Children with TB risk factors or weight loss should have a chest x-ray and purified protein derivative (PPD) testing. TEF = tracheoesophageal fistula; URI = upper respiratory infection. 2010 Mar; 156 (3): 352-8. DIFFERENTIAL DIAGNOSIS Influenza. Chung KF, Pavord ID. Am Fam Physician. An initial history, gathered from his mother because of the patient’s respiratory distress, revealed no recent travel. URI-like prodrome, stridor, barky cough, high fever, respiratory distress, toxic appearance, purulent secretions, Rhinorrhea, tachypnea, wheezing, crackles, retractions, nasal flaring, possible posttussive emesis, In infants up to 24 months; most common among those 3–6 months, Sometimes nasal swab for rapid viral antigen assays or viral culture, URI-like prodrome, barky cough (worsening at night), stridor, nasal flaring, retractions, tachypnea, Sometimes anteroposterior and lateral neck x-rays, Exposure to tobacco smoke, perfume, or ambient pollutants, Abrupt onset, high fever, irritability, marked anxiety, stridor, respiratory distress, drooling, toxic appearance, If patient is stable and clinical suspicion is low, lateral neck x-ray, Otherwise, examination in operating room with direct laryngoscopy, Chest x-ray (inspiratory and expiratory views), Viral: URI prodrome, fever, wheezing, staccato-like or paroxysmal cough, possible muscle soreness or pleuritic chest pain, Possible increased work of breathing, diffuse crackles, rhonchi, or wheezing, Bacterial: Fever, ill appearance, chest pain, shortness of breath, possible stomach pain or vomiting, Signs of focal consolidation including localized crackles, rhonchi, decreased breath sounds, egophony, and dullness to percussion, Coughing at the beginning of sleep or in the morning with waking, Sometimes nasal discharge, congestion; pain on either side of the nose; pain in the forehead, upper jaw, teeth, or between the eyes; headache and sore throat, Rhinorrhea, red swollen nasal mucosa, possible fever and sore throat, shotty cervical adenopathy (many small nontender nodes), Tracheomalacia: Congenital stridor or barky cough, possible respiratory distress, TEF: History of polyhydramnios (if accompanied by esophageal atresia), cough or respiratory distress with feeding, recurrent pneumonia, Tracheomalacia: Airway fluoroscopy and/or bronchoscopy, TEF: Attempt passage of a catheter into the stomach (helps in diagnosis of TEF with esophageal atresia), Contrast swallowing study, including esophagography, Intermittent episodes of cough with exercise, allergens, weather changes, or URIs, Atypical pneumonia (mycoplasma, Chlamydia), Possible ear pain, rhinitis, and sore throat, Birth defects of the lungs (eg, congenital adenomatoid malformation), Several episodes of pneumonia in the same part of the lungs, History of meconium ileus, recurrent pneumonia or wheezing, failure to thrive, foul-smelling stools, clubbing or cyanosis of nail beds, Molecular diagnosis with direct mutation analysis, History of acute onset of cough and choking followed by a period of persistent cough, Presence of small objects or toys near child, Infants and toddlers: History of spitting up after feedings, irritability with feeding, stiffening and arching of the back (Sandifer syndrome), failure to thrive, recurrent wheezing or pneumonia (see Gastroesophageal Reflux in Infants), Older children and adolescents: Chest pain or heartburn after meals and lying down, nighttime cough, wheezing, hoarseness, halitosis, water brash, nausea, abdominal pain, regurgitation (see Gastroesophageal Reflux Disease), Sometimes upper gastrointestinal study for determination of anatomy, Trial of H2 blockers or a proton pump inhibitor, Possible esophageal pH or impedance probe study, Trial of H2 blockers or proton pump inhibitors, 1–2 weeks catarrhal phase of mild URI symptoms, progression to paroxysmal cough, difficulty eating, apneic episodes in infants, inspiratory whoop in older children, posttussive emesis, Intranasal specimen for bacterial culture and polymerase chain reaction testing, Headache, itchy eyes, sore throat, pale nasal turbinates, cobblestoning of posterior oropharynx, history of allergies, nighttime cough, Trial of antihistamine and/or intranasal corticosteroids, Possible trial of a leukotriene inhibitor, History of respiratory infection followed by a persistent, staccato cough, History of repeated upper (otitis media, sinusitis) and lower (pneumonia) respiratory tract infections, Microscopic examination of living tissue (typically from sinus or airway mucosa) for cilia abnormalities, Persistent barky cough, possibly prominent during classes and absent during play and at night, Sometimes fever, chills, night sweats, lymphadenopathy, weight loss, Sputum culture (or morning gastric aspirate culture for children < 5 years), Interferon-gamma release assay (especially if there is a history of bacille Calmette-Guérin [BCG] vaccination). Prevalence, pathogenesis, and causes of chronic cough. It is important, however, to differentiate between acute … Acute cough: The majority of acute cough attacks in children are related to viral/post-viral URTI and do not require further investigation. Nature of cough; How long has the child been coughing for? As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching considerations with regard to differential diagnoses. They are helpful indicators to guide your differential diagnosis. 