Cough in children: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(8 intermediate revisions by 2 users not shown)
Line 6: Line 6:


==Overview==
==Overview==
[[Cough]] is a common presenting complaints of [[Pediatrics|pediatric]] population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by dynamic mechanism of [[respiratory]] airways. The word [[Cough|'Cough]]' is rooted to 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For Example, duration of presenting complaints, nature or quality, [[anatomical]] location, [[etiology]] and grades of coughs. Stimulation to cough [[receptors]] provokes sensations of coughing through [[afferent]] pathway via [[vagus nerve]], central respiratory centers in upper [[pons]] and [[medulla]], and [[efferent]] pathways via [[phrenic]] and [[vagus]] branches. Differential diagnosis of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of [[physical examination]], [[laboratory]], and [[imaging]] investigations. Some of the causes are emergently managed to reduce the [[mortality]] of a child.
[[Cough]] is a common complaint of the [[Pediatrics|pediatric]] population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of [[respiratory]] airways. The word [[Cough|'Cough]]' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, [[anatomical]] location, [[etiology]] and grades of coughs. Stimulation to cough [[receptors]] provokes sensations of coughing through the [[afferent]] pathway via the [[vagus nerve]], central respiratory centers in the upper [[pons]] and [[medulla]], and [[efferent]] pathways via the [[phrenic]] and [[vagus]] branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of [[physical examination]], [[laboratory]], and [[imaging]] investigations. Some of the causes are emergently managed to reduce the [[mortality]] of a child.The mainstay of therapy for cough is supportive. [[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].


==Historical Perspective==
==Historical Perspective==


*The word [[Cough]] was first derived from the middle English Coughen or old English Cohhian which was primarily composed of the middle Dutch Kochen and the high middle German Kuchen, in early 14th century.
*The word [[cough]] was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.
   
   
==Classification==
==Classification==


*[[Cough]] in children may be classified or defined according to the duration of [[Presenting symptom|presenting]] complaints, quality and sound, causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
*[[Cough]] in children may be classified or defined according to the duration of [[Presenting symptom|presenting]] complaints, quality and sound, and causes of cough into several groups.<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref>:
*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub classified into three categories.
*1 Duration of [[Presenting symptom|Presenting]] complaints: According to the duration of [[cough]], it can be sub-classified into three categories:
**[[Acute]]: < 3 weeks.
**[[Acute]]: < 3 weeks.
**[[Subacute]]: 3 to 8 weeks.
**[[Subacute]]: 3 to 8 weeks.
**[[Chronic]]: > 8 weeks.
**[[Chronic]]: > 8 weeks.


*2. [[Nature]] or Quality and sounds: According to the quality and sound cough can be sub classified in to following categories-
*2. [[Nature]] or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
**[[Dry Cough|Dry]] or Hacking or Nonproductive.
**[[Dry Cough|Dry]] or Hacking or Nonproductive.
**Wet or [[productive cough]].
**Wet or [[productive cough]].
Line 29: Line 29:
**Burning cough.
**Burning cough.


*3. Causes of Cough: Based on causes cough is subdivided into following three sub groups-
*3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
**Specific cough.
**Specific cough.
**Nonspecific cough.
**Nonspecific cough.
**Expected cough or Normal cough.
**Expected cough or Normal cough.


*4. [[Anatomic]] classification on causes of cough: Cough can be produced from different [[anatomical]] locations. for example-
*4. [[Anatomic]] classification on the causes of a cough: A cough can be produced from different [[anatomical]] locations. For example:
**[[Nose]] and [[Paranasal sinus|Paranasal]] sinuses.
**[[Nose]] and [[Paranasal sinus|Paranasal]] sinuses.
**[[Pharynx]].
**[[Pharynx]].
Line 46: Line 46:
**[[Esophagus]].
**[[Esophagus]].


*5. Grades of [[cough]]: Cough can be graded into four main sub categories-<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
*5. Grades of [[cough]]: Cough can be graded into four main sub categories:<ref name="pmid19136069">{{cite journal |vauthors=Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J |title=Semantics and types of cough |journal=Pulm Pharmacol Ther |volume=22 |issue=2 |pages=139–42 |date=April 2009 |pmid=19136069 |doi=10.1016/j.pupt.2008.12.008 |url=}}</ref>
**Eutussia or Normal.
**Eutussia or Normal.
**Hypertussia or Sensitized.
**Hypertussia or Sensitized.
Line 57: Line 57:
==Pathophysiology==
==Pathophysiology==


*[[Cough]] is natural [[Innate immune response|innate]] [[Primitive reflexes|primitive reflex]] that helps in mucocilliary clearance of foreign particles and secretions from [[Respiratory tract|respiratory t]]<nowiki/>racts. It is also a defensive mechanism protecting [[Respiratory|respiratory airway]]<nowiki/>s from [[aspiration]] of [[pathogens]], particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the [[Cough reflex|cough refle]]<nowiki/>x.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
*A [[cough]] is a natural [[Innate immune response|innate]] [[Primitive reflexes|primitive reflex]] that helps in mucocilliary clearance of foreign particles and secretions from [[Respiratory tract|respiratory t]]<nowiki/>racts. It is also a defense mechanism protecting the [[Respiratory|respiratory airway]]<nowiki/>s from [[aspiration]] of [[pathogens]], particulates and secretions. A complex arc comprised of neuro-respiratory pathways helps in initiating the [[Cough reflex|cough refle]]<nowiki/>x.<ref name="pmid22958367">{{cite journal |vauthors=Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F |title=Anatomy and neuro-pathophysiology of the cough reflex arc |journal=Multidiscip Respir Med |volume=7 |issue=1 |pages=5 |date=June 2012 |pmid=22958367 |doi=10.1186/2049-6958-7-5 |url=}}</ref>
{{Family tree/start}}
{{Family tree/start}}
{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in [[Respiratory airways]]}}
{{Family tree | | | | A01 | | | |A01=[[Mechanical]] and [[chemical]] stimulation of [[cough]] [[receptors]] (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in [[Respiratory airways]]}}
Line 68: Line 68:
{{Family tree/end}}
{{Family tree/end}}


*On [[gross pathology]], [[Bloody sputum|Bloody]], Serous , Mucoid, Rusty, Pink frothy, and [[Purulent]] are characteristic findings of [[sputum]] produced by [[coughing]].
*On [[gross pathology]], [[Bloody sputum|bloody]], serous , mucoid, rusty, pink frothy, and [[purulent]] are characteristic findings of [[sputum]] produced by [[coughing]].
*On [[microscopic]] [[histopathological]] [[analysis]], [[Pathogens]], [[Red blood cell|RBC]]<nowiki/>s, [[Leukocytes]], [[epithelial cells]] are characteristic findings of [[Sputum]] produced by [[coughing]].
*On [[microscopic]] [[histopathological]] [[analysis]], [[pathogens]], [[red blood cell|RBC]]<nowiki/>s, [[leukocytes]], [[epithelial cells]] are characteristic findings of [[sputum]] produced by [[coughing]].


==Causes==
==Causes==
Line 79: Line 79:
{{familytree/end}}
{{familytree/end}}


According to quality and sound of cough in children, the causes can be classified according to following chart.
According to quality and sound of cough in children, the causes can be classified according to the following chart:


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smokes), [[Post infectious cough]]. }}
{{familytree | | | | | | | | | |,|-| A01 |-| A02 | | | |A01=Dry or Hacking or [[Nonproductive]] |A02=[[Sinusitis]], [[Tonsillitis]], [[Pharyngitis]], [[Allergic Rhinitis]], [[GERD]], [[Asthma]], Environmental exposure to irritants([[pollen]], dust, mites, smoke), [[Post infectious cough]]. }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |!| | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Wet or [[productive]] cough |B02=[[Cystic fibrosis]], [[Bronchiectasis]], [[Bronchiolitis]], [[Tuberculosis]], [[Rhinitis]], [[Postnasal drip]], [[Pneumonia]], [[Emphysema]], [[Acute bronchitis]], [[Asthma]] }}
{{familytree | | | | | | | | | |)|-| B01 |-| B02 | | | |B01=Wet or [[productive]] cough |B02=[[Cystic fibrosis]], [[Bronchiectasis]], [[Bronchiolitis]], [[Tuberculosis]], [[Rhinitis]], [[Postnasal drip]], [[Pneumonia]], [[Emphysema]], [[Acute bronchitis]], [[Asthma]] }}
Line 98: Line 98:
{{familytree/end}}
{{familytree/end}}


Based on anatomical location the causes of cough in children can be demonstrated into following chart-
Based on anatomical location the causes of cough in children can be demonstrated in the following chart:


