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Chronic Cough in Children
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Chronic Cough in Children
, Pediatric Chronic Cough, Chronic Cough Evaluation in Children
Definitions
Children
Chronic Cough
Cough
duration longer than 4 weeks
Causes
Common etiologies (ages 6 to 15 years old)
See
Chronic Cough Causes in Children
Reactive airway disease or Bronchospastic condition
Occurs in 70% of children at some time
Worse at night and with
Exercise
Post-Viral inflammation (Post-
Bronchi
tic cough)
Persists 3 weeks after
Upper Respiratory Infection
Consider protracted
Bacteria
l
Bronchitis
Upper Airway Cough Syndrome
(
UACS
)
Rare in children under 6 years old (consider other diagnosis)
Allergic Rhinitis
Eliminate environmental allergans and irritants
Consider
Allergy Test
ing
Acute Sinusitis
Rhinorrhea
for 2 weeks is
Sinusitis
in 70-85% cases
Eye mattering may be associated
History
Nature of cough
Croup
y cough
Loose rattling cough
Throat clearing (Hawking) suggests postnasal drip
Dry brassy cough ("kak kak kak")
Cough
Timing
Cough
during sleep
Post
Nasal Discharge
Bronchospasm
Cough
on awakening (
Sputum
productive)
Consider
Cystic Fibrosis
Cough
with Feeding
Gastroesophageal Reflux
disease
Aspiration
Discoordinated swallow
Psychogenic cough disappears with sleep
Seasonal cough
Spring or fall:
Allergic Rhinitis
Winter: Bronchospasm from irritation
Exam
Gene
ral
Evaluate pediatric height and weight curves
Head and neck
Evaluate for
Acute Sinusitis
Evaluate for
Allergic Rhinitis
Chest
Anteroposterior Diameter
Localized crackles and
Wheeze
s
Resonance
Decreased air entry or lag
Digital Clubbing
Imaging
Chest XRay
Diagnostics
Pulmonary Function Test
ing
Labs
Consider
Sputum
exam
Purified Protein Derivative
(PPD)
Sweat Chloride
Management
First stage
Upper airway
Consider empiric
Sinusitis
antibiotic treatment
Consider trial of
Antihistamine
and
Decongestant
Use inhaled
Intranasal Corticosteroid
s if practical
Environmental control in child's bedroom
See
Environmental Allergen
Lower airway
Consider trial of
Inhaled Bronchodilator
s
Consider trial of
Inhaled Corticosteroid
s
Prednisone
short course occasionally may be helpful
Management
Next Stage (If failure of first stage)
Re-evaluation
Cystic Fibrosis
Asthma
Gastroesophageal Reflux
Congenital Anomaly
Foreign Body Aspiration
Immune disorder
Intensify
Asthma
therapy
Do not suppress the cough
References
Michaudet (2017) Am Fam Physician 96(9): 575-80 [PubMed]
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