2009, 5: 11-10.1186/1745-9974-5-11. At least 90% of children with cough have a respiratory tract infection such as a cold, croup, bronchitis, bronchiolitis, whooping cough, or pneumonia. 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. A chest radiograph should be considered when signs indicate lower respiratory tract involvement, progressive nature, hemoptysis or features of an undiagnosed chronic respiratory disorder. Note that these classifications are not mutually exclusive. The disease is often called acute subglottic laryngitis (ASL). Auscultate: is air entry symmetric? All children with chronic cough require a chest x-ray. For example, antibiotics should be given for bacterial pneumonia; bronchodilators and anti-inflammatory drugs should be given for asthma. 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). Cough is usually classified based on its duration, quality or etiology. Differential Diagnosis Diseases similar to acute bronchitis. The cough was non-productive but he said he would cough up clear mucous that was just like his rhinorrhea. Examine for nasal polyps and other nasal passage obstruction. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Classifications of Cough. Non-allergic wheezing in children occurs during acute infections, including viral bronchiolitis. The differential diagnosis of acute and sub acute cough is wide ranging and includes a plethora of diseases. Adenoid hypertrophy was found in the CRS group. Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing … Failure to thrive or weight loss can occur with TB or cystic fibrosis. 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. Differential Diagnoses. Bronchopulmonary Dysplasia (BPD) Imaging. Are there adventitious sounds? Differential Diagnosis . Classifications of Cough Cough is usually classified based on its duration, quality or etiology. Pediatric Bronchitis Differential Diagnoses. Lung examination focuses on presence of stridor, wheezing, crackles, rhonchi, decreased breath sounds, and signs of consolidation (eg, egophony, E to A change, dullness to percussion). Pediatric cough: children are not miniature adults. Causes of cough differ depending on whether the symptoms are acute (< 4 weeks) or chronic (> 4 weeks). Pediatric Aspergillosis. 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. (See table Some Causes of Cough in Children. Obtain a chest x-ray if patients have red flag findings or chronic cough. Rest and adequate hydration; NSAIDs; Antibiotics: generally not recommended! Cough is one of the most common complaints for which parents bring their children to a health care practitioner. Sixty five percents of ARS and 58.8% of CRS had abnormal x-ray findings. From developing new therapies that treat and prevent disease to helping people in need, we are committed to improving health and well-being around the world. PubMed Central Article PubMed Google Scholar 3. Article … 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). Is there evidence of fevers, failure to thrive or weight loss? Differential diagnosis. Children with red flag findings should have pulse oximetry and chest x-ray. Use of nonspecific drugs for cough suppression is discouraged in children. Cough is a common indication of respiratory illness and is one of the more common symptoms of children seeking medical attention. Allergy Asthma Proc. 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. 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. 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 expiratory organs to produce cough (see Figure 1). We do not control or have responsibility for the content of any third-party site. Symptoms are short-lived, usually lasting 3 to 7 days. Did this help with the present episode? 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. Aspiration Syndromes. Treatment. Chest radiograph can provide you with additional information, such as infiltrations/ consolidations, hyperinflation, peribronchial thickening, hyperinflation, atelectasis and chronic lung changes. Before we dive into the clinical approach to cough, let us review the respiratory physiology of cough. