acute cough differential diagnosis pediatrics

(See table Some Causes of Cough in Children. For children 6 months to 6 years, the parents should be asked about potential for foreign body aspiration, including older siblings or visitors with small toys, access to small objects, and consumption of small, smooth foods (eg, peanuts, grapes). Apr 19 2008;371(9621):1364-74). Rheumatic diseases). Diagnosis and management of cough: ACCP evidence-based clinical practice guidelines. 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. Listeners will learn to identify clinical features, develop a differential diagnosis, and appropriately investigate and acutely manage patients in respiratory distress. Acute cough is one of the most common complaints prompting patient visits to healthcare professionals. Is there increased work of breathing? Suspected Gastroesophageal reflux disorder unsuccessfully treated with an H2 blocker and/or proton pump inhibitor may require evaluation with a pH or impedance probe study or endoscopy. Chest radiograph can provide you with additional information, such as infiltrations/ consolidations, hyperinflation, peribronchial thickening, hyperinflation, atelectasis and chronic lung changes. 2009, 5: 11-10.1186/1745-9974-5-11. Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. Acute fever is infectious in most cases, and, of these, most are viral. Examine for nasal polyps and other nasal passage obstruction. At least 90% of children with cough have a respiratory tract infection such as a cold, croup, bronchitis, bronchiolitis, whooping cough, or pneumonia. Miles Weinberger, M.D., and Anthony Fischer, M.D., Ph.D. ABSTRACT. The differential diagnosis of children with frequent respiratory infection and wheezing should include Foreign body … Acute Sinusitis. Differential diagnosis of chronic cough in children. The pain is described as sharp, 4/10 in severity, located on the left side of her throat, and worsened with swallowing. Each cough is elicited by the stimulation of the cough reflex arc. Cough has a high frequency in pediatrics; it tends to persist, to ... SL, Winther B: Acute cough: a diagnostic and therapeutic challenge. Examine for edema, cyanosis, clubbing of fingers/toes, and skin lesions. We do not control or have responsibility for the content of any third-party site. Cough is a common indication of respiratory illness and is one of the more common symptoms of children seeking medical attention. 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The cough was non-productive but he said he would cough up clear mucous that was just like his rhinorrhea. Despite the broad repercussions of acute cough on patient quality of life, school and work productivity, and public health resources, research on this condition is minimal, as are the available treatment options. The differential diagnosis of acute and sub acute cough is wide ranging and includes a plethora of diseases. Head and neck examination should focus on presence and amount of nasal discharge and the condition of the nasal turbinates (pale, boggy, or inflamed). A cough is a forceful expulsion of air from the lungs that helps to clear secretions, foreign bodies, and irritants from the airway. the expiratory organs to produce cough (see Figure 1). Grad R. Chronic cough in children. For example, if allergic sinusitis is suspected and treated with an antihistamine that does not alleviate symptoms, a head CT may be necessary for further evaluation. It may be classified as acute (< 3 weeks), subacute (3–8 weeks), or chronic (> 8 weeks), as well as productive (with The disease is often called acute subglottic laryngitis (ASL). Cough receptors, which are afferent endings of the vagus nerve (cranial nerve X), are scattered in the airway mucosa and submucosa. Article … Chang AB. Children with TB risk factors or weight loss should have a chest x-ray and purified protein derivative (PPD) testing. Figure 1 – Cough reflex anatomy: Red dots represent the locations of the cough receptors. Efferent impulses are generated from the cough centre and are propagated via the spinal motor (to expiratory muscles), phrenic (to the diaphragm), and vagus (to the larynx, trachea, and bronchi) nerves to the expiratory organs to produce cough (see Figure 1). They are helpful indicators to guide your differential diagnosis. Inspect chest wall for signs of hyperinflation and deformities. 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. Before we dive into the clinical approach to cough, let us review the respiratory physiology of cough. Goldsobel AB, Chipps BE. 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. Has the child been on medication before (ex. 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) Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Obtain a chest x-ray if patients have red flag findings or chronic cough. 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). ), For acute cough, the most common cause is, For chronic cough, the most common causes are. The most common cause of an acute or subacute cough is a viral respiratory tract infection. A paroxysmal cough is characteristic of pertussis or certain viral pneumonias (adenovirus). What pets or animals did the child have contact with? Treatment. Differential diagnosis. Antitussives and expectorants lack proof of effect in most cases. Children with red flag findings should have pulse oximetry and chest x-ray. 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. Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. History and examination are adequate to make a diagnosis in children > 36 months who are otherwise well and not toxic-appearing. The receptor locations are represented by red dots in Figure 1. The CPM provides best-practice recommendations for differential diagnosis and management of acute cough and bronchitis. Chang AB, Glomb WB. A high index of suspicion for foreign body aspiration is needed if children are age 6 months to 6 years. Learn more about our commitment to Global Medical Knowledge. Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections. The physician should ask about associated symptoms. 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 Symptoms are short-lived, usually lasting 3 to 7 days. The peak incidence of cough in January and February is eight times higher than … The trusted provider of medical information since 1899, Nausea and Vomiting in Infants and Children, Obsessive-Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents, Adolescent patients who have obsessive-compulsive disorder (OCD) are most likely to also have which of the following, Last full review/revision Jun 2020| Content last modified Jun 2020, © 2020 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA), © 2021 Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA, Musculoskeletal and Connective Tissue Disorders. Duration: acute (< 2 weeks), subacute (2-4 weeks), chronic (> 4 weeks) Quality: moist/wet/productive vs. dry Ask about the age/duration of onset (congenital cause). Is there associated vomiting (post-tussive emesis)? 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. , MD, Sidney Kimmel Medical College of Thomas Jefferson University. a. a While cough due to many conditions such as asthma and aspiration will be discussed in the chronic category, these conditions can present acutely and subacutely. In <5% of cases, symptoms may last longer than five nights and <5% of children experience more than one episode. As a rule, acute bronchitis is easy to diagnose and does not require any far-reaching considerations with regard to differential diagnoses. Cough is one of the most common complaints for which parents bring their children to a health care practitioner. 58(8):1795-802, 805-6. . Treatment of cough is management of the underlying disorder. Am Fam Physician. Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted. 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