{{familytree/start |summary=PE diagnosis Algorithm.}}
{{familytree/start |summary=PE diagnosis Algorithm.}}
Line 201: Line 201:
*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
*[[Respiratory system|Subglottic]] narrowing ([[steeple sign]]) in postero−anterior [[Radiography|radiograph]] chest
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Decresed [[Lung volumes|tidal volume]]
*Decreased [[Lung volumes|tidal volume]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Clinical diagnosis.
*Clinical diagnosis.
Line 381: Line 381:
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
*Normal [[Airway|airways]] in [[chest X-ray|chest X−ray]]
*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  X−Ray]]
*[[Computed tomography|CT]] if there any abnormality in [[chest  X-Ray|chest  x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
*[[FEV1/FVC ratio]] <70%  and [[FEV1]] >15% increase after 15 minutes of 2 puffs of [[Beta-2-adrenoreceptor agonists|beta 2 sympathomimetic drug]]
Line 392: Line 392:
*Seasonal variation
*Seasonal variation
|-
|-
| style="background:#DCDCDC;" align="center" + |[[Bacterial Protracted Bonchitis]]<ref name="pmid32228653">{{cite journal |vauthors=Zhang XB, Wu X, Nong GM |title=Update on protracted bacterial bronchitis in children |journal=Ital J Pediatr |volume=46 |issue=1 |pages=38 |date=March 2020 |pmid=32228653 |pmc=7106696 |doi=10.1186/s13052-020-0802-z |url=}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/patients/patient-resources/resources/pbb-in-children.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref>
| style="background:#DCDCDC;" align="center" + |[[Bacterial Protracted Bronchitis]]<ref name="pmid32228653">{{cite journal |vauthors=Zhang XB, Wu X, Nong GM |title=Update on protracted bacterial bronchitis in children |journal=Ital J Pediatr |volume=46 |issue=1 |pages=38 |date=March 2020 |pmid=32228653 |pmc=7106696 |doi=10.1186/s13052-020-0802-z |url=}}</ref><ref name="urlwww.thoracic.org">{{cite web |url=https://www.thoracic.org/patients/patient-resources/resources/pbb-in-children.pdf |title=www.thoracic.org |format= |work= |accessdate=}}</ref>
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" align="center" + |Chronic
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Atleast four weeks
*At least four weeks
| style="background:#F5F5F5;" align="center" + | +(Purulent)
| style="background:#F5F5F5;" align="center" + | +(Purulent)
| style="background:#F5F5F5;" align="center" + |−
| style="background:#F5F5F5;" align="center" + |−
Line 408: Line 408:
*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
*[[Polymerase chain reaction|PCR]] in bacterial infection may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Chest X-ray|Chest X−ray]] to exclude other diseases
*[[Chest X-ray|Chest x−ray]] to exclude other diseases
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*FEV1 < 80%
*FEV1 < 80%
Line 437: Line 437:
*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
*[[Sputum]] culture for [[Fungus|fungi]], [[bacteria]] and [[Mycobacterium|mycobacteria]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest X−Ray]]
*Linear [[atelectasis]] and dilated [[Airway|airways]] in [[chest X-Ray|chest x−ray]]
*Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.
*Bronchoscopy, Upper GI Endoscopy, MRI/CT will provide information of other etiologies.
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
Line 466: Line 466:
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
*Hyperinflated lungs, [[atelectasis]], and [[mediastinitis]]
*Shift in [[Chest X-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
*Shift in [[Chest x-ray|chest radiograph]] when the object is [[radio-opaque|radio−opaque]]
*[[Computed tomography|CT]] may be helpful
*[[Computed tomography|CT]] may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
Line 497: Line 497:
*[[Urinalysis]] & [[urine culture]] ( in infants)
*[[Urinalysis]] & [[urine culture]] ( in infants)
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Chest X-Ray|Chest X−Ray]] may be helpful
*[[Chest X-Ray|Chest x−ray]] may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
*Normal function or obstructive changes ([[FEV1/FVC ratio|FEV1/FVC]] <70%)
Line 548: Line 548:
*Nasal Flaring, Grunting
*Nasal Flaring, Grunting
*Tachypnea, Tachycardia
*Tachypnea, Tachycardia
*vomiting
*Vomiting
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Leftward shift [[leukocytosis]]
*Leftward shift [[leukocytosis]]
Line 554: Line 554:
*[[Sputum culture]] in hospitalized patients
*[[Sputum culture]] in hospitalized patients
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest X−ray]]
*[[Consolidation (medicine)|Consolidation]], [[cavitation]], and infiltrated [[interstitial]] in [[chest X-ray|chest x−ray]]
*Anatomical changes observed in chest [[Computed tomography|CT]]
*Anatomical changes observed in chest [[Computed tomography|CT]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specific
*Not specific
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Infiltration observed in [[chest X-ray|chest X−ray]]
*Infiltration observed in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Community-acquired pneumonia|Community−acquired pneumonia]]
*[[Community-acquired pneumonia|Community−acquired pneumonia]]
Line 584: Line 584:
*Molecular testing may be helpful
*Molecular testing may be helpful
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest X−Ray]]
*Reactivation of [[Tuberculosis|TB]] is observed as [[Infiltration (medical)|infiltration]] in the upper [[Lobe (anatomy)|lobe]] in [[Chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Decreased [[FEV1]]
*Decreased [[FEV1]]
Line 643: Line 643:
*[[Complete blood count]]
*[[Complete blood count]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest X−ray]]
*[[Cardiomegaly]], interstitial [[edema]], alveolar [[edema]], [[Pleural effusion]] and blood redistribution in lower lobes in [[chest X-ray|chest x−ray]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specific
*Not specific
Line 667: Line 667:
*[[Hoarseness]]
*[[Hoarseness]]
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*Not specifc
*Not specific
| style="background:#F5F5F5;" + |
| style="background:#F5F5F5;" + |
*[[Electrocardiogram]] may be helpful
*[[Electrocardiogram]] may be helpful
Line 735: Line 735:
==Epidemiology and Demographics==
==Epidemiology and Demographics==


*[[Cough]] is one of the most common [[presenting]] [[symptoms]] of [[children]] in [[Outpatient|outpatient department]].
*A [[cough]] is one of the most common [[presenting]] [[symptoms]] of [[children]] in the [[Outpatient|outpatient department]].
*Ninety percent of [[acute cough]] in children is resolved within three weeks. The [[prevalence]] of [[Chronic cough|Chronic Cough]] in [[children]] is approximately 5% to 10% in [[United States|USA]] according to [[American Academy of Pediatrics]].
*Ninety percent of [[acute cough]]s in children are resolved within three weeks. The [[prevalence]] of [[Chronic cough|chronic cough]] in [[children]] is approximately 5% to 10% in the [[United States|USA]] according to the [[American Academy of Pediatrics]].
   
   
===Age===
===Age===
Line 748: Line 748:
===Race===
===Race===


*There are [[racial]] predilection for certain causes of [[Cough in children]]. [[Asthma]] is predominant in Blacks and American Indians or Alaska native while [[Cystic fibrosis]], [[Wegener's granulomatosis]] are more frequently affecting Caucasians according to [[American Lung Association]].
*There are [[racial]] predispositions for certain causes of [[cough in children]]. [[Asthma]] is predominant in Blacks and American Indians or Alaska natives while [[Cystic fibrosis]], [[Wegener's granulomatosis]] more frequently affect Caucasians according to the [[American Lung Association]].


==Risk Factors==
==Risk Factors==
*Common [[risk factors]] in the [[development]] of Cough in children are:<ref name="pmid16428686">{{cite journal |vauthors=Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UBS, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM |title=Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=1S–23S |date=January 2006 |pmid=16428686 |pmc=3345522 |doi=10.1378/chest.129.1_suppl.1S |url=}}</ref><ref name="pmid4806394">{{cite journal |vauthors=Hope-Simpson RE, Miller DL |title=The definition of acute respiratory illnesses in general practice |journal=Postgrad Med J |volume=49 |issue=577 |pages=763–70 |date=November 1973 |pmid=4806394 |pmc=2495832 |doi=10.1136/pgmj.49.577.763 |url=}}</ref>
*Common [[risk factors]] in the [[development]] of a cough in children are:<ref name="pmid16428686">{{cite journal |vauthors=Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash UBS, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM |title=Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines |journal=Chest |volume=129 |issue=1 Suppl |pages=1S–23S |date=January 2006 |pmid=16428686 |pmc=3345522 |doi=10.1378/chest.129.1_suppl.1S |url=}}</ref><ref name="pmid4806394">{{cite journal |vauthors=Hope-Simpson RE, Miller DL |title=The definition of acute respiratory illnesses in general practice |journal=Postgrad Med J |volume=49 |issue=577 |pages=763–70 |date=November 1973 |pmid=4806394 |pmc=2495832 |doi=10.1136/pgmj.49.577.763 |url=}}</ref>
**[[Preterm birth|Preterm]] Birth and delivery by [[caesarian section]].
**[[Preterm birth|Preterm]] birth and delivery by [[caesarian section]].
**[[Respiratory Distress Syndrome]].
**[[Respiratory Distress Syndrome]].
**[[Congenital Heart Disease]].
**[[Congenital Heart Disease]].
Line 768: Line 768:
==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==


