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Approach to chronic cough in children

Julie M Marchant, MBBS, FRACP, PhD
Section Editor
George B Mallory, MD
Deputy Editor
Alison G Hoppin, MD


An effective cough is essential for maintaining respiratory health. Cough is the most common reason why patients acutely seek medical consult in countries where data are available such as in the United States [1] and Australia [2]. Cough as a symptom is sometimes trivialized by health professionals, but is often distressing to parents irrespective of whether the cough is acute [3] or chronic [4].

There are many causes of cough; the majority originate in the lungs but there are also nonpulmonary etiologies, some proven and others controversial. The causes are presented in the table (table 1) and further discussed in another topic review (see "Causes of chronic cough in children"). Careful assessment of children with chronic cough is important to identify any underlying disease. Etiologies of chronic cough in children are different to adults and, thus, clinicians should use pediatric-specific cough guidelines [5]. As an example, gastroesophageal reflux and upper airway cough syndrome (formerly known as postnasal drip syndrome), are thought to be common causes of chronic cough in adults, but are controversial as common causes of chronic cough in children [6,7]. The approach outlined in this topic review is designed for use in all patients up to 18 years of age. However, for adolescents 15 years and older, it is reasonable to use adult guidelines and algorithms, since the etiologies of chronic cough in adolescents are fairly similar to those in adults. (See "Evaluation of subacute and chronic cough in adults" and "Treatment of subacute and chronic cough in adults".)

An approach to the diagnosis and management of chronic cough in children is presented here, preceded by a brief overview of the epidemiology, physiology, and pathophysiology. Approaches to wheezing and stridor in children are presented separately, although these symptoms may present concurrently. (See "Evaluation of wheezing in infants and children" and "Assessment of stridor in children".)


Chronic cough — Chronic cough in children 14 years and younger usually is defined as a daily cough lasting four or more weeks [8]. This definition is based upon expert consensus, as expressed in guidelines from the American College of Chest Physicians (ACCP) and Thoracic Society of Australia and New Zealand (TSANZ) [8]. The rationale is that most acute respiratory infections in children resolve within this interval [5], and that the presence of chronic cough impairs quality of life (QoL) [9] and may represent sinister underlying etiologies [10]. The four-week threshold was selected to permit relatively early diagnosis of serious underlying illness such as missed foreign body [11] and bronchiectasis [12] to prevent future respiratory morbidity. However, these guidelines also envision watchful waiting for certain patients with chronic cough when specific symptoms and/or signs (specific cough pointers) are absent [5].

The British Thoracic Society (BTS) utilizes a threshold of eight weeks duration [13], which is the threshold used to define chronic cough in adults [14]. However, the guideline also encourages individualized management by including the caveat that a "relentlessly progressive prolonged acute cough [>three weeks]…may warrant investigation before eight weeks" [13].


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Literature review current through: Jul 2017. | This topic last updated: Aug 09, 2017.
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