Cough resident survival guide (pediatrics)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]

Synonyms and keywords:

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.

• Life threatening cause 1
• Life threatening cause 2
• Life threatening cause 3

Common Causes

Acute cough (less than 3 weeks)	Subacute (3 to 8 weeks) or chronic cough (3 to 4 months)
Common cold Bronchitis or Bronchiolitis Asthma Pertussis Croup Influenza Foreign body Pneumonia Second-hand smoke Gastroesophageal reflux disease (GERD)	Urinary tract infection Transient unexplained Stones Exercise Trauma Polycystic kidney disease

Diagnosis

The approach to diagnosis of Cough in children is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of Cough.

Cough

Characterize the symptoms ❑ Chronic wet/productive cough ❑ Chest pain ❑ History suggestive of inhaled foreign body ❑ Dyspnea ❑ Exertional dyspnea ❑ Hemoptysis ❑ Failure to thrive ❑ Choking ❑ Vomiting ❑ Cardiac anomaly ❑ Neurodevelopmental abnormalities ❑ Recurrent sinopulmonary infections ❑ Immunodeficiency ❑ Epidemiologic risk factors for exposure to TB

Examine the patient ❑ Respiratory distress ❑ Digital clubbing ❑ Chest wall deformity ❑ Auscultatory crackles

Order Chest X-ray or spirometry (if child is able to perform)

Wet Cough or Productive Cough with sputum

Dry Cough

Consider the diagnosis of Bacterial bronchitis

Consider the diagnosis of Asthma ❑ History of bilateral wheeze and exertional dyspnea ❑ Absence of other cough symptoms ❑ Absence of findings on lung examination ❑ Reversible obstructive defect or normal finding on spirometry (if performed)

Consider the diagnosis of Retained foreign body ❑ History of choking or sudden onset of symptoms ❑ Monophonic or unilateral wheeze ❑ Chest X-ray finding suggesting foreign body

Consider the other type of cough ❑ Tracheomalacia ❑ Pertussis ❑ Habit cough/ tic cough (typically absent at night or when distracted and may be honking or short/dry)

Antibiotics for 2 to 4 weeks

Trial of Asthma therapies for 2 to 4 weeks

Perform rigid bronchoscopy for foreign body removal

Perform tests to confirm the diagnosis and treat as appropriate

Cough resolves ❑ Likely bacterial bronchitis ❑ Reassess in 3 to 4 months to confirm that child remains well

Productive cough continues after 4 weeks ❑ Consider the diagnosis of: Tuberculosis Primary ciliary dyskinesia Cystic fibrosis Bronchiectasis

Asthma Improved ❑ Continue treatment Asthma not improved ❑ Reassess for other causes of cough

No foreign body ❑ Reassess for other causes of cough

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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