*The majority of patients with [[acute cough]] have recovery within three weeks in 90% of cases. Some of cases are progressed to [[subacute]] and [[chronic]] phases. [[Chronic cough]] lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.<ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
*The majority of patients with [[acute cough]] have recovery within three weeks in 90% of cases. Some cases are progressed to [[subacute]] and [[chronic]] phases. [[Chronic cough]] lasts more than eight weeks whereas recurrent cough can affect a child for more than two years with 1-2 weeks duration in each episodes.<ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
*Early clinical features include frequent episodes of [[Coughing]], [[Runny nose]], [[Sneezing]], [[Low grade fever]], [[Sore Throat]], [[Night Sweats]], Arching Back, [[Irritability]], [[Failure to thrive]], [[Fussiness]], Chocking sensation(Foreign body impaction).<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref>
*Early clinical features include frequent episodes of [[coughing]], [[runny nose]], [[sneezing]], [[low grade fever]], [[sore throat]], [[night sweats]], arching back, [[irritability]], [[failure to thrive]], [[fussiness]], and a choking sensation(foreign body impaction).<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref>
*If left untreated, acute cough can cause following [[Complications|complication]] in children<ref name="urlAcute cough in children">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056681/ |title=Acute cough in children |format= |work= |accessdate=}}</ref><ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
*If left untreated, acute cough can cause following the [[Complications|complication]]s in children:<ref name="urlAcute cough in children">{{cite web |url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056681/ |title=Acute cough in children |format= |work= |accessdate=}}</ref><ref name="pmid12014540">{{cite journal |vauthors=Hay AD, Wilson AD |title=The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review |journal=Br J Gen Pract |volume=52 |issue=478 |pages=401–9 |date=May 2002 |pmid=12014540 |pmc=1314298 |doi= |url=}}</ref>
**[[Otitis Media]]
**[[Otitis Media]]
**[[Rash]]
**[[Rash]]
Line 783: Line 783:
**[[Pneumothorax]]
**[[Pneumothorax]]
**[[Pneumomediastinum]]
**[[Pneumomediastinum]]
*[[Ribs fracture]]
*[[Rib fracture]]


*[[Prognosis]] is generally excellent and efficiently treatable in most of the etiology of cough in children.
*[[Prognosis]] is generally excellent and efficiently treatable in most of the etiology of cough in children.
Line 789: Line 789:
==Diagnosis==
==Diagnosis==
===Diagnostic Criteria===
===Diagnostic Criteria===
 
*Diagnosis of causes of a cough is made after a detailed history, [[Presenting symptom|presenting]] complaints and [[physical examination]] and laboratory findings in some cases. Cough can be classified according to:<ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
*Diagnosis of Causes of Cough is made after a detailed history, [[Presenting symptom|presenting]] complaints and [[physical examination]] and laboratory findings in some cases. Cough can be classified according to-
**Duration.
**Duration.
**Nature or quality of cough.
**Nature or quality of cough.
Line 797: Line 796:
**Grade.
**Grade.


A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount work of breathing, presence of shortness of breathing, relation with [[vomiting]], food intake, [[posture]], presence of blood, systemic findings(fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of chocking, household socioeconomic status, family history, Vaccination history, drug abuse and smoking in family members, atopy, Antenatal, perinatal, postnatal, birth history, developmental history, feeding history.
A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with [[vomiting]], food intake, [[posture]], presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.


The following signs are alarming which need further emergent evaluation by the physician.
The following signs are alarming which need further emergent evaluation by the physician:


:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
:*[[Cyanosis]] or [[hypoxemia]] or [[hypoxia]]
Line 820: Line 819:
:*[[Failure to thrive]]
:*[[Failure to thrive]]
:*[[Fussiness]]
:*[[Fussiness]]
:*[[Chocking sensation]]([[Foreign body]] impaction)
:*[[Choking sensation]]([[Foreign body]] impaction)
:*[[Chills and Rigor]]
:*[[Chills and Rigor]]
:*[[Wheezing]]
:*[[Wheezing]]
Line 827: Line 826:
===Physical Examination===
===Physical Examination===


*Patients with [[Cough]] are usually restless, [[irritable]], fussy. Children with severe [[respiratory distress]] usually are [[toxic]] and [[cyanotic]] in appearance. Presence of [[grunting]], nasal flaring, [[Intercostal]] or [[subcostal]] [[retraction]] or [[Accessory muscles of respiration|Accessory muscle]] usage needs prompt evaluation.<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref>
*Patients with [[cough]] are usually restless, [[irritable]], fussy. Children with severe [[respiratory distress]] usually are [[toxic]] and [[cyanotic]] in appearance. Presence of [[grunting]], nasal flaring, [[intercostal]] or [[subcostal]] [[retraction]] or [[accessory muscles of respiration|accessory muscle]] usage needs prompt evaluation.<ref name="pmid16618239">{{cite journal |vauthors=Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM |title=Cough in children: definitions and clinical evaluation |journal=Med J Aust |volume=184 |issue=8 |pages=398–403 |date=April 2006 |pmid=16618239 |doi=10.5694/j.1326-5377.2006.tb00290.x |url=}}</ref><ref name="pmid8144301">{{cite journal |vauthors=Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE |title=Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry |journal=Int J Epidemiol |volume=22 |issue=6 |pages=1166–73 |date=December 1993 |pmid=8144301 |doi=10.1093/ije/22.6.1166 |url=}}</ref>
*Physical examination may be remarkable for:
*Physical examination may be remarkable for:


*Vital signs: Documentation according to patient's [[age]]-
*Vital signs: Documentation according to patient's [[age]]
**[[Blood pressure]]
**[[Blood pressure]]
**[[Temperature]]
**[[Temperature]]
Line 836: Line 835:
**[[Heart rate]]
**[[Heart rate]]


