Cough resident survival guide (pediatrics): Difference between revisions
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* According to Chang et al., for children aged less than 14-years with [[chronic cough]] (> 4 weeks duration) without an underlying lung disease, treatment for [[Gastroesophageal reflux disease|gastroesophageal reflux disease (GERD)]] should not be used when there are no clinical features of [[gastroesophageal reflux]] such as recurrent regurgitation, [[Dystonia|dystonic neck posturing]] in infants, or [[epigastric pain|heartburn/epigastric pain]] in older children (Grade1B). <ref name="urljournal.chestnet.org">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(19)30831-1/pdf |title=journal.chestnet.org |format= |work= |accessdate=}}</ref> | * According to Chang et al., for children aged less than 14-years with [[chronic cough]] (> 4 weeks duration) without an underlying lung disease, treatment for [[Gastroesophageal reflux disease|gastroesophageal reflux disease (GERD)]] should not be used when there are no clinical features of [[gastroesophageal reflux]] such as recurrent regurgitation, [[Dystonia|dystonic neck posturing]] in infants, or [[epigastric pain|heartburn/epigastric pain]] in older children (Grade1B). <ref name="urljournal.chestnet.org">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(19)30831-1/pdf |title=journal.chestnet.org |format= |work= |accessdate=}}</ref> | ||
* For children aged less than 14-years with [[chronic cough]] (> 4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with [[Gastroesophageal reflux|gastroesophageal pathological reflux]], [[Proton pump inhibitors|acid suppressive therapy]] should not be used solely for their [[chronic cough]] (Grade 1C). <ref name="urljournal.chestnet.org">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(19)30831-1/pdf |title=journal.chestnet.org |format= |work= |accessdate=}}</ref> | * For children aged less than 14-years with [[chronic cough]] (> 4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with [[Gastroesophageal reflux|gastroesophageal pathological reflux]], [[Proton pump inhibitors|acid suppressive therapy]] should not be used solely for their [[chronic cough]] (Grade 1C). <ref name="urljournal.chestnet.org">{{cite web |url=https://journal.chestnet.org/article/S0012-3692(19)30831-1/pdf |title=journal.chestnet.org |format= |work= |accessdate=}}</ref> | ||
* According to CHEST guidelines 2017, For children aged less than 14-years with [[chronic cough]], basing the management on the etiology of the [[cough]] is recommended. An empirical approach aimed at treating [[Cough |upper airway cough syndrome]] due to a [[Rhinosinusitis|rhinosinus condition]], [[GERD]] and/or [[asthma]] should not be used unless other features consistent with these conditions are present. <ref name="pmid28143696">{{cite journal| author=Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K | display-authors=etal| title=Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report. | journal=Chest | year= 2017 | volume= 151 | issue= 4 | pages= 884-890 | pmid=28143696 | doi=10.1016/j.chest.2017.01.025 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28143696 }} </ref> | |||
==References== | ==References== | ||
Revision as of 10:39, 6 September 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Tayyaba Ali, M.D.[2]
Synonyms and keywords: Cough in childhood, Cough in children, An approach to cough in children
| Cough resident survival guide (pediatrics) Microchapters |
|---|
| Overview |
| Causes |
| FIRE |
| Diagnosis |
| Treatment |
| Do's |
| Don'ts |
Overview
This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.
Causes
Life Threatening Causes
Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated.
