A barking or brassy cough suggests tracheomalacia. In some children the quality of cough is recognisable and suggestive of specific aetiology. Ask the child to perform their usual cough, and huff (forced expiration) while palpating the chest.Check for nasal polyps (cystic fibrosis must be excluded).Conduct ear, nose and throat examination.Upper airway symptoms (rhinitis, ear infections, glue ear).Quality of cough, for example barking, wheezing or honking.History and examination of a child with chronic cough Examination must include a respiratory, cardiovascular and ENT assessment. Parental reporting of the child’s cough does not correlate well with the frequency, duration or intensity of the actual cough Clinical evaluationĬlinical evaluation of cough should always include a detailed history including environmental factors, particularly exposure to tobacco smoke, and eliciting parental concerns and expectations. The child with non-serious, treatable illness such as gastro-oesophageal reflux disease ( GORD) or upper airway cough syndrome.The child with serious underlying illness such as cystic fibrosis or TB.In cases of isolated chronic cough a history and examination, followed by targeted investigations if necessary, should place the child in one of five broad diagnostic categories: Parental discrimination between a wet and a dry cough, however, is a good predictor of secretions in the lower airway. In many cases the reported 'severity' of coughing in a child is related to how it affects the parents or teachers. Parental reporting of cough does not correlate well with the frequency, duration or intensity of the actual objective cough. Symptom reportingĪccurate and reliable symptom reporting is important in the assessment of cough. Cough may also be the first sign of a serious illness.Ĭareful evaluation of the chronic cough, to identify any features that merit referral and address parental concerns, is crucial.

But chronic cough can have a significant impact on a family’s quality of life - it affects the child’s sleep, school attendance and play. Most cases of cough relate to the respiratory infections that would be expected an otherwise healthy child. There is no consensus on the duration in children. Chronic cough is defined as a non-resolving daily cough lasting longer than 4-8 weeks. 0.5 CPD Credits Click here to take a test on this article and claim your certificate on MIMS LearningĬhronic cough is a common presenting symptom in children, accounting for a high number of repeat consultations.

Tracheomalacia nocturnal cough