It can be caused by members of several families of viruses; the most common are the more than 100 serotypes of rhinoviruses. Bronchopulmonary Dysplasia (BPD) Imaging. 3. Acute Sinusitis. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. Little evidence exists to support the use of cough suppressants and mucolytic agents. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. The CPM provides best-practice recommendations for differential diagnosis and management of acute cough and bronchitis. Children with red flag findings should have pulse oximetry and chest x-ray. They are helpful indicators to guide your differential diagnosis. A barky cough suggests croup or tracheitis; it can also be characteristic of psychogenic cough or a postrespiratory tract infection cough. Chest.2006;129(1 suppl):1S–292S. History of present illness should cover duration and quality of cough (barky, staccato, paroxysmal) and onset (sudden or indolent). Acute cough in children with upper respiratory infection symptoms and no red flag findings is usually caused by a viral infection, and testing is rarely indicated. The most common main complaints in acute and chronic rhinosinusitis were cough and rhinorrhea. Rest and adequate hydration; NSAIDs; Antibiotics: generally not recommended! Differential Diagnosis of Acute Pharyngitis: Evaluation (history): Respiratory distress: epiglottitis, retropharyngeal abscess, peritonsillar abscess, EBV (obstruction in or near pharynx) Fatigue: infectious mononucleuosis; Abrupt onset: epiglottitis; Evaluation (physical examination): Vesicles anterior: herpetic stomatitis, SJS, Behcet Note that these classifications are not mutually exclusive. Cough receptors, which are afferent endings of the vagus nerve (cranial nerve X), are scattered in the airway mucosa and submucosa. Chang AB. Children with stridor, drooling, fever, and marked anxiety need to be evaluated for epiglottitis, typically in the operating room by an ear, nose, and throat specialist prepared to immediately place an endotracheal or tracheostomy tube. Differential Diagnoses. Coughing at the beginning of sleep and in the morning with waking usually indicates sinusitis; coughing in the middle of the night is more consistent with asthma. Cough is a common indication of respiratory illness and is one of the more common symptoms of children seeking medical attention. Miles Weinberger, M.D., and Anthony Fischer, M.D., Ph.D. ABSTRACT. An initial history, gathered from his mother because of the patient’s respiratory distress, revealed no recent travel. Learn more about our commitment to Global Medical Knowledge. Note that these classifications are not mutually exclusive. Influenza. Is there evidence of fevers, failure to thrive or weight loss? Children with viral infections should receive supportive care, including oxygen and/or bronchodilators as needed. The peak incidence of cough in January and February is eight times higher than … The cervical and supraclavicular areas should be inspected and palpated for lymphadenopathy. Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing … What relieves the cough? Differential diagnosis. Bronchodilators)? Cystic fibrosis, immunodeficiencies, obstruction (intrinsic [eg, foreign body] or extrinsic [eg, compressing nodes or tumor]), pulmonary sequestration, bronchial stenosis, or bronchiectasis. Differential Diagnosis Diseases similar to acute bronchitis. History and examination are adequate to make a diagnosis in children > 36 months who are otherwise well and not toxic-appearing. Goldsobel AB, Chipps BE. Passive Smoking and Lung Disease. Classifications of Cough Cough is usually classified based on its duration, quality or etiology. Persistent or recurrent fever and symptoms. Pediatric Bronchitis Differential Diagnoses. Acute upper / lower respiratory tract infection (ARI), Inhalation injury (acute exposure to smoke or volatile substances), Interstitial lung disease (i.e. A cough is a forceful expulsion of air from the lungs that helps to clear secretions, foreign bodies, and irritants from the airway. Obtain a chest x-ray if patients have red flag findings or chronic cough. Despite the broad repercussions of acute cough on patient quality of life, school and work productivity, and public health resources, research on this condition is minimal, as are the available treatment options. Classifying cough as an aid to suggesting differential diagnoses. At least 90% of children with cough have a respiratory tract infection such as a cold, croup, bronchitis, bronchiolitis, whooping cough, or pneumonia. They are helpful indicators to guide your differential diagnosis. The pain is described as sharp, 4/10 in severity, located on the left side of her throat, and worsened with swallowing. 2010 Jan; 188 Suppl 1:S33-40. In young children with sudden cough and no fever or URI symptoms, the examiner should have a high index of suspicion for foreign body aspiration. Nighttime cough can indicate postnasal drip or asthma. Cough. The following findings are of particular concern: Clinical findings frequently indicate a specific cause (see Table: Some Causes of Cough in Children); the distinction between acute and chronic cough is particularly helpful although it is important to note that many disorders that cause chronic cough begin acutely and patients may present before 4 weeks have passed. Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections. Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted. 2010 Mar; 156 (3): 352-8. Acute cough: The majority of acute cough attacks in children are related to viral/post-viral URTI and do not require further investigation. Cough is a reflex that helps clear the airways of secretions, protects the airway from foreign body aspiration, and can be the manifesting symptom of a disease. Review of systems should note symptoms of possible causes, including abdominal pain (some bacterial pneumonias), weight loss or poor weight gain and foul-smelling stools (cystic fibrosis), and muscle soreness (possible association with viral illness or atypical pneumonia but usually not with bacterial pneumonia). , MD, Sidney Kimmel Medical College of Thomas Jefferson University. Inspect chest wall for signs of hyperinflation and deformities. Nature of cough; How long has the child been coughing for? Head and neck examination should focus on presence and amount of nasal discharge and the condition of the nasal turbinates (pale, boggy, or inflamed). Examine for edema, cyanosis, clubbing of fingers/toes, and skin lesions. Chronic cough, defined as daily cough of at least 4 weeks in duration, (1) can be associated with an … Persistent or recurrent radiologic findings. DIFFERENTIAL DIAGNOSIS For example, antibiotics should be given for bacterial pneumonia; bronchodilators and anti-inflammatory drugs should be given for asthma. Note that these classifications are not mutually exclusive. Chest. Bacterial Tracheitis. Bronchiolitis. Examination of extremities should note clubbing or cyanosis of nail beds (cystic fibrosis). Acute cough is most commonly associated with the common cold, but it also can be associated with life-threatening conditions (e.g., pulmonary embolism, congestive heart failure, pneumonia). What pets or animals did the child have contact with? Examine for nasal polyps and other nasal passage obstruction. Failure to thrive or weight loss can occur with TB or cystic fibrosis. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Nevertheless, the same principles of management apply once the diagnosis is made. Some of these symptoms are ubiquitous (eg, runny nose, sore throat, fever); others may suggest a specific cause: headache, itchy eyes, and sore throat (postnasal drip); wheezing and cough with exertion (asthma); night sweats (tuberculosis [TB]); and spitting up, irritability, or arching of the back after feedings in infants (gastroesophageal reflux). Allergy Asthma Proc. The differential diagnosis of children with frequent respiratory infection and wheezing should include Foreign body … Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing may be necessary. Useful if suspicion for foreign body is high. 2. Chemoreceptors are sensitive to acid, heat, and capsaicin derivatives through the activation of type 1 vanilloid receptor (TRPV1) and are located mainly in the distal airways. Is there increased work of breathing? Auscultate: is air entry symmetric? The physician should ask about associated symptoms. The first step in the treatment of acute cough is to determine if the cause of the cough is one of these serious conditions or an acute upper respiratory infection (i.e., common cold), lower respiratory tract infection, or an exacerbation of a pr… Normal Cardiac Physiology – Transition From Fetal to Neonatal, Basic Physiology and Approach to Heart Sounds, Pharmacology of Common Agents Used in Gastrointestinal Conditions, Pediatric Gastrointestinal History Taking, Common Paediatric Skin Conditions & Birthmarks, Approach to the child with mental health concerns, Approach to a the Child with a Fever and Rash, Approach to a Routine Adolescent Interview, Sore Throat in Children – Clinical Considerations and Evaluation, Conjunctivitis: Approach to the Child with a Red Eye, Diaper Rash: Clinical Considerations and Evaluation, Evaluation of Pediatric Development (Normal), Basics to the Approach of Developmental Delay, Principles of Pharmacotherapy in Neurology, Iron-deficiency and Health Consequences in Children, Approach to Pediatric Leukemias and Lymphomas, Common Pediatric Bone Diseases-Approach to Pathological Fractures, © Copyright The University of British Columbia. Chung KF, Pavord ID. Listeners will learn to identify clinical features, develop a differential diagnosis, and appropriately investigate and acutely manage patients in respiratory distress. For example, if allergic sinusitis is suspected and treated with an antihistamine that does not alleviate symptoms, a head CT may be necessary for further evaluation. 58(8):1795-802, 805-6. . ), For acute cough, the most common cause is, For chronic cough, the most common causes are. What type of exposure triggers the cough? Figure 1 – Cough reflex anatomy: Red dots represent the locations of the cough receptors. Please confirm that you are a health care professional. Weinberger M, Fischer A: Differential diagnosis of chronic cough in children. Click for pdf: Approach to a child with a cough. Acute cough in children with upper respiratory infection symptoms and no red flag findings is usually caused by a viral infection, and testing is rarely indicated. Cough in the pediatric population. 