Cough in children

Questionnaire/history:

Onset of symptoms?

Duration of cough?

Frequency of cough?

Type of cough (dry or productive)?

Colour of sputum/phlegm?

Precipitating or exacerbating factors?

Diurnal variation?

Unwell?

Red flags? - Neonatal onset? - Failure to thrive? - Abnormal voice/cry? - Haemoptysis? - Clubbing? - Present during feeds? - Sudden onset? Triggers?

Associated symptoms?

- Sharp chest pain when breathing deeply (pleuritic pain)?

- Chest pains also when not coughing?

- Difficulty in breathing?

--- On exertion only?

--- At rest?

--- At night?

- Wheezing?

- Coughing up blood (haemoptysis)?

- Fever?

- Maximum temperature?

- Sweats?

- Chills?

- Runny nose?

- Nasal or sinus congestion?

- Dark yellow or green nasal discharge?

- Sore throat?

- Hoarseness?

- Trouble swallowing?

- Fatigue?

- Muscle and joint aches?

- Headache?

- New loss of smell or taste?

- Nausea/vomiting/diarrhoea?

- Peripheral oedema with weight gain?

Covid-19 lateral flow tests?

Past medical history?

- Higher risk of complications?

--- Pre-existing comorbidity?

--- Young children born prematurely?

Family history?

Smoking history?

Recent travel history?

Current medication?

Known drug allergies?

Examination:

Altered level of consciousness?

Blood pressure?

Pulse?

Temperature?

SpO2?

RR?

Throat inspection?

Ear inspection?

Use of accessory muscles of respiration?

Chest auscultation?

(Heart auscultation?)

NEWS2?

CRB65 score?

- Confusion?

- RR >30?

- SBP <90 or DBP <60mmHg?

Diagnosis:

Upper RTI?

Acute bronchitis?

Pneumonia?

Possible Covid-19 infection?

Confirmed Covid-19 infection by PCR test?

Acute exacerbation of a pre-existing condition:

- Upper airway cough syndrome (post-nasal drip)?

- Asthma?

- COPD?

GORD?

Pertussis?

Pulmonary embolism?

Pneumothorax?

Post-infectious cough?

Sub-acute cough (3-4 weeks) (?cause)?

Chronic cough (4+ weeks) (?cause)?

Other?

Management:

Home care advice given?

Advised: Majority of coughs in preschool children are self-limiting Most preschool children will have 6-10 coughs per year It is normal for coughs to persist (only around 50% by day 10, and 10% will persist beyond day 25)

Usually caused by a viral upper respiratory tract infection such as a cold or flu Antibiotics make little difference to how long a cough lasts

To drink plenty of fluids (to aim half a litre every four hours)

Paracetamol and/or ibuprofen with food (if no nausea or vomiting) for any associated pain

Could try: Hot lemon and honey (squeeze half a lemon into a mug of boiled water and add 1 to 2 teaspoons of honey) eg four times daily

Herbal remedy pelargonium root extract (eg Benylin Herbal Cough & Cold Sugar Free Syrup) to support the immune system

Expectorant guaifenesin (eg Benylin Mucus Cough Max) to thinnen and loosen the mucus (phlegm) to make it easier to cough up

Cough suppressant dexatromethorphan (if the cough is not persistent, such as in asthma, or accompanied by excessive secretions) (eg Benylin Dry Coughs) To seek medical advice if new or rapidly or significantly worsening symptoms (eg a lot of dark yellow, green or brown phlegm, worsening chest pains, shortness of breath or fever) or symptoms do not improve in 3-4 weeks or becoming systemically very unwell