Cough in children: When should we worry?

S2C – APSR Joint Symposium (Paediatric Bronchiectasis and Chronic Cough)
COUGH IN CHILDREN: WHEN SHOULD WE WORRY?

Patrick Chan Wai Kiong
Gleneagles Medical Centre, Kuala Lumpur, Malaysia

Cough is a a very common reason for health care visits, with a chronic persistent cough encountered in 5 - 10% of children based on parental questionnaire surveys. Nonetheless, a cough in the shadow of the post covid era can result in the child being isolated and if prolonged has significant detriment to the quality of life for both patient and caregiver. The cough is of concern if it is prolonged and chronic; defined as a cough unremitting for the duration of at least 4 weeks (CHEST 2020 Consensus Statement). The initial evaluation must include a careful history taking of the cough duration and its character namely if it is wet, dry, nocturnal, identification of triggers, weight loss, choking and if any, concurrent wheeze. A targeted physical examination should examine for clubbing, failure to thrive, chest deformity and abnormal breath sounds; which are important RED FLAG clinical findings that can help determine a possible diagnosis. There are generally 3 categories of chronic cough in children; but they show considerable overlap and may evolve between categories at various points of time. 1. The normal child with recurrent episodes of acute cough from viral upper respiratory tract infections that merges with one another; also described as Nursery School Syndrome. 2. The child with the persistent dry cough, almost daily and can be attributed to nasal allergies, upper airway cough syndrome 3. The child with key RED FLAG clinical features and may be due to Bronchiectasis, Protracted Bacterial Bronchitis, Asthma, Tuberculosis, Inhaled Foreign Body. Based on the numerous guidelines on evaluating chronic cough in children, the initial step of management consists of history taking followed by physical examination, chest radiography, and spirometry (in older children who are cooperative). Meticulous and thorough history taking is a cornerstone to this process, for which the primary cost is the clinician’s time.