Chronic cough in a child

Differential diagnosis

  • The normal, well child
    • Post viral
    • Psychogenic cough
  • Non-serious, treatable illness
    • GORD
    • Post nasal drip
  • Asthma syndrome
    • Wheeze, Diurnal variation, Exercise, Cold air, Pets
  • Serious underlying illness
    • CF, Bronchiectasis – Neonatal onset, productive cough
    • Retained inhaled foreign body – Very acute onset
    • Other infections
      • TB, Pertussis (paroxysms with inspiratory whoop), Mycoplasma pneumoniae, Chlamydia
    • Others
      • Immune deficiencies
      • Primary ciliary disorders
      • Recurrent pulmonary aspiration
      • Anatomical Disorder – Tracheomalacia
      • Interstitial lung disease – Shortness of breath
      • Cardiac disease

 

Data gathering

  • Red flags
    • Neonatal onset
    • Chronic moist cough with sputum production
    • Failure to thrive
    • Family history of lung disease
    • Haemoptysis
  • Others
    • DIB
    • Triggers
    • URTI symptoms
    • Relation to meals, Lying down
    • Wheeze, Diurnal variation, Exercise, Cold air, Pets
    • Smoking at home
  • Examination
    • HR, Sats, RR
    • Chest, CVS, ENT
    • Clubbing, Nasal polyps – ?CF

 

Clinical management

  • Investigations
    • CXR
  • Treatment
    • Monitor
    • Parental smoking cessation
    • Depending on cause
      • Trial of Salbutamol/spacer + Beclometasone 200mcg BD for 8 weeks
        • upon improvement, the ICS should be stopped and a diagnosis of asthma should only be made if cough reoccurs
      • Trial of Gaviscon + Ranitidine
      • Trial of prolonged course of antibiotics
        • e.g. co-amoxiclav for 2-3 weeks
  • Follow-up / Safety net
    • 90% of coughs settle within 4 weeks – consider investigating earlier if not starting to improve or deterioration

 

Notes

  • Duration
    • Normal – up to 4 weeks
    • Subacute cough – 3-8 weeks
    • Chronic cough – > 8 weeks