**[[Growth]] charts and [[Human development (biology)|developmental]] milestones: [[Weight]], [[Height]], [[Length]], Occipitofrontal Circumference
**[[Growth]] charts and [[Human development (biology)|developmental]] milestones: [[weight]], [[height]], [[length]], occipitofrontal circumference
*General Appearance: Level of [[consciousness]], [[Cyanosis]], Distressed or ill appearing, Hydration and nutritional status.
*General Appearance: Level of [[consciousness]], [[Cyanosis]], Distressed or ill-appearing, hydration and nutritional status.
*[[Skin]]: [[Turgor]], [[color]], texture, [[Rash|rashes]] or any other abnormal findings.
*[[Skin]]: [[Turgor]], [[color]], texture, [[Rash|rashes]] or any other abnormal findings.
*[[Lymphatics]]: [[Lymphadenopathy]], location, Number and size, consistency, adherence to underlying structures.
*[[Lymphatics]]: [[Lymphadenopathy]], location, number and size, consistency, adherence to underlying structures.
*[[Head]]: Size, shape, [[Fontanelle|fontanelle,]] overlapping [[suture]], [[scalp]], [[hair]].
*[[Head]]: Size, shape, [[Fontanelle|fontanelle,]] overlapping [[suture]], [[scalp]], [[hair]].
*[[Eyes]]: [[Lacrimation]], [[redness]], [[irritation]],  [[conjunctival injection]], [[Periorbital Edema|periorbital]] redness.
*[[Eyes]]: [[Lacrimation]], [[redness]], [[irritation]],  [[conjunctival injection]], [[Periorbital Edema|periorbital]] redness.
*[[Ears]]: Position of ears along with [[external auditory canal]], [[tympanic membrane]] visualization.
*[[Ears]]: Position of ears along with [[external auditory canal]], [[tympanic membrane]] visualization.
*[[Nose]]: Any deviation of [[nasal septum]], normal or hypertrophied inferior [[Nasal concha|turbinate]], [[nasal polyps]] and [[congestion]], [[nasal discharge]], tenderness over [[sinus]] point.
*[[Nose]]: Any deviation of [[nasal septum]], normal or hypertrophied inferior [[Nasal concha|turbinate]], [[nasal polyps]] and [[congestion]], [[nasal discharge]], tenderness over [[sinus]] point.
*[[Mouth]] and [[throat]]:
*[[Mouth]] and [[throat]]: Look for any associated abnormality
**[[Lips]]: [[Color]], [[Mucous membrane|mucosal]] abnormality and [[congenital]] lesions.
**[[Lips]]: [[Color]], [[Mucous membrane|mucosal]] abnormality and [[congenital]] lesions.
**[[Buccal mucosa]]: Hydration, Color, Presence of anomaly.
**[[Buccal mucosa]]: Hydration, Color, Presence of anomaly.
Line 854: Line 853:
*[[Neck]]: [[Thyroid]], [[trachea]] position and examination, any [[cystic]] or [[nodular]] masses, presence of [[nuchal rigidity]].
*[[Neck]]: [[Thyroid]], [[trachea]] position and examination, any [[cystic]] or [[nodular]] masses, presence of [[nuchal rigidity]].
*[[Respiratory system|Respiratory]]:  
*[[Respiratory system|Respiratory]]:  
**[[Inspection (medicine)|Inspection]]: Breathing pattern(Abdominal and periodic), Respiratory rate, Accessory muscle usage, Chest wall shape.
**[[Inspection (medicine)|Inspection]]: Breathing pattern (abdominal and periodic), respiratory rate, accessory muscle usage, chest wall shape.
**[[Auscultation]]: Breath sound symmetry, [[vesicular]], [[bronchial]], [[rales]], [[rhonchi]], wheezes, [[stridor]].
**[[Auscultation]]: breath sound symmetry, [[vesicular]], [[bronchial]], [[rales]], [[rhonchi]], wheezes, [[stridor]].
**[[Percussion]]: [[Resonance]], hyper resonance and dull.
**[[Percussion]]: [[resonance]], hyper resonance and dull.
**[[Palpation]]: [[Trachea]] position, [[tactile fremitus]].
**[[Palpation]]: [[trachea]] position, [[tactile fremitus]].
*[[Cardiovascular]]: [[Rhythm]], [[Heart murmur|murmur]], any radiation of sound, [[pulse]] in both extremities.
*[[Cardiovascular]]: [[rhythm]], [[heart murmur|murmur]], any radiation of sound, [[pulse]] in both extremities.
*[[Gastrointestinal tract|Gastrointestinal]]: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses. or rebound guarding.
*[[Gastrointestinal tract|Gastrointestinal]]: Shape of abdomen, Umbilicus, Bowel sounds, Palpation to evaluate any organomegaly or masses or rebound guarding.
*[[Musculoskeletal system|Musculoskeletal]]: Aching back, [[scoliosis]], [[lordosis]], [[kyphoscoliosis]], swelling and tenderness in any muscles, joint, [[clubbing]], [[edema]], deformity of extremities, [[gait]] and [[posture]], any sign for [[hip dysplasia]].
*[[Musculoskeletal system|Musculoskeletal]]: Aching back, [[scoliosis]], [[lordosis]], [[kyphoscoliosis]], swelling and tenderness in any muscles, joint, [[clubbing]], [[edema]], deformity of extremities, [[gait]] and [[posture]], any sign for [[hip dysplasia]].
*[[CNS]]: [[Primitive reflexes|Primitive reflex,]] superficial and deep [[tendon reflex]], strength and tone of muscles, [[Cranial nerves|cranial nerve]] examination.
*[[CNS]]: [[Primitive reflexes|Primitive reflex,]] superficial and deep [[tendon reflex]], strength and tone of muscles, [[Cranial nerves|cranial nerve]] examination.
Line 866: Line 865:
===Laboratory Findings===
===Laboratory Findings===


*There are no specific [[Laboratory findings template|laboratory findings]] associated with cough. [[Laboratory test]] are done to differentiate the causes of cough in children<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>.
*There are no specific [[Laboratory findings template|laboratory findings]] associated with cough. [[Laboratory test]]s are done to differentiate the causes of cough in children<ref name="urlCough • 2: Chronic cough in children | Thorax">{{cite web |url=https://thorax.bmj.com/content/58/11/998 |title=Cough • 2: Chronic cough in children &#124; Thorax |format= |work= |accessdate=}}</ref>.
*[[Complete blood count|Complete Blood Count]]
*[[Complete blood count|Complete Blood Count]]
*[[Arterial blood gases|Arterial blood gas analysis]]
*[[Arterial blood gases|Arterial blood gas analysis]]
*[[Culture medium|Culture]] of nasopharyngeal swab and Broncho alveolar lavage
*[[Culture medium|Culture]] of nasopharyngeal swab and broncho alveolar lavage
*[[Gross examination|Gross]] and [[Microscopic examination|microscopic]] analysis and [[Sputum culture|culture of sputum]]
*[[Gross examination|Gross]] and [[Microscopic examination|microscopic]] analysis and [[Sputum culture|culture of sputum]]
*[[AFB stain|AFB]] testing and [[tuberculosis]] screening
*[[AFB stain|AFB]] testing and [[tuberculosis]] screening
Line 875: Line 874:
*Serum [[Immunoglobulins]], [[autoantibodies]]
*Serum [[Immunoglobulins]], [[autoantibodies]]
*[[Sweat test]]
*[[Sweat test]]
*Exhaled [[Nitric oxide]] test
*Exhaled [[nitric oxide]] test
*[[Esophageal|Esophagea]]<nowiki/>l [[pH]]
*[[Esophageal|Esophagea]]<nowiki/>l [[pH]]
*Serology for Pertusis, CMV, Chlamydia, HIV.
*Serology for Pertusis, CMV, Chlamydia, HIV.
Line 883: Line 882:


===X-ray===
===X-ray===
Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for example- [[Pneumonia]], [[Croup]], [[Bronchitis]], [[Epiglottitis]], [[Foreign body]] impaction etc. [[X-rays|X-ray]] of [[Paranasal sinus|paranasal sinuses]] helps in diagnosis of [[sinusitis]], deviated nasal septum.
Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: [[Pneumonia]], [[Croup]], [[Bronchitis]], [[Epiglottitis]], [[Foreign body]] impaction etc. [[X-rays|X-ray]] of [[Paranasal sinus|paranasal sinuses]] helps in diagnosis of [[sinusitis]], deviated nasal septum.


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
[[Echocardiography]]/[[ultrasound]]  may be helpful in the diagnosis of causes of [[cough in children]]. [[Echocardiography|Echocardiographic]] findings aids in diagnosis of [[congenital heart disease]], whereas USG findings can help in evaluating complication like [[peritonsillar abscess]], [[retropharyngeal abscess]] promptly.
[[Echocardiography]]/[[ultrasound]]  may be helpful in the diagnosis of causes of [[cough in children]]. [[Echocardiography|Echocardiographic]] findings aide in the diagnosis of [[congenital heart disease]], whereas USG findings can help in evaluating complications like [[peritonsillar abscess]], [[retropharyngeal abscess]] promptly.


===CT scan===
===CT scan===
The [[High Resolution CT|High resolution CT]] is used for diagnosing causes of [[chronic cough]] in children for example [[bronchiectasis]]. Sometimes it helps in identifying [[Congenital heart disease|congenital heart]] and [[Lung|lung anomalie]]<nowiki/>s.
The [[High Resolution CT|High resolution CT]] is used for diagnosing causes of [[chronic cough]] in children such as [[bronchiectasis]]. Sometimes it helps in identifying [[Congenital heart disease|congenital heart]] and [[Lung|lung anomalie]]<nowiki/>s.


===MRI===
===MRI===
[[Chest]] [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of Dynamic function of airways disease.<ref name="pmid26342643">{{cite journal |vauthors=Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH |title=Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging |journal=Pediatr Radiol |volume=45 |issue=13 |pages=1901–15 |date=December 2015 |pmid=26342643 |pmc=4666905 |doi=10.1007/s00247-015-3420-y |url=}}</ref>. MRI can provide detailed findings of [[perfusion]], [[ventilation]] mechanism of [[lungs]] and [[diaphragm]]. It can show oxygen enhancement, congenital anomalies too.
A [[Chest]] [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of the dynamic function of airways disease.<ref name="pmid26342643">{{cite journal |vauthors=Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH |title=Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging |journal=Pediatr Radiol |volume=45 |issue=13 |pages=1901–15 |date=December 2015 |pmid=26342643 |pmc=4666905 |doi=10.1007/s00247-015-3420-y |url=}}</ref>. MRI can provide detailed findings of [[perfusion]], [[ventilation]] mechanism of [[lungs]] and [[diaphragm]]. It can show oxygen enhancement, congenital anomalies too.


