II. Definitions: Children
-
Chronic Cough
- Cough duration longer than 4 weeks
III. 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-Bronchitic cough)
- Persists 3 weeks after Upper Respiratory Infection
- Consider protracted Bacterial 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 Testing
- Acute Sinusitis
- Rhinorrhea for 2 weeks is Sinusitis in 70-85% cases
- Eye mattering may be associated
IV. History
- Nature of cough
- Croupy 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
- Cough during sleep
- Associated factors
- Exposures (e.g. Tobacco smoke)
- Underlying conditions
- Asthma
- Feeding difficulties
- Neurodevelopmental disorders
- Immunodeficiency
V. Exam
-
General
- Evaluate pediatric height and weight curves
- Vital Signs
- Head and neck
- Evaluate for Acute Sinusitis
- Evaluate for Allergic Rhinitis
- Chest
VI. Findings: Red Flags for Serious Underlying Conditions
- Chest Pain
- Dyspnea
- Tachypnea
- Digital Clubbing
- Failure to Thrive
- Feeding difficulties
- Hemoptysis
- Recurrent Pneumonia
VII. Imaging
-
Chest XRay
- Obtain in most cases of persistent cough without localizing symptoms (esp. age >3-6 years old)
VIII. Diagnostics
IX. Labs: Consider
- Sputum exam
- Purified Protein Derivative (PPD)
- Sweat Chloride
X. Differential Diagnosis
- See Chronic Cough Causes in Children
- Most common causes
- Asthma or reactive airway disease
- Upper Airway Cough Syndrome
- Gastroesophageal Reflux
- Protracted Bacterial Bronchitis
- Bronchiectasis
- Serious chronic conditions (see red flag findings above)
- Aspiration lung disease
- Interstitial Lung Disease
- Cardiac conditions
- Airway abnormalities
XI. Management: First stage
- Upper airway (e.g. congestion, Rhinorrhea, post-nasal drainage)
- Consider empiric Antibiotic treatment for Sinusitis or protracted Bacterial Bronchitis (prolonged wet cough)
- Consider trial of Antihistamine (with or without a Decongestant)
- Use inhaled Intranasal Corticosteroids if practical
- Environmental control in child's bedroom
- Lower airway (reversible airway obstruction with Wheezing; Asthma or reactive airway disease)
- Consider trial of Inhaled Bronchodilators
- Consider trial of Inhaled Corticosteroids
- Prednisone short course occasionally may be helpful
XII. Management: Next Stage (If failure of first stage)
- Re-evaluation
- Intensify Asthma therapy
- Do not suppress the cough