Medical Progress

Cough in the Pediatric Population

The Cough Reflex

Cough is a protective reflex, a component of normal respiratory physiology that enhances mucociliary function and clears excessive secretions and airway debris from the respiratory tract, as well as a very common symptom of respiratory disease. Cough receptors are located in the respiratory tract from the larynx to the segmental bronchi.⁸ The cough reflex has vagal afferent input, brain stem centralization with cortical modulation, and motor efferent activity involving respiratory muscles.

Defining Cough in Children

Children cough differently from adults in terms of duration, presentation, and underlying causes. The classification of cough in children reflects these differences.

Etiology of Abnormal Pediatric Cough

A previously proposed diagnostic paradigm of specific versus nonspecific cough in children forms the basis of the approach to evaluation and treatment in the 2006 ACCP guidelines.13, 24 Specific cough is associated with underlying respiratory or systemic disease, and the need for further investigation is typically evident from coexisting symptoms and signs, radiographs, and laboratory results (Table II; available at www.jpeds.com ). A frequent (daily) wet cough is the best clinical marker of the

Evaluating Chronic Cough in Children

There are no historical features of cough that provide a clear diagnosis in most cases of pediatric chronic, nonspecific cough. Rather than applying a comprehensive battery of tests for chronic cough in all children, most clinicians use clinical pointers in the history and physical examination to target the investigation.

The recommended evaluation of chronic cough is outlined in Figure 1. A trial of pharmacotherapy is often used as a diagnostic modality, although spontaneous resolution of cough

Treating Pediatric Cough

Children with chronic cough need a different management protocol than adults. Cough in children should be treated according to etiology; however, for chronic nonspecific cough, empiric trials of therapy are frequently used. There is little evidence to support the use of medications for symptomatic relief only in acute cough.¹³

Conclusion

Cough in children is common, and the majority of cases reflect respiratory infections. Cough is rarely associated with a serious disorder; all children with cough persisting for >8 weeks should be evaluated. A careful history, physical examination, chest x-ray, and spirometry (in an able child) are recommended for all children with chronic cough. If a diagnosis is not evident (“nonspecific” cough), then an approach based on characterizing the cough as “wet” or “dry” may be helpful. In each