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. 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… Rheumatic diseases). History of present illness should cover duration and quality of cough (barky, staccato, paroxysmal) and onset (sudden or indolent). Figure 1 – Cough reflex anatomy: Red dots represent the locations of the cough receptors. Black arrows represent the afferent pathway and purple arrows represent the efferent pathway. verify here. Persistent or recurrent fever and symptoms. Centers for … HPI: The patient reports steadily worsening sore throat over the past 2 days, associated with a sensation of swelling. Is there increased work of breathing? Useful if suspicion for foreign body is high. Some of these receptors are mechanosensitive and some are chemosensitive. In Canada, croup season peaks over the fall and winter (3, 8, 9). A cough is considered chronic when it lasts ⬎ 4 weeks. The most common main complaints in acute and chronic rhinosinusitis were cough and rhinorrhea. They are helpful indicators to guide your differential diagnosis. In <5% of cases, symptoms may last longer than five nights and <5% of children experience more than one episode. Acute cough in children is mostly caused by upper respiratory tract infections (URTIs). 17 year-old female presenting to the pediatric ED with sore throat for 2 days. Weinberger M, Fischer A: Differential diagnosis of chronic cough in children. Cough in the pediatric population. 2010 Jan; 188 Suppl 1:S33-40. 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. Chronic cough, defined as daily cough of at least 4 weeks in duration, (1) can be associated with an … The pharynx should be checked for postnasal drip. Duration: acute (< 2 weeks), subacute (2-4 weeks), chronic (> 4 weeks) Quality: moist/wet/productive vs. dry Lung. 2. 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. Duration: 1. acute (< 2 weeks) 2. subacute (2-4 weeks) 3. chronic (> 4 weeks) Quality: moist/wet/productive vs. dry Etiology: specific (attributable to an underlying problem) or non-specific (absence of identifiable problem) In healthy children it may be normal in the absence of any disease to cough ten times a day. Bacterial Tracheitis. Treatment of cough is management of the underlying disorder. In 60% of patients, the barky cough disappears after 48 hours . Past medical history should cover recent respiratory infections, repeated pneumonias, history of known allergies or asthma, risk factors for TB (eg, exposure to a person who has known or suspected TB infection, exposure to prisons, HIV infection, travel to or immigration from countries that have endemic infection), and exposure to respiratory irritants. Please confirm that you are a health care professional. 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. This site complies with the HONcode standard for trustworthy health information:   Is there a family history of atopy (eczema, allergies, asthma), cystic fibrosis, and/or primary ciliary dyskinesia? IgA and IgG Subclass Deficiencies. Last updated on December 15, 2011 @7:34 pm, Emergency Procedures | Accessibility | Contact UBC  | © Copyright The University of British Columbia, Approach to the Child with a fever and rash, Approach to Cyanotic Congenital Heart Disease in the Newborn. Ask about a history of choking (suspect foreign objects in airway). 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. Persistent or recurrent radiologic findings. The most common cause of an acute or subacute cough is a viral respiratory tract infection. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Bronchiolitis. The peak incidence of cough in January and February is eight times higher than … Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Acute cough is one of the most common complaints prompting patient visits to healthcare professionals. Cough is a common reason for pediatric outpatient visits. Differential diagnosis of chronic cough in children. Acute Sinusitis. 1. Click for pdf: Approach to a child with a cough. What relieves the cough? Is there any shortness of breath (dyspnea)? 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. (modified from Chung KF, Pavord ID. Ask about the age/duration of onset (congenital cause). Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing may be necessary. Differential diagnosis of acute and sub acute cough. Chest. 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. Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Signs of respiratory distress (eg, nasal flaring, intercostal retractions, cyanosis, grunting, stridor, marked anxiety) should be noted. 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