A 5-year-old child with severe respiratory distress exhibits a seal bark cough and fever. What do you suspect?

The presence of a seal bark cough, along with severe respiratory distress and fever in a 5-year-old child, strongly suggests croup. Croup, also known as laryngotracheobronchitis, is characterized by a distinctive cough that sounds like a barking seal, often due to swelling in the upper airway caused by viral infection, most commonly parainfluenza virus. The accompanying fever indicates an inflammatory process, which is typical in cases of croup.

Children with croup often have symptoms that worsen at night, and they may exhibit stridor (a high-pitched wheezing sound) when breathing in due to airway narrowing. This symptomatology aligns perfectly with the scenario described. Recognizing these clinical features is important for timely and appropriate intervention in pediatric patients, as croup can sometimes lead to significant airway obstruction if not managed properly.

In contrast, bronchitis tends to present with a productive cough without the classic seal bark sound; pneumonia often involves more localized symptoms such as chest pain and the presence of crackles upon auscultation; and asthma, while it can cause wheezing and respiratory distress, usually does not present with a seal bark cough or fever as initial symptoms.