A 3-week-old infant has difficulty breathing and feeding. The mother reports that the infant's cry has become hoarse. The infant is bottle-fed and is not offered honey with feedings. The most likely diagnosis is:

A 3-week-old infant has difficulty breathing and feeding. The mother reports that the infant's cry has become hoarse. The infant is bottle-fed and is not offered honey with feedings. The most likely diagnosis is:

• A. Botulism
• B. Laryngeal web
• C. Viral infection
• D. Vocal nodules

Answer: (B)

A hoarse cry with breathing and feeding difficulties in a 3-week-old most often points to a congenital laryngeal abnormality that narrows the airway and affects voice. A laryngeal web is a thin membrane across the glottis formed during embryologic development when the laryngeal lumen fails to recanalize properly. This causes hoarseness and can lead to feeding difficulty and respiratory distress because the airway is restricted. In this scenario, other considerations are less likely. Botulism would typically present with a floppy, weak infant with poor suck and hypotonia, and there’s a known risk factor with honey ingestion. Viral infections usually bring fever and systemic symptoms rather than a specifically hoarse cry in a neonate. Vocal nodules arise from chronic vocal abuse and are not expected in a newborn. So, the presentation best fits a congenital laryngeal web, which affects both voice quality and airway patency in infancy.

A hoarse cry with breathing and feeding difficulties in a 3-week-old most often points to a congenital laryngeal abnormality that narrows the airway and affects voice. A laryngeal web is a thin membrane across the glottis formed during embryologic development when the laryngeal lumen fails to recanalize properly. This causes hoarseness and can lead to feeding difficulty and respiratory distress because the airway is restricted.

In this scenario, other considerations are less likely. Botulism would typically present with a floppy, weak infant with poor suck and hypotonia, and there’s a known risk factor with honey ingestion. Viral infections usually bring fever and systemic symptoms rather than a specifically hoarse cry in a neonate. Vocal nodules arise from chronic vocal abuse and are not expected in a newborn.

So, the presentation best fits a congenital laryngeal web, which affects both voice quality and airway patency in infancy.