Which of the following is a sign that a child may require hospitalization for asthma?

Severe wheezing is a critical sign indicating that a child may require hospitalization for asthma. This symptom often suggests significant bronchial constriction and compromised airway function. When wheezing is severe, it typically points to an exacerbation of asthma that is not responding adequately to standard treatments, such as bronchodilators, and may indicate the risk of respiratory failure.

In the context of asthma management, hospitalization is often necessary when symptoms escalate to a point where outpatient interventions are ineffective, leading to the need for more intensive care and monitoring. Severe wheezing may accompany symptoms like shortness of breath, inability to speak in full sentences, or reliance on accessory muscles for breathing, all of which further underline the urgency for medical intervention.

While fever and chills might indicate an infection that can complicate asthma, and fatigue and lethargy could reflect a child's overall decreased energy levels due to illness, these symptoms do not directly indicate the severity or imminent danger associated with an asthma crisis as severe wheezing does. Unusual skin rashes may signal other medical concerns but are not typically associated with acute asthma exacerbations. Therefore, severe wheezing stands out as a clear indication that the child may require hospitalization to ensure appropriate treatment and stabilization.