===Other Imaging Findings===
===Other Imaging Findings===
Line 903: Line 902:
===Other Diagnostic Studies===
===Other Diagnostic Studies===


Other investigations done to rule out [[differential diagnosis]] of [[cough in children]] are-
Other investigations done to rule out [[differential diagnosis]] of [[cough in children]] are:


*[[Spirometry]] for evaluating [[Pulmonary function test|pulmonary function test.]]
*[[Spirometry]] for evaluating [[Pulmonary function test|pulmonary function test.]]
Line 916: Line 915:


   
   
*The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in following sequences-<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |pmc=6372369 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref><ref name="pmid23115499">{{cite journal |vauthors=Goldman RD |title=Treating cough and cold: Guidance for caregivers of children and youth |journal=Paediatr Child Health |volume=16 |issue=9 |pages=564–9 |date=November 2011 |pmid=23115499 |pmc=3223897 |doi=10.1093/pch/16.9.564 |url=}}</ref><ref name="urlGuidelines for Evaluating Chronic Cough in Pediatrics - CHEST">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(15)52858-4/fulltext#seccestitle90 |title=Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST |format= |work= |accessdate=}}</ref>
*The mainstay of therapy for cough is supportive. Management of acute and chronic cough in children can be provided in the following sequences:<ref name="pmid30805435">{{cite journal |vauthors=Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S |title=Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA) |journal=Int J Pediatr Adolesc Med |volume=2 |issue=1 |pages=38–43 |date=March 2015 |pmid=30805435 |pmc=6372369 |doi=10.1016/j.ijpam.2015.03.001 |url=}}</ref><ref name="pmid23115499">{{cite journal |vauthors=Goldman RD |title=Treating cough and cold: Guidance for caregivers of children and youth |journal=Paediatr Child Health |volume=16 |issue=9 |pages=564–9 |date=November 2011 |pmid=23115499 |pmc=3223897 |doi=10.1093/pch/16.9.564 |url=}}</ref><ref name="urlGuidelines for Evaluating Chronic Cough in Pediatrics CHEST">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(15)52858-4/fulltext#seccestitle90 |title=Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST |format= |work= |accessdate=}}</ref><ref name="pmid30828592">{{cite journal |vauthors=Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ |title=Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough |journal=Glob Pediatr Health |volume=6 |issue= |pages=2333794X19831296 |date=2019 |pmid=30828592 |pmc=6390215 |doi=10.1177/2333794X19831296 |url=}}</ref>
*Identification of etiology of cough and emergently manage the emergency condition such as [[foreign body impaction]], severe respiratory distress, [[apnea]] with maintenance of airways, breathing, circulation.
*Identification of etiology of cough and emergently manage the emergency condition such as [[foreign body impaction]], severe respiratory distress, [[apnea]] with maintenance of airways, breathing, circulation.
*General measures with adequate hydration, nasal airway clearance with normal saline, reducing fever with [[antipyretics]] are done to give comfort to child.
*General measures with adequate hydration, nasal airway clearance with normal saline, reducing fever with [[antipyretics]] are done to give comfort to the child.
*Medical management:
*Medical management:
**[[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
**[[Antihistamine]], [[antitussive]] medications and [[nasal decongestant]] are provided for alleviating symptoms of [[acute cough]]. [[Allergic]] conditions are treated with [[steroids]].
**[[Bronchodilators]] ([[Ipratropium bromide]], [[Albuterol]], [[Salmeterol]], [[Salbutamol]]), [[Antibiotic]] ([[Amoxicillin-Clavulanate|Amoxicillin/Clavulanate]], [[Cephalosporins]], [[Respiratory]] [[fluoroquinolones]], [[Antiviral]], [[Antifungal]], [[Antiparasitic]]) are used according to [[Evidence-based medicine|evidence based management]] of particular causes of cough in children.
**[[Bronchodilators]] ([[Ipratropium bromide]], [[Albuterol]], [[Salmeterol]], [[Salbutamol]]), [[Antibiotic]] ([[Amoxicillin-Clavulanate|Amoxicillin/Clavulanate]], [[Cephalosporins]], [[Respiratory]] [[fluoroquinolones]], [[Antiviral]], [[Antifungal]], [[Antiparasitic]]) are used according to [[Evidence-based medicine|evidence-based management]] of particular causes of cough in children.


===Surgery===
===Surgery===


*Some [[surgical procedure]] are performed for patients with [[Tonsillitis]], [[Adenoid hypertrophy|adenoid hypertroph]]<nowiki/>y, severe cases of [[laryngomalacia]], [[tracheoesophageal fistula]], [[congenital heart disease]], [[complications]] of any disease or trauma in [[ear]], [[nose]], [[Paranasal sinus|sinuses]], [[pharynx]], [[larynx]], [[trachea]], [[bronchus]], [[Lung|lungs]], [[ribs]].
*Some [[surgical procedure]]s are performed for patients with [[Tonsillitis]], [[Adenoid hypertrophy|adenoid hypertroph]]<nowiki/>y, severe cases of [[laryngomalacia]], [[tracheoesophageal fistula]], [[congenital heart disease]], [[complications]] of any disease or trauma in [[ear]], [[nose]], [[Paranasal sinus|sinuses]], [[pharynx]], [[larynx]], [[trachea]], [[bronchus]], [[Lung|lungs]], and [[ribs]].
   
   
===Prevention===
===Prevention===


*Effective measures for the [[primary prevention]] of cough include-
*Effective measures for the [[primary prevention]] of cough include:
**Care givers should be given [[health education]] on pros and cons of [[vaccination]], alarming features of cough.
**Caregivers should be given [[health education]] on pros and cons of [[vaccination]], alarming features of cough.
**Physical [[hygiene]] including [[airways]] of an infant or a child should be maintained to prevent complications.
**Physical [[hygiene]] including [[airways]] of an infant or a child should be maintained to prevent complications.
**Head should be raised to prevent irritations in [[throat]].
**Head should be raised to prevent irritations in [[throat]].
Line 936: Line 935:
**Adequate [[hydration]] to prevent formation of [[dry sputum]].
**Adequate [[hydration]] to prevent formation of [[dry sputum]].
**Avoidance of triggers in case of [[atopic]] patient.
**Avoidance of triggers in case of [[atopic]] patient.
**[[Nutritional]] balances should be maintained for rebooting the [[immunity]].
**[[Nutritional]] balance should be maintained for rebooting the [[immunity]].


==References==
==References==
Line 942: Line 941:
   
   
[[Category:Pediatrics]]
[[Category:Pediatrics]]
[[Category:Primary care]]
[[Category:Up-To-Date]]

Latest revision as of 21:03, 24 February 2021

WikiDoc Resources for Cough in children

Articles

Most recent articles on Cough in children

Most cited articles on Cough in children

Review articles on Cough in children

Articles on Cough in children in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Cough in children

Images of Cough in children

Photos of Cough in children

Podcasts & MP3s on Cough in children

Videos on Cough in children

Evidence Based Medicine

Cochrane Collaboration on Cough in children

Bandolier on Cough in children

TRIP on Cough in children

Clinical Trials

Ongoing Trials on Cough in children at Clinical Trials.gov

Trial results on Cough in children

Clinical Trials on Cough in children at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Cough in children

NICE Guidance on Cough in children

NHS PRODIGY Guidance

FDA on Cough in children

CDC on Cough in children

Books

Books on Cough in children

News

Cough in children in the news

Be alerted to news on Cough in children

News trends on Cough in children

Commentary

Blogs on Cough in children

Definitions

Definitions of Cough in children

Patient Resources / Community

Patient resources on Cough in children

Discussion groups on Cough in children

Patient Handouts on Cough in children

Directions to Hospitals Treating Cough in children

Risk calculators and risk factors for Cough in children

Healthcare Provider Resources

Symptoms of Cough in children

Causes & Risk Factors for Cough in children

Diagnostic studies for Cough in children

Treatment of Cough in children

Continuing Medical Education (CME)

CME Programs on Cough in children

International

Cough in children en Espanol

Cough in children en Francais

Business

Cough in children in the Marketplace

Patents on Cough in children

Experimental / Informatics

List of terms related to Cough in children

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Synonyms and keywords: Cough in kids

Overview

Cough is a common complaint of the pediatric population of the outpatient department. It is a natural reflex by which foreign and infectious particles are cleared through an involuntary expulsive force of air by the dynamic mechanism of respiratory airways. The word 'Cough' is derived from the 14th century Dutch word 'Kochen' and the high middle German word 'Kuchen'. Cough is classified under several categories. For example, duration of the complaint, nature or quality, anatomical location, etiology and grades of coughs. Stimulation to cough receptors provokes sensations of coughing through the afferent pathway via the vagus nerve, central respiratory centers in the upper pons and medulla, and efferent pathways via the phrenic and vagus branches. Differential diagnoses of cough are evaluated through identifying specific etiology, presenting symptoms, detailed history and findings of physical examination, laboratory, and imaging investigations. Some of the causes are emergently managed to reduce the mortality of a child.The mainstay of therapy for cough is supportive. Antihistamine, antitussive medications and nasal decongestant are provided for alleviating symptoms of acute cough. Allergic conditions are treated with steroids.

