Cough

  • See also

    Pertussis/Whooping cough
    Asthma
    Foreign body

    Key Points

    1. The most common cause of cough is an upper respiratory tract infection, usually viral in nature
    2. In a well child with a normal examination, investigations and treatment are rarely needed
    3. Children with persistent cough (longer than 3 weeks) may require further assessment

    Background

    • Cough is a non-specific symptom
    • Young children develop 6-12 respiratory tract infections per year, usually accompanied by cough. In most children, the cough is self-limiting (1-3 weeks)
    • In general, if a child presents with a history of daily cough for greater than 3 weeks, further assessment is required
    • A productive cough is abnormal in children and usually has an identifiable specific cause

    The most common cause of cough in children of all ages is upper respiratory infection. Other common causes vary according to the age of the child. Some examples include:

    Infants Structural abnormalities of the airways, tracheo-oesophageal fistula, vascular rings or other anomalies
    Toddlers Foreign body, viral induced wheeze
    Older children Asthma*, chronic rhinitis
    Adolescents Asthma*, smoking, psychogenic factors

    *In the absence of wheeze or dyspnoea, asthma is unlikely to cause non-specific isolated cough

    Assessment

    Red flag features in Red

    History:

    • Onset (eg. sudden onset without a viral prodrome or onset after choking episode may suggest foreign body inhalation)
    • Associated with feeds
    • Type (eg. paroxysmal cough may suggest pertussis, chlamydia, or foreign body. Honking or a bizzare disruptive cough may suggest psychogenic cough. Barking cough suggests croup)
    • Pattern (eg. if absent during sleep, consider habit cough)
    • Distinguish recurrent episodes from continuous cough
    • Symptoms of sinusitis, chronic rhinitis, atopic conditions and asthma
    • Exercise tolerance
    • Poor growth
    • Any other medical concerns (eg. recurrent pneumonia, cardiac disease, immunodeficiency)
    • Exposure to passive smoking

    Examination:

    • Fever
    • Loss of muscle bulk and subcutaneous fat stores
    • Abnormal cardiac examination
    • Clubbing
    • Respiratory signs – particularly wheeze, differential air entry or crepitations

    Management

    In a well child with a normal examination, investigations and treatment are rarely needed. Chest X-ray and other investigations should be performed as indicated by clinical suspicion 

    Well child, normal examination

    • Reassure
    • Avoid exposure to irritants such as cigarette smoke (see also  smoking parents)
    • Cough medicines, decongestants, antihistamines, antibiotics do NOT have a role
    • Arrange follow up with local doctor in 2-3 weeks

    Unwell child or abnormal examination 

    • Treat according to findings and results of investigations

    Persistent cough (greater than 4 weeks duration) consider:

    If history or examination not consistent with any of the above, consider Chest X-Ray, spirometry and / or other investigations as needed – follow up with a Paediatrician 

    Consider consultation with local paediatric team when:

    Unwell child
    Persistent cough

    Consider transfer when:

    Children requiring care above the level of comfort of the local hospital

    For emergency advice and paediatric or neonatal ICU transfers, call the Paediatric Infant Perinatal Emergency Retrieval (PIPER) Service: 1300 137 650.

    Consider discharge when:

    Child is stable
    Investigations and follow up arranged if needed

    Parent information sheet

    Cough

    Last Updated September, 2019 

  • Reference List

    1. Brodie, M. Childhood cough. BMJ. 2012. 344:e1177. Retrieved from https://doi.org/10.1136/bmj.e1177
    2. Chang AB, Glomb WB. Guidelines for evaluating chronic cough in paediatrics: ACCP evidence-based clinical practice guidelines. Chest. 2006. 129 (1), (suppl): 260S – 283S
    3. Chang AB, Oppenheimer JJ, Weinberger M. Use of management pathways or algorithms in children with chronic cough: systemic reviews. Chest. 2016. 149 (1), 106 – 119
    4. Kasai AS, Kamerman-Kretzmer RJ. Cough. Pediatrics in Review. 2019. 40 (4), 157 – 167. [Available from: https://pedsinreview.aappublications.org/content/40/4/157]