and crackles fits bronchiolitis, which is most often due to RSV and commonly affects children under 2 years old, though it can occur around this age. The wheezes and crackles reflect obstruction and inflammation of the bronchioles, not just the larger airways.

Other conditions have distinguishing features not present here. Croup usually shows a barking cough with inspiratory stridor from upper-airway swelling. Epiglottitis presents with drooling, a muffled voice, and a toxic appearance, often in a child who looks very ill. Asthma can cause wheezing, but fever and diffuse crackles are less typical in a first acute presentation at this age.

So the best suspicion given the age and findings is bronchiolitis.