Historical Perspective

  • The word cough was first derived from the middle English word 'Coughen' or old English 'Cohhian' which was primarily composed of the middle Dutch 'Kochen' and the high middle German 'Kuchen', in early 14th century.

Classification

  • Cough in children may be classified or defined according to the duration of presenting complaints, quality and sound, and causes of cough into several groups.[1]:
  • 1 Duration of Presenting complaints: According to the duration of cough, it can be sub-classified into three categories:
  • 2. Nature or quality and sounds: According to the quality and sound, the cough can be sub-classified in to following categories:
    • Dry or Hacking or Nonproductive.
    • Wet or productive cough.
    • Staccato or short repetitive cough.
    • Whooping or paroxysmal violent or spasmodic cough.
    • Barking cough: Brassy barking or Honking barking.
    • Phlegmy cough.
    • Burning cough.
  • 3. Causes of Cough: Based on the causes, a cough is subdivided into following three subgroups:
    • Specific cough.
    • Nonspecific cough.
    • Expected cough or Normal cough.
  • 5. Grades of cough: Cough can be graded into four main sub categories:[2]
    • Eutussia or Normal.
    • Hypertussia or Sensitized.
    • Hypotussia or Desensitized.
    • Dystussia or Pathological.
    • Atussia or Absent.

Cough in children can also be classified under infectious (Bacterial, Viral, fungal, Parasitic) or non-infectious categories broadly.

Pathophysiology

 
 
 
Mechanical and chemical stimulation of cough receptors (RARs or Rapidly adapting receptors, C fibers or slowly adapting receptors) in Respiratory airways
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Afferent pathways: Sensory nerve fibers via Vagus Nerve from ciliated columnar epithelium of upper airways, cardiac and esophageal branches from diaphragm send impulse to central cough center
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Central cough center in upper brain stem medulla and pons send impulse of sequence of phases (Inspiratory, Compressive, Expiratory) for constituting cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Efferent pathways: The nucleus retroambigualis sends impulse via phrenic and spinal motor nerves to diaphragm and abdominal and respiratory muscles, the nucleus ambiguous sends impulse to larynx by laryngeal branches of vagus nerve
 
 
 

Causes

Causes of cough in children according to duration[4][5][6]:

 
 
 
 
 
 
 
 
Cough
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute(<3 weeks) •Common Cold
Allergic Rhinitis
Bronchitis
Bronchiolitis
Asthma
Whooping Cough
Influenza
Croup or Tracheolaryngobronchitis
Pneumonia
Irritation by smoking
Foreign Body
GERD
 
 
 
 
Subacute(3-8 weeks) •Whooping Cough or Pertussis
•Post infectious Cough
Bacterial Sinusitis
Asthma
 
 
 
 
Chronic(>8 weeks) •Upper Airway Cough Syndrome
Asthma
Bronchiectasis in Cystic fibrosis and Kartagener Syndrome
Chronic sinusitis
Malacia
•Foreign Body
Nonasthmatic eosinophilic bronchitis
•Respiratory environmental toxins

According to quality and sound of cough in children, the causes can be classified according to the following chart:

 
 
 
 
 
 
 
 
 
 
 
 
Dry or Hacking or Nonproductive
 
Sinusitis, Tonsillitis, Pharyngitis, Allergic Rhinitis, GERD, Asthma, Environmental exposure to irritants(pollen, dust, mites, smoke), Post infectious cough.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Wet or productive cough
 
Cystic fibrosis, Bronchiectasis, Bronchiolitis, Tuberculosis, Rhinitis, Postnasal drip, Pneumonia, Emphysema, Acute bronchitis, Asthma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes of Cough based on Nature or quality and sound
 
 
 
 
Staccato or short repetitive cough
 
Chlamydia pneumonia
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Whooping or paroxysmal violent or spasmodic cough
 
Pertussis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Barking cough
 
Brassy barking: Croup, Tracheomalacia, Laryngitis, Tracheitis
Honking barking: Psychogenic cough , Tourette syndrome (habit cough)
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stridor
 
Viral Croup, Epiglottis, Bacterial tracheitis, Retropharyngeal and peritonsilar abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Burning cough
 
Bacterial Bronchitis, Irritants
 
 
 
 
 
 

Based on anatomical location the causes of cough in children can be demonstrated in the following chart:

 
 
 
 
 
 
 
 
 
 
 
 
Nose and Paranasal sinuses
 
Rhinitis, Foreign Body, Sinusitis, Nasal polyp, ppHypertrophied inferior turbinate]]
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pharynx
 
Pharyngitis, Foreign Body, Irritants
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Larynx
 
Laryngitis, Epiglottis, Tonsillitis, Laryngomalacia, Subglottic stenosis, Foreign body
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Trachea and Bronchi
 
Tracheitis, Croup, Bronchiolitis, Bronchiectasis, Bronchitis, Cystic fibrosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Causes based on anatomic location
 
 
 
 
Pulmonary parenchyma
 
Pneumonia, Tuberculosis, Environmental toxin, Respiratory distress syndrome, Aspiration syndrome, Hypersensitivity Pneumonitis, Connective tissue disease, Alveolar capillary dysplasia, Neuroendocrine cell hyperplasia of infancy, Medications, Mutations causing surfactant dysfunction, Emphysema
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Pleura
 
Pleurisy, Pneumothorax, Hemothorax, Parapneumonic effusions, Pleural tuberculosis, Congenital hydrothorax and chylothorax
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mediastinum
 
Mediastinitis, Mediastinal Tuberculosis, Thymoma, Thymic hyperplasia, Thymic carcinoma, Neuroblastoma, Ganglioneuroma, Non Hodgkin lymphoma, Sarcoma, Mature teratoma, Endodermal sinus tumor, Hemangioma, Wilms tumor, Lymphangioma
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Heart and blood vessels
 
Congenital heart disease, Myocarditis, Heart failure, Cardiomyopathies, Wegener granulomatosis, Valvular heart disease, Vasculitis, Arteriovenous malformation
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
External ear and Tympanic membrane
 
Otitis media and externa, Impaction of foreign body, wax, Myringitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Esophagus
 
GERD, Tracheoesophageal Fistula
 
 
 
 
 
 

Differentiating Cough from other Diseases

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Respiratory Upper airway diseases Epiglottitis[7][8] Abrupt or acute
  • 12−24 hours
+ +
  • Elevated white blood count in CBC
  • Blood culture may show bacterial growth
  • Epiglottal culture in intubated patients may show bacterial growth
  • Enlarge epiglottis (>8 mm), loss of vallecular air space and distended hypopharynx as known as 'Thumb print' sign on lateral neck X−ray may be helpful
  • Normal function
Croup[9] Acute
  • 3−5 days
+ + +
  • Clinical diagnosis.
  • Laboratory findings and imaging are not necessary for diagnosis
Pertussis[10][11] Acute
  • Two weeks
+ Whooping sound + + +
  • Clear chest
  • Normal function
  • Culture
Common Cold[12] Acute
  • 3−10 days
+ +
  • Bacterial culture is not indicated
  • Normal function
  • Clinical diagnosis
Tonsilitis[13][14][15] Acute or Acute Recurrent, Chronic
  • Varies
+(Mucus from inflamed tissue) −/+ + Odynophagia, Tachypnea
  • Rapid Antigen Detecting Test
  • Throat Swab Culture
  • EBV Heterophile Antibody Test
  • Monospot Test
  • Complete Blood Count
  • Chest X−Ray shows normal finding. USG may show Peritonsillar abscess.
  • Normal function
  • Rapid Antigen Detecting Test
Seasonal Influenza[16][17] Acute
  • Upper respiratory tract symptoms with fever peaking at three to four days, resolved by seven to ten days.
+(High grade) +
  • Normal function
  • Clinical diagnosis
Sinusitis[18][19] Acute, Subacute, Chronic, recurrent
  • Acute: < four weeks
  • Subacute: four−twelve weeks
  • Chronic: > twelve weeks
  • Recurrent: > four episodes / acute episode of rhinosinusitis yearly.
+ + +
  • Restlessness, Nasal Congestion, Post Nasal Drip, Facial Pain, Rhinorrhea
  • Air−fluid level, mucosal edema and bony erosion of sinus on CT
  • MRI for distinguish the etiology
  • Normal function

