Prominent upper airway symptoms
Symptoms from first day of life
Sudden onset symptoms, which always suggests a foreign body
Chronic moist cough/sputum >8 weeks duration every day
Worse after meals, irritable feeder, arches back, vomits, suggests
gastro-oesophageal reflux
Systemic illness or immunodeficiency
Continuous, unremitting symptoms
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Clubbing, weight loss, failure to thrive
Upper airway disease – tonsillar hypertrophy, rhinitis, nasal polyps
which last mandates consideration of cystic fibrosis
Unusually severe chest deformity
Fixed monophonic wheeze, stridor, asymmetrical signs
Signs of cardiac or systemic disease
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