An 18-month-old with inspiratory stridor at rest and mild respiratory distress most likely has which condition?

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

Answer: (B)

Inspiratory stridor in a toddler points to upper airway narrowing, and in an 18-month-old the most classic cause is viral laryngotracheitis, or croup. The inflammation and edema occur just below the vocal cords, narrowing the subglottic region and producing a harsh, high-pitched sound with inhalation. The accompanying barky cough and the pattern of mild distress with stridor at rest fit this age group and presentation.

Epiglottitis would tend to look very different—sudden onset with high fever, drooling, a muffled voice, and a toxic-looking child who may assume a tripod position. Bronchiolitis mainly affects the lower airways, causing tachypnea, wheezing, and crackles rather than prominent inspiratory stridor. Asthma typically shows expiratory wheeze and a history of atopy or triggers, not primarily inspiratory stridor.