Chronic Cough in Children

Aka: Chronic Cough in Children, Pediatric Chronic Cough, Chronic Cough Evaluation in Children

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