_

Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical findings Lab findings Imaging PFT Gold standard
Respiratory Lower airway Asthma[20][21] Chronic
  • Years
+ Clear mucoid or yellow sputum +
  • Family history
  • Seasonal variation
Bacterial Protracted Bronchitis[22][23] Chronic
  • At least four weeks
+(Purulent) + +/− +
  • FEV1 < 80%
  • Clinical diagnosis
  • Majority of cases are caused by Streptococci Pneumoniae, Hemophylous Influenza, Staphylococcus aureus
Bronchiectasis[24][25][26] Chronic
  • Months to years
+ Mucopurulent sputum + +
  • CT of chest
'Foreign body aspiration[27][28][29] Acute
  • Sudden Onset
+ +/- +/- +
  • No specific tests
  • Not specific
  • In children <1 year
  • Organic materials in children
Bronchiolitis[30][31] Acute
  • 8−15 days
+ + +
  • Rhinorrhoea
  • Cyanosis, Hypoxia
  • Intercostal and subcostal retraction
  • Tachypnea
  • Wheezing
  • Crackles
  • Grunting and Nasal Flaring
  • Clinical diagnosis
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Respiratory Lung Parenchyma Pneumonia[32][33][34] Acute + + +
  • Crackles
  • Egophony
  • Decreased bronchial sounds, Rhonchi
  • Rapid Breathing
  • Intercostal retractions
  • Nasal Flaring, Grunting
  • Tachypnea, Tachycardia
  • Vomiting
  • Not specific
Tuberculosis (TB)[35] Chronic[36]
  • Weeks to months
+ + + + +
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Cardiac Cardiac Failure[37][38] Acute
  • Hours
+ + The following investigations may be helpful:
  • Not specific
  • Clinical diagnosis
  • Tests are supportive
Congenital Heart Disease Acute or Chronic
  • Variable
+ + +
  • Not specific
Organ system Diseases Clinical manifestations Diagnosis Other features
Symptoms Physical exam
Onset Duration Productive cough Hemoptysis Weight loss Fever Dyspnea Physical Examination Lab findings Imaging PFT Gold standard
Gastrointestinal Gastroesophageal reflux[39][40] Chronic
  • Variable
+ + +
*Apnea
  • Epigastric pain
  • Not specific
  • Normal function
  • PH testing
−−

Epidemiology and Demographics

Age

Gender

  • Boys are more commonly affected with cough than girls.[42]

Race

Risk Factors

Natural History, Complications and Prognosis

  • Prognosis is generally excellent and efficiently treatable in most of the etiology of cough in children.

Diagnosis

Diagnostic Criteria

  • Diagnosis of causes of a cough is made after a detailed history, presenting complaints and physical examination and laboratory findings in some cases. Cough can be classified according to:[48]
    • Duration.
    • Nature or quality of cough.
    • Etiology.
    • Anatomic location.
    • Grade.

A detailed history focusing on onset of disease, factors worsening the episodes, time of worsening, alleviating factors, amount of work to breathe, presence of shortness of breathing, relation with vomiting, food intake, posture, presence of blood, systemic findings (fever, weight loss, hypotension, syncope, vertigo, dizziness, failure to thrive), episodes of choking, household socioeconomic status, family history, vaccination history, drug abuse and smoking in family members, atopy, antenatal, perinatal, postnatal, birth history, developmental history, feeding history.

The following signs are alarming which need further emergent evaluation by the physician:

Symptoms

  • Cough may be associated with the following depending upon the cause:

Physical Examination

Laboratory Findings

Electrocardiogram

An ECG may not be helpful in the diagnosis of congenital heart disease, myocarditis, valvular heart disease, in children.

X-ray

Anterior/posterior view, lateral Chest and neck x-ray may be helpful in the diagnosis of causes of cough in children for: Pneumonia, Croup, Bronchitis, Epiglottitis, Foreign body impaction etc. X-ray of paranasal sinuses helps in diagnosis of sinusitis, deviated nasal septum.

Echocardiography or Ultrasound

Echocardiography/ultrasound may be helpful in the diagnosis of causes of cough in children. Echocardiographic findings aide in the diagnosis of congenital heart disease, whereas USG findings can help in evaluating complications like peritonsillar abscess, retropharyngeal abscess promptly.

CT scan

The High resolution CT is used for diagnosing causes of chronic cough in children such as bronchiectasis. Sometimes it helps in identifying congenital heart and lung anomalies.

MRI

A Chest MRI may be helpful in the diagnosis of the dynamic function of airways disease.[49]. MRI can provide detailed findings of perfusion, ventilation mechanism of lungs and diaphragm. It can show oxygen enhancement, congenital anomalies too.

Other Imaging Findings

Other imaging techniques are used to evaluate causes of cough in children.

Other Diagnostic Studies

Other investigations done to rule out differential diagnosis of cough in children are:

Treatment

Medical Therapy

Surgery

Prevention

  • Effective measures for the primary prevention of cough include:
    • Caregivers should be given health education on pros and cons of vaccination, alarming features of cough.
    • Physical hygiene including airways of an infant or a child should be maintained to prevent complications.
    • Head should be raised to prevent irritations in throat.
    • Humidified air will help clearing the sputum easily.
    • Adequate hydration to prevent formation of dry sputum.
    • Avoidance of triggers in case of atopic patient.
    • Nutritional balance should be maintained for rebooting the immunity.

