Chronic Cough in Children

Background

• Chronic cough in children is defined as a cough for > 3-4 weeks.
• Common causes of chronic cough in children include:
  • untreated asthma
  • infectious
  • allergic
  • environmental exposure
  • foreign body in respiratory tract
  • somatic cough syndrome or tic cough
  • bronchopulmonary dysplasia
  • irritant in the external ear canal
  • aspiration

Evaluation

• Assess the patient's clinical presentation and perform a thorough physical examination which may reveal the specific cause of a chronic cough.
• Consider chest x-ray and age-appropriate pre- and post-beta 2 agonist spirometry in most children with a chronic cough of uncertain etiology; however, in children with no specific clinical pointers, an x-ray may not be necessary if there are features of a postviral cough or pertussis-like illness (Weak recommendation).
• Perform other testing based on the suspected diagnosis, including blood tests, cultures, imaging studies, allergy testing, pulmonary function tests, bronchoscopy, testing for gastroesophageal reflux, and other diagnostic testing .

Management

• Consider management options based on the identified etiology, including watchful waiting, removal or reduction of environmental exposures, trial of asthma treatment, trial of antibiotics, trial of gastroesophageal reflux treatment, behavioral approaches, or referral to a pediatric pulmonologist or other subspecialist.
• Antitussive medications and most over-the-counter cough suppressants are not recommended and may be contraindicated in many conditions.