Clinical Pediatrics Volume 46 Number 3 April 2007 283-289 © 2007 Sage Publications 10.1177/0009922806289086 http://clp.sagepub.com hosted at http://online.sagepub.com

Dysphonia Divya Seth, MD,1 Sanjay Chawla, MD,1 Rosemary Shy, MD,2 Deepak Kamat, MD, PhD2 Patient Report

A

previously healthy 4-month-old African American boy was hospitalized for bronchiolitis. He presented with cough and runny nose, with large mucus production for 3 weeks and wheezing for 2 days. During this time, he was also noticed to have developed hoarseness of voice and a barely audible, weak cry. He had also been choking and gagging on feeds, with decreased oral intake over the previous week. He was vomiting off and on and had become very irritable. He did not have a fever or diarrhea, but his stools were yellow and frothy. He was treated with cool mist, nebulized albuterol, intravenous fluids, and nasogastric tube feedings. His birth history was nonsignificant, and his birth weight was 2.46 kg (5%-10%). His medical history was significant for poor weight gain, which had led to changing of formulas. The patient’s diet consisted of Isomil (Abbott Laboratories, Abbott Park, Ill) (20 cal/oz) 4 oz every 3 to 4 hours, thickened with rice cereal. Family history was nonsignificant. Developmental milestones were age appropriate. On admission, his temperature was 37.0°C, heart rate, 126 beats/min; respiratory rate, 44/min; and oxygen saturation of 95% on room air. Growth parameters showed that his weight was 4.66 kg (