A 4-week-old male was brought for consultation with a one-week history of "noisy breathing." His parents note that his noisy breathing is worse when they lay him down or with crying. It is most noticeable when he takes a breath in. There has been no history of fever, coughing, runny nose, and change in his cry, apnea, or feeding difficulties. He has been gaining weight appropriately. Prenatal course was uneventful and he was delivered at 38 weeks gestation by spontaneous vaginal delivery without complications. Family History is unremarkable. Physical Exam VS T 37.0, P 120, RR 48, oxygen saturation 98% in room air.
Weight and height are at the 50 percentile. He is alert, active, in no acute distress. Audible inspiratory stridor noted in the supine position, improved with extension of his neck. His anterior fontanel is soft and flat. His eyes and ears are normal. Nasal flaring…
