For a 1-week-old infant who exhibits high-pitched breathing that improves during sleep, what is the best initial management approach?

The best initial management approach for a 1-week-old infant exhibiting high-pitched breathing that improves during sleep is reassurance and supportive therapy. This symptom could indicate a condition like laryngomalacia, which is common in infants and often characterized by a high-pitched sound during breathing, especially during exertion, while typically resolving or improving during sleep when the airway is less dynamic.

In many cases, laryngomalacia does not require immediate medical intervention since it often resolves on its own as the infant grows. The management primarily involves monitoring the infant's condition and providing reassurance to the parents, emphasizing that it is generally a benign condition that is self-limiting.

When considering other options, immediate hospitalization may not be necessary if the infant is stable and the symptoms are not indicative of a more serious condition. Administration of bronchodilators is not typically effective for this type of upper airway obstruction caused by laryngomalacia. Performing a chest X-ray might be warranted if there are signs of respiratory distress or if a more concerning diagnosis needs to be ruled out, but it is not the first step in management for mild cases of high-pitched breathing without distress. Hence, reassurance and supportive care is the most appropriate initial management.