2. As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching considerations with regard to differential diagnoses. Are there adventitious sounds? Lung. Acute fever is infectious in most cases, and, of these, most are viral. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. The Merck Manual was first published in 1899 as a service to the community. Over the summer he had been active but had not been training before also starting running with the cross-country running team. Grad R. Chronic cough in children. Use of nonspecific drugs for cough suppression is discouraged in children. It may be classified as acute (< 3 weeks), subacute (3–8 weeks), or chronic (> 8 weeks), as well as productive (with Non-allergic wheezing in children occurs during acute infections, including viral bronchiolitis. Ask about the age/duration of onset (congenital cause). Each cough is elicited by the stimulation of the cough reflex arc. A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. 10.2500/aap.2014.35.3711. Differential diagnosis of acute and sub acute cough. Is there any shortness of breath (dyspnea)? Chang AB, Glomb WB. a. a While cough due to many conditions such as asthma and aspiration will be discussed in the chronic category, these conditions can present acutely and subacutely. In: UpToDate, Mallory GB (Ed), Hoppin AG (Ed), UpToDate, Waltham, MA, 2009. Pediatric … KEY POINTS • Diagnosis of acute bronchitis should be made only after ruling out other sources of cough — including pneumonia, asthma, influenza, pertussis, and acute exacerbations of chronic bronchitis (AECB). There was no significant difference in symptoms between both groups, except for periorbital pain and sleep apnea which were found more frequently in the chronic group. In healthy children it may be normal in the absence of any disease to cough ten times a day. The pharynx should be checked for postnasal drip. Via the vagus nerve, impulses from the cough receptors are propagated to the cough center in the medulla and nucleus tractus solitaris. Before we dive into the clinical approach to cough, let us review the respiratory physiology of cough. The most common cause of an acute or subacute cough is a viral respiratory tract infection. Pediatric cough: children are not miniature adults. Atypical Mycobacterial Infection . This podcast was developed by Sarah Buttle with the help of Dr. Tom Kovesi. Making a differential diagnosis when a patient presents with a cough can be challenging however when the clinician ask about the other associated symptoms such as fever, vomiting, night sweats, weight loss, sputum production and quantity, smoking history, drug use and most importantly the duration of the cough,making a differential diagnosis becomes less challenging. Differential Diagnosis . For children 6 months to 6 years, the parents should be asked about potential for foreign body aspiration, including older siblings or visitors with small toys, access to small objects, and consumption of small, smooth foods (eg, peanuts, grapes). In 60% of patients, the barky cough disappears after 48 hours . Article … They are helpful indicators to guide your differential diagnosis. If an inhaled foreign body is suspected as the cause of an acute cough, … All children with chronic cough require a chest x-ray. Children with repeated episodes of pneumonia, poor growth, or foul-smelling stools should have a chest x-ray and sweat testing for cystic fibrosis. Chronic cough — Chronic cough in children aged 14 years and younger is typically defined as a cough lasting more than four weeks . Acute cough in children with upper respiratory infection symptoms and no red flag findings is usually caused by a viral infection, and testing is rarely indicated. See differential diagnosis of acute cough; For cough persisting ≥ 8 weeks, see differential diagnosis of chronic cough; The differential diagnoses listed here are not exhaustive. Not only does it cause discomfort for the child, cough also elicits stress and sleepless nights for their parents. Cough has a high frequency in pediatrics; it tends to persist, to ... SL, Winther B: Acute cough: a diagnostic and therapeutic challenge. Aspiration Syndromes. Pediatric Aspergillosis. (See table Some Causes of Cough in Children. Mechanoreceptors are sensitive to touch or displacement and are located mainly in the proximal airway such as larynx and trachea. PubMed Central Article PubMed Google Scholar 3. 2014, 35 (2): 95-103. Can help delineate obstructive vs. restrictive lung disease, Required in the diagnosis of asthma (child must be >6yo and cooperative). A cough is considered chronic when it lasts ⬎ 4 weeks. We do not control or have responsibility for the content of any third-party site. In <5% of cases, symptoms may last longer than five nights and <5% of children experience more than one episode. A high index of suspicion for foreign body aspiration is needed if children are age 6 months to 6 years. Foreign body aspiration and diseases such as cystic fibrosis and primary ciliary dyskinesia are less common, but they can all result in persistent cough. Cough as a manifestation of respiratory disease can range from minor upper respiratory tract infections to serious conditions such as bronchiectasis. 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