What should be suspected when a child presents with respiratory distress a week after near-drowning?

When a child presents with respiratory distress following a near-drowning incident, pneumonia should be suspected due to the increased risk of aspiration. After water exposure, the inhalation of foreign fluid can lead to pneumonia, which may develop within days to weeks. This is particularly relevant in the context of near-drowning, as water enters the lungs, creating a potential for infection due to the introduction of pathogens or chemical irritants.

While asthma, pertussis, and bronchiolitis can cause respiratory distress in children, they are generally not directly linked to the recent incident of near-drowning in the same way that pneumonia is. Asthma typically presents with wheezing and may have a chronic component, pertussis is characterized by a severe cough and a distinct paroxysmal pattern, and bronchiolitis usually occurs in infants as a viral infection leading to wheezing. However, these conditions would not follow the specific history of fluid aspiration quite like pneumonia would. Thus, the timeline and context of near-drowning make pneumonia the most likely diagnosis in this scenario.