(modified from Chung KF, Pavord ID. Differential diagnosis. The following findings are of particular concern: Clinical findings frequently indicate a specific cause (see Table: Some Causes of Cough in Children); the distinction between acute and chronic cough is particularly helpful although it is important to note that many disorders that cause chronic cough begin acutely and patients may present before 4 weeks have passed. Prevalence, pathogenesis, and causes of chronic cough. They are helpful indicators to guide your differential diagnosis. 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. As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching considerations with regard to differential diagnoses. The most common main complaints in acute and chronic rhinosinusitis were cough and rhinorrhea. Aspiration Syndromes. Children with stridor, drooling, fever, and marked anxiety need to be evaluated for epiglottitis, typically in the operating room by an ear, nose, and throat specialist prepared to immediately place an endotracheal or tracheostomy tube. The cough was non-productive but he said he would cough up clear mucous that was just like his rhinorrhea. The disease is often called acute subglottic laryngitis (ASL). A high index of suspicion for foreign body aspiration is needed if children are age 6 months to 6 years. Duration: 1. acute (< 2 weeks) 2. subacute (2-4 weeks) 3. chronic (> 4 weeks) Quality: moist/wet/productive vs. dry Etiology: specific (attributable to an underlying problem) or non-specific (absence of identifiable problem) They are helpful indicators to guide your differential diagnosis. At least 90% of children with cough have a respiratory tract infection such as a cold, croup, bronchitis, bronchiolitis, whooping cough, or pneumonia. A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. Chronic cough — Chronic cough in children aged 14 years and younger is typically defined as a cough lasting more than four weeks . What type of exposure triggers the cough? The CPM provides best-practice recommendations for differential diagnosis and management of acute cough and bronchitis. Differential Diagnosis of Acute Pharyngitis: Evaluation (history): Respiratory distress: epiglottitis, retropharyngeal abscess, peritonsillar abscess, EBV (obstruction in or near pharynx) Fatigue: infectious mononucleuosis; Abrupt onset: epiglottitis; Evaluation (physical examination): Vesicles anterior: herpetic stomatitis, SJS, Behcet Cough is a common reason for pediatric outpatient visits. The Merck Manual was first published in 1899 as a service to the community. Fagnan LJ. Persistent or recurrent radiologic findings. The link you have selected will take you to a third-party website. In young children with sudden cough and no fever or URI symptoms, the examiner should have a high index of suspicion for foreign body aspiration. Auscultate: is air entry symmetric? A staccato cough is consistent with a viral or atypical pneumonia. Making an exact diagnosis of cough can be difficult, but useful pointers include the part of the respiratory tract that is most affected, the season, and pattern recognition. The differential diagnosis of children with frequent respiratory infection and wheezing should include Foreign body … Guidelines for evaluating chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines. Black arrows represent the afferent pathway and purple arrows represent the efferent pathway. 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). Passive Smoking and Lung Disease. Little evidence exists to support the use of cough suppressants and mucolytic agents. Making a differential diagnosis when a patient presents with a cough can be challenging however when the clinician ask about the other associated symptoms such as fever, vomiting, night sweats, weight loss, sputum production and quantity, smoking history, drug use and most importantly the duration of the cough,making a differential diagnosis becomes less challenging. 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). Inspect chest wall for signs of hyperinflation and deformities. There was no significant difference in symptoms between both groups, except for periorbital pain and sleep apnea which were found more frequently in the chronic group. Lung. A paroxysmal cough is characteristic of pertussis or certain viral pneumonias (adenovirus). ), For acute cough, the most common cause is, For chronic cough, the most common causes are. Did this help with the present episode? 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. The legacy of this great resource continues as the Merck Manual in the US and Canada and the MSD Manual outside of North America. Children with viral infections should receive supportive care, including oxygen and/or bronchodilators as needed. Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted. 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