Common Causes
| Acute cough (less than 3 weeks)[1] | Subacute (3 to 8 weeks) or chronic cough (3 to 4 months)[2] |
|---|---|
|
Isolated cough: otherwise healthy child
|
Diagnosis
The approach to diagnosis of Cough in children is based on a step-wise testing strategy. Below is an algorithm summarising the identification and laboratory diagnosis of Cough.[3][4]
Characterize the symptoms ❑ Chronic wet/productive cough ❑ Chest pain ❑ History suggestive of inhaled foreign body ❑ Dyspnea ❑ Exertional dyspnea ❑ Hemoptysis ❑ Failure to thrive ❑ Choking ❑ Vomiting ❑ Cardiac anomaly ❑ Neurodevelopmental abnormalities ❑ Recurrent sinopulmonary infections ❑ Immunodeficiency ❑ Epidemiologic risk factors for exposure to TB | |||||||||||||||||||||||||||||||||||||||||
Examine the patient ❑ Respiratory distress ❑ Digital clubbing ❑ Chest wall deformity ❑ Auscultatory crackles | |||||||||||||||||||||||||||||||||||||||||
Order Chest X-ray or spirometry (if child is able to perform) | |||||||||||||||||||||||||||||||||||||||||
Consider the diagnosis of Bacterial bronchitis | Consider the diagnosis of Asthma ❑ History of bilateral wheeze and exertional dyspnea ❑ Absence of other cough symptoms ❑ Absence of findings on lung examination ❑ Reversible obstructive defect or normal finding on spirometry (if performed) | Consider the diagnosis of Retained foreign body ❑ History of choking or sudden onset of symptoms ❑ Monophonic or unilateral wheeze ❑ Chest X-ray finding suggesting foreign body | Consider the other type of cough ❑ Tracheomalacia ❑ Pertussis ❑ Habit cough/ tic cough (typically absent at night or when distracted and may be honking or short/dry) | ||||||||||||||||||||||||||||||||||||||
Antibiotics for 2 to 4 weeks | Trial of Asthma therapies for 2 to 4 weeks | Perform rigid bronchoscopy for foreign body removal | Perform tests to confirm the diagnosis and treat as appropriate | ||||||||||||||||||||||||||||||||||||||
Cough resolves ❑ Likely bacterial bronchitis ❑ Reassess in 3 to 4 months to confirm that child remains well | Productive cough continues after 4 weeks ❑ Consider the diagnosis of: | ||||||||||||||||||||||||||||||||||||||||
Treatment
Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.
Do's
- For children aged less than 14-years with chronic cough (> 4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with gastroesophageal pathological reflux, they should be treated for GERD in accordance to evidence-based GERD specific guidelines (Grade 1B). [5][6]
Don'ts
- According to Chang et al., for children aged less than 14-years with chronic cough (> 4 weeks duration) without an underlying lung disease, treatment for gastroesophageal reflux disease (GERD) should not be used when there are no clinical features of gastroesophageal reflux such as recurrent regurgitation, dystonic neck posturing in infants, or heartburn/epigastric pain in older children (Grade1B). [7]
- For children aged less than 14-years with chronic cough (> 4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with gastroesophageal pathological reflux, acid suppressive therapy should not be used solely for their chronic cough (Grade 1C). [7]
- According to CHEST guidelines 2017, For children aged less than 14-years with chronic cough, basing the management on the etiology of the cough is recommended. An empirical approach aimed at treating upper airway cough syndrome due to a rhinosinus condition, GERD and/or asthma should not be used unless other features consistent with these conditions are present. [8]
References
- ↑ 1.0 1.1 "www.ncbi.nlm.nih.gov" (PDF).
- ↑ 2.0 2.1 de Jongste JC, Shields MD (2003). "Cough . 2: Chronic cough in children". Thorax. 58 (11): 998–1003. doi:10.1136/thorax.58.11.998. PMC 1746521. PMID 14586058.
- ↑ Rochwerg B, Brochard L, Elliott MW, Hess D, Hill NS, Nava S; et al. (2017). "Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure". Eur Respir J. 50 (2). doi:10.1183/13993003.02426-2016. PMID 28860265.
- ↑ Weinberger M, Hoegger M (2016). "The cough without a cause: Habit cough syndrome". J Allergy Clin Immunol. 137 (3): 930–1. doi:10.1016/j.jaci.2015.09.002. PMID 26483178.
- ↑ Rosen R, Vandenplas Y, Singendonk M, Cabana M, DiLorenzo C, Gottrand F; et al. (2018). "Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition". J Pediatr Gastroenterol Nutr. 66 (3): 516–554. doi:10.1097/MPG.0000000000001889. PMC 5958910. PMID 29470322.
- ↑ "Overview | Gastro-oesophageal reflux disease in children and young people: diagnosis and management | Guidance | NICE".
- ↑ 7.0 7.1 "journal.chestnet.org".
- ↑ Chang AB, Oppenheimer JJ, Weinberger MM, Rubin BK, Grant CC, Weir K; et al. (2017). "Management of Children With Chronic Wet Cough and Protracted Bacterial Bronchitis: CHEST Guideline and Expert Panel Report". Chest. 151 (4): 884–890. doi:10.1016/j.chest.2017.01.025. PMID 28143696.