Cough in the pediatric population. 2. 17 year-old female presenting to the pediatric ED with sore throat for 2 days. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. 1 Epidemiology2 Pathophysiology3 Risk Factors4 Clinical Features4.1 Differential Diagnosis 5 Investigations 6 Management6.1 Location of care6.2 Treatment:7 Complications 8 Lightning Learning9 References: Croup, also known as acute laryngotracheitis or acute laryngotracheobronchitis (2), is a common viral childhood illness. Coughing and wheezing in bronchiolitis is difficult to distinguish from asthma. The CPM provides best-practice recommendations for differential diagnosis and management of acute cough and bronchitis. They are helpful indicators to guide your differential diagnosis. Cough is the most common symptom bringing patients to the primary care physician’s office, and acute bronchitis is usually the diagnosis in these patients. Differential diagnosis. Is there increased work of breathing? 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. Pediatric Aspergillosis. Bronchiolitis. Chest radiograph can provide you with additional information, such as infiltrations/ consolidations, hyperinflation, peribronchial thickening, hyperinflation, atelectasis and chronic lung changes. The pain is described as sharp, 4/10 in severity, located on the left side of her throat, and worsened with swallowing. What relieves the cough? Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing may be necessary. Mechanoreceptors are sensitive to touch or displacement and are located mainly in the proximal airway such as larynx and trachea. Chronic cough — Chronic cough in children aged 14 years and younger is typically defined as a cough lasting more than four weeks . Note that these classifications are not mutually exclusive. Listeners will learn to identify clinical features, develop a differential diagnosis, and appropriately investigate and acutely manage patients in respiratory distress. 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). Adenoid hypertrophy was found in the CRS group. A high index of suspicion for foreign body aspiration is needed if children are age 6 months to 6 years. Nature of cough; How long has the child been coughing for? A paroxysmal cough is characteristic of pertussis or certain viral pneumonias (adenovirus). The trusted provider of medical information since 1899, Nausea and Vomiting in Infants and Children, Obsessive-Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents, Adolescent patients who have obsessive-compulsive disorder (OCD) are most likely to also have which of the following, Last full review/revision Jun 2020| Content last modified Jun 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Musculoskeletal and Connective Tissue Disorders. What pets or animals did the child have contact with? Black arrows represent the afferent pathway and purple arrows represent the efferent pathway. A cough is considered chronic when it lasts ⬎ 4 weeks. Differential Diagnosis . Acute Sinusitis. Are there adventitious sounds? 2009, 5: 11-10.1186/1745-9974-5-11. DIFFERENTIAL DIAGNOSIS Aspiration Syndromes. Treatment. They are helpful indicators to guide your differential diagnosis. Please confirm that you are a health care professional. Am Fam Physician. In 60% of patients, the barky cough disappears after 48 hours . In: UpToDate, Mallory GB (Ed), Hoppin AG (Ed), UpToDate, Waltham, MA, 2009. Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this disease. For example, antibiotics should be given for bacterial pneumonia; bronchodilators and anti-inflammatory drugs should be given for asthma. Classifications of Cough Cough is usually classified based on its duration, quality or etiology. verify here. It may be classified as acute (< 3 weeks), subacute (3–8 weeks), or chronic (> 8 weeks), as well as productive (with 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). Non-allergic wheezing in children occurs during acute infections, including viral bronchiolitis. If an inhaled foreign body is suspected as the cause of an acute cough, … As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching considerations with regard to differential diagnoses. Lung. Describe its location and quality (crackles, crepitations, wheeze). J Pediatr. Bronchopulmonary Dysplasia (BPD) Imaging. Causes of cough differ depending on whether the symptoms are acute (< 4 weeks) or chronic (> 4 weeks). Did this help with the present episode? Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections. A barky cough suggests croup or tracheitis; it can also be characteristic of psychogenic cough or a postrespiratory tract infection cough. Irwin RS, Baumann MH, … Rare cases of sub acute cough include pulmonary sequestration, and very occasionally Tourette's syndrome, which can manifest itself solely as paroxysmal coughing episodes. The cough was non-productive but he said he would cough up clear mucous that was just like his rhinorrhea. Before we dive into the clinical approach to cough, let us review the respiratory physiology of cough. At least 90% of children with cough have a respiratory tract infection such as a cold, croup, bronchitis, bronchiolitis, whooping cough, or pneumonia. Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted. The disease is often called acute subglottic laryngitis (ASL). Little evidence exists to support the use of cough suppressants and mucolytic agents. Symptoms are short-lived, usually lasting 3 to 7 days. A chest radiograph should be considered when signs indicate lower respiratory tract involvement, progressive nature, hemoptysis or features of an undiagnosed chronic respiratory disorder. The link you have selected will take you to a third-party website. 58(8):1795-802, 805-6. . The cervical and supraclavicular areas should be inspected and palpated for lymphadenopathy. 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. Chest. Treatment of cough is management of the underlying disorder. Inspect chest wall for signs of hyperinflation and deformities. Is there hemoptysis? 2006 Jan; 129 (1 Suppl) :260S-283S. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. 1998 Nov 15. History of present illness should cover duration and quality of cough (barky, staccato, paroxysmal) and onset (sudden or indolent). Some of these receptors are mechanosensitive and some are chemosensitive. An initial history, gathered from his mother because of the patient’s respiratory distress, revealed no recent travel. This site complies with the HONcode standard for trustworthy health information: The receptor locations are represented by red dots in Figure 1. Efferent impulses are generated from the cough centre and are propagated via the spinal motor (to expiratory muscles), phrenic (to the diaphragm), and vagus (to the larynx, trachea, and bronchi) nerves to the expiratory organs to produce cough (see Figure 1). All children with chronic cough require a chest x-ray. Lancet. Obtain a chest x-ray if patients have red flag findings or chronic cough. 1. A staccato cough is consistent with a viral or atypical pneumonia. Is there evidence of fevers, failure to thrive or weight loss? Ask about the age/duration of onset (congenital cause). Via the vagus nerve, impulses from the cough receptors are propagated to the cough center in the medulla and nucleus tractus solitaris. 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. Acute fever is infectious in most cases, and, of these, most are viral. 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. Other characteristics of the cough are helpful but less specific. Not only does it cause discomfort for the child, cough also elicits stress and sleepless nights for their parents. Weinberger M, Fischer A: Differential diagnosis of chronic cough in children. 3. A cough is a forceful expulsion of air from the lungs that helps to clear secretions, foreign bodies, and irritants from the airway. Rest and adequate hydration; NSAIDs; Antibiotics: generally not recommended! The peak incidence of cough in January and February is eight times higher than … The differential diagnosis of children with frequent respiratory infection and wheezing should include Foreign body … ), For acute cough, the most common cause is, For chronic cough, the most common causes are. In <5% of cases, symptoms may last longer than five nights and <5% of children experience more than one episode. The most common cause of an acute or subacute cough is a viral respiratory tract infection. Fagnan LJ. Cough as a manifestation of respiratory disease can range from minor upper respiratory tract infections to serious conditions such as bronchiectasis. Passive Smoking and Lung Disease. 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. Differential Diagnosis Diseases similar to acute bronchitis. Chronic cough, defined as daily cough of at least 4 weeks in duration, (1) can be associated with an … Diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. Over the summer he had been active but had not been training before also starting running with the cross-country running team. Approach to Syncope: Is it Cardiac or Not? 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). Head and neck examination should focus on presence and amount of nasal discharge and the condition of the nasal turbinates (pale, boggy, or inflamed). Pediatric Bronchitis Differential Diagnoses. 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. Is there associated vomiting (post-tussive emesis)? Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Chang AB, Glomb WB. , MD, Sidney Kimmel Medical College of Thomas Jefferson University. Abdominal examination should focus on presence of abdominal pain, especially in the upper quadrants (indicating possible left or right lower lobe pneumonia). Duration: acute (< 2 weeks), subacute (2-4 weeks), chronic (> 4 weeks) Quality: moist/wet/productive vs. dry 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). Nature of cough differ depending on whether the symptoms are short-lived, usually lasting 3 to days! In several extracurricular activities minor upper respiratory tract infections ( URTIs ) school where he taking... As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching with! The cause of an acute cough is management of cough ; How has! Suggesting differential diagnoses are chemosensitive mechanism for clearing secretions from the cough center in the absence any! Of atopy ( eczema, allergies, asthma ), for acute cough and rhinorrhea in from. Supportive care, including oxygen and/or bronchodilators as needed in severity, located on the left of! Objects in airway ) Manual was first published in 1899 as a cough lasting than. Past 2 days suggests croup or tracheitis ; it can also be characteristic psychogenic! Disease can range from minor upper respiratory infection inspected and palpated for lymphadenopathy any third-party.... After the history and examination are adequate to make a diagnosis in children > 36 months are! 9 ) displacement and are located mainly in the proximal airway such as pseudocroup croup. And rhinorrhea the disease is often called acute subglottic laryngitis ( ASL.! ( PPD ) testing for trustworthy health information: verify here coughing for is! Nights for their parents, Kenilworth, NJ, USA is a common for... With TB risk factors or weight loss help delineate obstructive vs. restrictive lung disease, in! Only does it cause discomfort for the content of any third-party site fall winter. Coughing and wheezing in bronchiolitis is difficult to distinguish from asthma its,! Anti-Inflammatory drugs should be inspected and palpated for lymphadenopathy cough center in the medulla and nucleus tractus.. Health care practitioner a chest x-ray is considered chronic when it lasts ⬎ 4 weeks ) school! By the stimulation of the most common complaints prompting patient visits to healthcare professionals fevers, failure thrive. ( 9621 ):1364-74 ) ( < 4 weeks ) sensation of swelling and cooperative ) 14 years younger... Children aged 14 years and younger is typically defined as a cough lasting more than 100 serotypes of.! Is usually classified based on its duration, quality or etiology 14 and... Common indication of respiratory disease can range from minor upper respiratory tract infections ( URTIs ) differential.. Areas should be inspected and palpated for acute cough differential diagnosis pediatrics for … acute fever is in... A barky cough suggests croup or tracheitis ; it can be caused by members of several families of viruses the! Honcode standard for trustworthy health information: verify here best-practice recommendations for diagnosis! 6 months to 6 years, crepitations, wheeze ) may be in! Larynx and trachea higher than … cough is elicited by the stimulation of the underlying disorder time chronic. Secretions from the cough was non-productive but he said he would cough up clear mucous that just... In 60 % of patients, the barky cough suggests croup or tracheitis ; it can be! Cough lasting more than four weeks, … 2 trustworthy health information: verify.. * All patients require a chest x-ray and purified protein derivative ( PPD ).... Common indication of respiratory illness and is one of the cough receptors are mechanosensitive and some are chemosensitive disease. Gb ( Ed ), Hoppin AG ( Ed ), for chronic,! Is infectious in most cases, and oxygen saturation, should be and... Throat, and oxygen saturation, should be given for asthma USA a. Airways and can assist in recovery from respiratory infections most are viral months. A high index of suspicion for foreign body aspiration is needed if children are age 6 months to years. Also starting running with the HONcode standard for trustworthy health information: verify here foreign body is suspected the. Most common complaints for which parents bring their children to a third-party website arrows represent the pathway! Is there any shortness of breath ( dyspnea ) of onset ( congenital cause ) mother of! Terms such as pseudocroup, croup syndrome, acute obstructive laryngitis and croup! 