References

  1. 1.0 1.1 Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S (March 2015). "Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA)". Int J Pediatr Adolesc Med. 2 (1): 38–43. doi:10.1016/j.ijpam.2015.03.001. PMID 30805435.
  2. Chung KF, Bolser D, Davenport P, Fontana G, Morice A, Widdicombe J (April 2009). "Semantics and types of cough". Pulm Pharmacol Ther. 22 (2): 139–42. doi:10.1016/j.pupt.2008.12.008. PMID 19136069.
  3. Polverino M, Polverino F, Fasolino M, Andò F, Alfieri A, De Blasio F (June 2012). "Anatomy and neuro-pathophysiology of the cough reflex arc". Multidiscip Respir Med. 7 (1): 5. doi:10.1186/2049-6958-7-5. PMID 22958367.
  4. 4.0 4.1 "Acute cough in children".
  5. Kwon NH, Oh MJ, Min TH, Lee BJ, Choi DC (May 2006). "Causes and clinical features of subacute cough". Chest. 129 (5): 1142–7. doi:10.1378/chest.129.5.1142. PMID 16685003.
  6. Bergamini M, Kantar A, Cutrera R, Interest Group I (2017). "Analysis of the Literature on Chronic Cough in Children". Open Respir Med J. 11: 1–9. doi:10.2174/1874306401711010001. PMID 28553418. Vancouver style error: initials (help)
  7. Abdallah C (July 2012). "Acute epiglottitis: Trends, diagnosis and management". Saudi J Anaesth. 6 (3): 279–81. doi:10.4103/1658-354X.101222. PMC 3498669. PMID 23162404.
  8. "Epiglottitis, Acute Laryngitis, and Croup".
  9. Cherry, James D. (2008). "Croup". New England Journal of Medicine. 358 (4): 384–391. doi:10.1056/NEJMcp072022. ISSN 0028-4793.
  10. Bellamy EA, Johnston ID, Wilson AG (1987). "The chest radiograph in whooping cough". Clin Radiol. 38 (1): 39–43. PMID 3816065.
  11. "Pertussis | Whooping Cough | Clinical | Information | CDC".
  12. Eccles R (2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMID 16253889.
  13. Stelter K (2014). "Tonsillitis and sore throat in children". GMS Curr Top Otorhinolaryngol Head Neck Surg. 13: Doc07. doi:10.3205/cto000110. PMC 4273168. PMID 25587367.
  14. Bartlett A, Bola S, Williams R (2015). "Acute tonsillitis and its complications: an overview". J R Nav Med Serv. 101 (1): 69–73. PMID 26292396.
  15. Di Muzio F, Barucco M, Guerriero F (December 2016). "Diagnosis and treatment of acute pharyngitis/tonsillitis: a preliminary observational study in General Medicine". Eur Rev Med Pharmacol Sci. 20 (23): 4950–4954. PMID 27981538.
  16. Kumar V (February 2017). "Influenza in Children". Indian J Pediatr. 84 (2): 139–143. doi:10.1007/s12098-016-2232-x. PMID 27641976.
  17. Kondrich J, Rosenthal M (June 2017). "Influenza in children". Curr Opin Pediatr. 29 (3): 297–302. doi:10.1097/MOP.0000000000000495. PMID 28346272.
  18. Badr DT, Gaffin JM, Phipatanakul W (September 2016). "Pediatric Rhinosinusitis". Curr Treat Options Allergy. 3 (3): 268–281. doi:10.1007/s40521-016-0096-y. PMC 5193235. PMID 28042527.
  19. Shahid SK (2012). "Rhinosinusitis in children". ISRN Otolaryngol. 2012: 851831. doi:10.5402/2012/851831. PMC 3671714. PMID 23762621.
  20. Gelfand EW (May 2009). "Pediatric asthma: a different disease". Proc Am Thorac Soc. 6 (3): 278–82. doi:10.1513/pats.200808-090RM. PMC 2677403. PMID 19387030.
  21. van Aalderen WM (2012). "Childhood asthma: diagnosis and treatment". Scientifica (Cairo). 2012: 674204. doi:10.6064/2012/674204. PMC 3820621. PMID 24278725.
  22. Zhang XB, Wu X, Nong GM (March 2020). "Update on protracted bacterial bronchitis in children". Ital J Pediatr. 46 (1): 38. doi:10.1186/s13052-020-0802-z. PMC 7106696 Check |pmc= value (help). PMID 32228653 Check |pmid= value (help).
  23. "www.thoracic.org" (PDF).
  24. Pizzutto SJ, Hare KM, Upham JW (2017). "Bronchiectasis in Children: Current Concepts in Immunology and Microbiology". Front Pediatr. 5: 123. doi:10.3389/fped.2017.00123. PMC 5447051. PMID 28611970.
  25. Redding GJ (February 2009). "Bronchiectasis in children". Pediatr Clin North Am. 56 (1): 157–71, xi. doi:10.1016/j.pcl.2008.10.014. PMID 19135586.
  26. Bouyahia O, Essadem L, Matoussi N, Gharsallah L, Fitouri Z, Mrad Mazigh S, Boukthir S, Bellagah I, Ben Becher S, Sammoud El Gharbi A (November 2008). "Etiology and outcome of bronchiectasis in children: a study of 41 patients". Tunis Med. 86 (11): 996–9. PMID 19213492.
  27. Fraga Ade M, Reis MC, Zambon MP, Toro IC, Ribeiro JD, Baracat EC (February 2008). "Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment". J Bras Pneumol. 34 (2): 74–82. doi:10.1590/s1806-37132008000200003. PMID 18345450.
  28. Aslan N, Yıldızdaş D, Özden Ö, Yöntem A, Horoz ÖÖ, Kılıç S (2019). "Evaluation of foreign body aspiration cases in our pediatric intensive care unit: Single-center experience". Turk Pediatri Ars. 54 (1): 44–48. doi:10.14744/TurkPediatriArs.2019.60251. PMC 6559979 Check |pmc= value (help). PMID 31217709.
  29. Ayed AK, Jafar AM, Owayed A (August 2003). "Foreign body aspiration in children: diagnosis and treatment". Pediatr Surg Int. 19 (6): 485–8. doi:10.1007/s00383-003-0965-x. PMID 12736750.
  30. Friedman JN, Rieder MJ, Walton JM (November 2014). "Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age". Paediatr Child Health. 19 (9): 485–98. doi:10.1093/pch/19.9.485. PMC 4235450. PMID 25414585.
  31. Smith DK, Seales S, Budzik C (January 2017). "Respiratory Syncytial Virus Bronchiolitis in Children". Am Fam Physician. 95 (2): 94–99. PMID 28084708.
  32. Katz SE, Williams DJ (March 2018). "Pediatric Community-Acquired Pneumonia in the United States: Changing Epidemiology, Diagnostic and Therapeutic Challenges, and Areas for Future Research". Infect Dis Clin North Am. 32 (1): 47–63. doi:10.1016/j.idc.2017.11.002. PMC 5801082. PMID 29269189.
  33. Rodrigues C, Groves H (March 2018). "Community-Acquired Pneumonia in Children: the Challenges of Microbiological Diagnosis". J Clin Microbiol. 56 (3). doi:10.1128/JCM.01318-17. PMC 5824044. PMID 29237789. Vancouver style error: initials (help)
  34. Scott JA, Wonodi C, Moïsi JC, Deloria-Knoll M, DeLuca AN, Karron RA, Bhat N, Murdoch DR, Crawley J, Levine OS, O'Brien KL, Feikin DR (April 2012). "The definition of pneumonia, the assessment of severity, and clinical standardization in the Pneumonia Etiology Research for Child Health study". Clin Infect Dis. 54 Suppl 2: S109–16. doi:10.1093/cid/cir1065. PMC 3297550. PMID 22403224.
  35. Thomas TA (August 2017). "Tuberculosis in Children". Pediatr Clin North Am. 64 (4): 893–909. doi:10.1016/j.pcl.2017.03.010. PMC 5555046. PMID 28734517.
  36. Marais BJ, Schaaf HS (July 2014). "Tuberculosis in children". Cold Spring Harb Perspect Med. 4 (9): a017855. doi:10.1101/cshperspect.a017855. PMC 4143109. PMID 25037105.
  37. "Cough or difficulty in breathing - Pocket Book of Hospital Care for Children - NCBI Bookshelf".
  38. Jayaprasad N (2016). "Heart Failure in Children". Heart Views. 17 (3): 92–99. doi:10.4103/1995-705X.192556. PMC 5105230. PMID 27867456.
  39. Juchet A, Brémont F, Dutau G, Olives JP (August 2001). "[Chronic cough and gastroesophageal reflux in children]". Arch Pediatr (in French). 8 Suppl 3: 629–634. doi:10.1016/s0929-693x(01)80018-x. PMID 11683086.
  40. Chang AB, Cox NC, Faoagali J, Cleghorn GJ, Beem C, Ee LC, Withers GD, Patrick MK, Lewindon PJ (February 2006). "Cough and reflux esophagitis in children: their co-existence and airway cellularity". BMC Pediatr. 6: 4. doi:10.1186/1471-2431-6-4. PMC 1409774. PMID 16504152.
  41. Chang AB, Glomb WB (January 2006). "Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 260S–283S. doi:10.1378/chest.129.1_suppl.260S. PMID 16428719.
  42. "Prevalence of cough throughout childhood: A cohort study".
  43. Irwin RS, Baumann MH, Bolser DC, Boulet LP, Braman SS, Brightling CE, Brown KK, Canning BJ, Chang AB, Dicpinigaitis PV, Eccles R, Glomb WB, Goldstein LB, Graham LM, Hargreave FE, Kvale PA, Lewis SZ, McCool FD, McCrory DC, Prakash U, Pratter MR, Rosen MJ, Schulman E, Shannon JJ, Hammond CS, Tarlo SM (January 2006). "Diagnosis and management of cough executive summary: ACCP evidence-based clinical practice guidelines". Chest. 129 (1 Suppl): 1S–23S. doi:10.1378/chest.129.1_suppl.1S. PMC 3345522. PMID 16428686. Vancouver style error: initials (help)
  44. Hope-Simpson RE, Miller DL (November 1973). "The definition of acute respiratory illnesses in general practice". Postgrad Med J. 49 (577): 763–70. doi:10.1136/pgmj.49.577.763. PMC 2495832. PMID 4806394.
  45. 45.0 45.1 Hay AD, Wilson AD (May 2002). "The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review". Br J Gen Pract. 52 (478): 401–9. PMC 1314298. PMID 12014540.
  46. 46.0 46.1 Chang AB, Landau LI, Van Asperen PP, Glasgow NJ, Robertson CF, Marchant JM, Mellis CM (April 2006). "Cough in children: definitions and clinical evaluation". Med J Aust. 184 (8): 398–403. doi:10.5694/j.1326-5377.2006.tb00290.x. PMID 16618239.
  47. 47.0 47.1 "Cough • 2: Chronic cough in children | Thorax".
  48. 48.0 48.1 Gadomski AM, Aref GH, Hassanien F, el Ghandour S, el-Mougi M, Harrison LH, Khallaf N, Black RE (December 1993). "Caretaker recognition of respiratory signs in children: correlation with physical examination findings, x-ray diagnosis and pulse oximetry". Int J Epidemiol. 22 (6): 1166–73. doi:10.1093/ije/22.6.1166. PMID 8144301.
  49. Ciet P, Tiddens HA, Wielopolski PA, Wild JM, Lee EY, Morana G, Lequin MH (December 2015). "Magnetic resonance imaging in children: common problems and possible solutions for lung and airways imaging". Pediatr Radiol. 45 (13): 1901–15. doi:10.1007/s00247-015-3420-y. PMC 4666905. PMID 26342643.
  50. Goldman RD (November 2011). "Treating cough and cold: Guidance for caregivers of children and youth". Paediatr Child Health. 16 (9): 564–9. doi:10.1093/pch/16.9.564. PMC 3223897. PMID 23115499.
  51. "Guidelines for Evaluating Chronic Cough in Pediatrics - CHEST".
  52. Krishnan S, Ianotti V, Welter J, Gallagher MM, Ndjatou T, Dozor AJ (2019). "Bronchodilators, Antibiotics, and Oral Corticosteroids Use in Primary Care for Children With Cough". Glob Pediatr Health. 6: 2333794X19831296. doi:10.1177/2333794X19831296. PMC 6390215. PMID 30828592.