![]() What medications, if any, does the child take?Īlthough the differential diagnosis for chronic pediatric cough is quite varied, the child's age can help narrow the investigation.What treatments have been tried, and what were their effects?.Does the child (or do the parents) smoke? Is there evidence of environmental pollutants in the home?.Is there a family history of respiratory, allergic, or infectious disease?.What is the cough's character or quality? How disruptive is it?.Is the cough an isolated symptom if not, what other symptoms exist?.K ey questions to askĪlthough multiple etiologies can overlap, the following questions 1 can help determine the etiology of a particular cough: ![]() The Table lists cough characteristics and associated symptoms that should raise these red flags. ![]() Such cases require thorough evaluation to ensure that underlying problems are properly identified and, to the extent possible, addressed. Outside CRS and garden-variety URTIs, other forms of abnormal, persistent coughing in children can be associated with more severe, progressive underlying illnesses and/or structural abnormalities. Additionally, all children with cough persisting beyond 8 weeks should be evaluated. When to worryĬhildren in whom cough reflex hypersensitivity persists beyond 3 weeks may require evaluation. Other conditions associated with increased CRS include asthma, gastroesophageal reflux disease (GERD, albeit weakly), and angiotensin-converting enzyme inhibitor therapy. However, the aftermath of viral respiratory tract infections can include upregulation of cough reflex sensitivity (CRS), which can provoke coughing long after the infection has resolved. In otherwise healthy children, these coughs stem from transient situations that are likely to be self-limited. Recommended: Feds weigh in on vaccine warsīecause most acute (lasting longer than 3 weeks) and subacute (lasting 3 to 8 weeks) coughs in adults and children signal viral URTIs, they do not demand specific diagnostic evaluation. Coughing associated with a typical viral URTI lasts 14 to 21 days. 2 Of concern, however, is chronic cough, which for practical purposes most experts define as cough lasting more than 4 weeks, 3 based on the expected duration of acute URTIs, which represent the most common cause of coughing in adults and children. Healthy school-aged children typically cough between 10 and 34 times daily. These afferent nerves communicate with the brainstem, which signals motor nerves that activate respiratory muscles to produce the characteristic cough response. The cough reflex occurs when inhaled, aspirated, or locally produced objects activate sensory nerves located throughout the airway. However, a practical approach focuses on red-flag symptoms that help point the way toward appropriate management strategies regardless of diagnosis. 1 However, the search for an underlying etiology often proves fruitless, and in other cases multiple etiologies may overlap, making diagnosis and treatment difficult. However, still, more information is needed regarding cause-effect relationships and longitudinal trends of nocturnal cough in asthma.Ĭopyright © 2023, StatPearls Publishing LLC.As complex as it is common, chronic cough in children presents diagnostic and treatment challenges that are complicated by a dearth of solid data and, often, the anxieties of well-meaning parents.Īn important defense mechanism for clearing the airway and signaling the presence of an upper respiratory tract infection (URTI), coughing represents the most common reason for pediatrician visits in the United States. Marsden et al reported that the parameter of nocturnal cough could be a valid indicator for asthma control. In asthma, symptoms usually worsen at night and cause awakenings affecting the quality of life. This cough reflex has neuroplasticity in such a way that hypersensitive response is triggered over time because of the cough itself causing chronic irritation and inflammation and leading to tissue remodeling.Īsthma is a highly prevalent chronic respiratory disease with nocturnal cough as one of the presenting features. Nocturnal cough is distressing and may cause disturbances in sleep. ![]() ![]() Women tend to have a chronic cough more often and have heightened cough reflex sensitivity compared to men. Impairment or absence of the coughing mechanism can be dangerous and even fatal in disease. A cough is a symptom and a reflex action that is an essential protective and defensive act that secures the removal of mucus, noxious substances, and infections from the larynx, trachea, and larger bronchi. ![]()
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