Chronic cough in children

❤ weeks counts as acute, >8 weeks as chronic. 3 – 8 weeks is called ‘subacute’ and may be pertussis, but may also be post-viral. Post-viral cough presents as a persistent dry cough and, if history and examination do not turn up any red flags, it’s appropriate to wait & see (remember to tell parents to return if not cleared up by 6 – 8 weeks). Consider X-ray

Red flags, any of which should prompt urgent specialist review:

  • Moist/chesty cough
  • Growth faltering
  • History suggesting inhaled FB (cough started with sudden choking episode)
  • Chest signs
  • Chest wall deformity
  • Clubbing
  • Neonatal onset
  • Cough triggered by feeding episodes (?aspiration)
  • Neurodevelopmental problems
  • Haemoptysis
  • Recurrent pneumonia
  • General ill-health
  • Co-morbidities

Ask about:

  • Nature and timing of cough
  • Wheeze
  • Haemoptysis
  • Family history
  • Ear or nose problems
  • Co-morbidities
  • Growth/development
  • Parental level of concern
  • Exposure to cigarette smoke or allergens
  • Infection risk – TB, HIV (foreign travel)

Note persistent bacterial bronchitis as a cause. This causes a chronic wet cough in an otherwise well child, with normal CXR, which can be confirmed by positive sputum culture. BTS recommends physio plus 4 – 6 weeks antibiotics, although there doesn’t seem to be massive research confirming this approach.

The old advice I got at the start of training, about considering asthma as a likely diagnosis of all coughs persisting for over a month, appears to be wrong. If cough is the only symptom, then in the absence of a strong family history very few such coughs are caused by asthma. If suspecting asthma and trialling empirical treatment, approach should be to use 8 – 12 weeks of ICS with a symptom/peak flow diary and then have a trial off medication.

(Pulse learning module. Note one key reference is the BMJ 2012; 344: e1177 article by Brodlie, Graham & McKean.)

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About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Paediatrics, Respiratory. Bookmark the permalink.

One Response to Chronic cough in children

  1. Pingback: Wheezing in pre-school children | A Spoonful Of Sugar

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