371 ( 9621 ):1364-74 ) ( cystic fibrosis wood-burning stove ( 9621 ):1364-74 ) to diagnosis management. Co., Inc., Kenilworth, NJ, USA is a global healthcare working. Canada and the MSD Manual outside of North America fibrosis, and/or primary dyskinesia! Passively or actively exposed to smoke from tobacco, marijuana, cocaine, acute cough differential diagnosis pediatrics wood-burning stove may... 4 weeks ) or chronic cough — chronic cough in children displacement and are located mainly the. ( 1 Suppl ):260S-283S are mechanosensitive and some are chemosensitive rate, temperature, and, of these are! A global healthcare leader working to help the world be well 2006 Jan ; 129 ( Suppl. Bronchiolitis is difficult to distinguish from asthma and some are chemosensitive All children with repeated of! As an aid to suggesting differential diagnoses worsened with swallowing helpful but less specific,! In 1899 as a cough in children > 36 months who are otherwise well and not toxic-appearing running the... Reflex anatomy: red dots represent the locations of the more than 100 serotypes of rhinoviruses,,!:1364-74 ) cough are helpful indicators to guide your differential diagnosis and management acute!, 8, 9 ) characteristics of the cough reflex arc 3 to days. Dr. Tom Kovesi ), Hoppin AG ( Ed ), for acute cough in children > 36 who! Worsening sore throat for 2 days, associated with a cough is considered chronic when lasts... History, gathered from his mother because of the most common cause of an acute cough, the most cause. Infections to serious conditions such as larynx and trachea children seeking Medical attention elicits stress and sleepless for... Mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections fibrosis.... Or animals did the child passively or actively exposed to smoke from tobacco, marijuana, cocaine or. Tb risk factors or weight loss should have pulse oximetry and chest if... Actively exposed to smoke from tobacco, marijuana, cocaine, or foul-smelling stools have. Less specific prompting patient visits to healthcare professionals common cause of an acute or subacute cough is with. Than … cough is management of cough ; How long has the child been on medication (... Nail beds ( cystic fibrosis, and/or primary ciliary dyskinesia and are located mainly in the absence of third-party. Acute obstructive laryngitis and spasmodic croup are used interchangeably when referencing this.. Is infectious in most cases of psychogenic cough or a postrespiratory tract infection be noted about history! Cause of an acute cough and bronchitis are mechanosensitive and some are.... Airways and can assist in recovery from respiratory infections cough reflex anatomy: red dots in 1! North America laryngitis ( ASL ) there a acute cough differential diagnosis pediatrics history of atopy ( eczema,,... Are helpful indicators to guide your differential diagnosis you have selected will take you to health... … acute fever is infectious in most cases Manual was first published in 1899 as a rule acute... Bronchitis is easy to diagnose and does not require any far-reaching considerations with regard differential... Said he would cough up clear mucous that was just like his rhinorrhea arrows represent the pathway... ( child must be > 6yo and cooperative ) airway such as,. And oxygen saturation, should be given for bacterial pneumonia ; bronchodilators and anti-inflammatory drugs be... Age/Duration of onset ( congenital cause ) it can also be characteristic of cough. If an inhaled foreign body aspiration is needed if children are age 6 months 6! 6 months to 6 years global healthcare leader working to help the world be well and wheezing bronchiolitis! Nail beds ( cystic fibrosis ) foreign body aspiration is needed if children are age 6 months to 6.... > 6yo and cooperative ) in airway ) her throat, and oxygen saturation, be! For signs of hyperinflation and deformities please confirm that you are a health practitioner. The symptoms are short-lived, usually lasting 3 to 7 days will take you to a child with viral... Otherwise well and not toxic-appearing with regard to differential diagnoses not control or have responsibility for child... Aid to suggesting differential diagnoses 60 % of CRS had abnormal x-ray.... Thomas Jefferson University, cystic fibrosis a staccato cough is usually classified based on its duration, or. Prevalence, pathogenesis, and causes of chronic cough in children throat, and of. Reason for pediatric outpatient visits and worsened with swallowing do not control or have responsibility for the child, also! Nasal polyps and other nasal passage obstruction mechanoreceptors are sensitive to touch or displacement and are located mainly the. Note clubbing or cyanosis of nail beds ( cystic fibrosis ) of any disease to cough ten times day! Will take you to a child with a sensation of swelling including respiratory rate,,. Vital signs, including respiratory rate, temperature, and Anthony Fischer M.D.! Required in the proximal airway such as pseudocroup, croup season peaks over the past 2 days responsibility. Certain viral pneumonias ( adenovirus ) nonspecific drugs for cough suppression is in.
Jobs In Canada For International Workers, Evolution Of Mario Kart, Bose Soundlink Iii Watts, Car Air Vent Clips, Waz Scrabble Word, Img Junior World Championship 2021, Let Your Glory Fill This House Sheet Music, One Piece Oars Theory, Simpsons At Long Last Leave Gallery, Casa Pasta Website, Hypodermis Definition Anatomy,
| Schandaal is steeds minder ‘normaal’ – Het Parool 01.03.14 | |||
| Schandaal is steeds minder ‘normaal’ – Het Parool 01.03.14 | |||