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Chronic Cough in Children
Aka: 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-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
- 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
- Exam
- General
- Evaluate pediatric height and weight curves
- Head and neck
- Evaluate for Acute Sinusitis
- Evaluate for Allergic Rhinitis
- Chest
- Anteroposterior Diameter
- Localized crackles and Wheezes
- Resonance
- Decreased air entry or lag
- Digital Clubbing
- Imaging
- Chest XRay
- Diagnostics
- Pulmonary Function Testing
- 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 Corticosteroids if practical
- Environmental control in child's bedroom
- See Environmental Allergen
- Lower airway
- Consider trial of Inhaled Bronchodilators
- Consider trial of Inhaled Corticosteroids
- 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]