Chronic Cough in Children

Differentials

Common:

• Postviral: Up to 8 weeks

• Sinusitis: Rhinorrhoea, itchy eyes, sneezing

• Asthma/Wheeze: Night cough, wheeze, family hx

Others:

• Pertussis: Paroxysmal, post-tussive vomiting, sick contacts

• Foreign Body: Sudden onset, choking, absent during sleep

• Habit Cough: "Honking" (teens), "throat-clearing" (younger), absent during sleep

• PBB: Persistent wet cough, resolves with antibiotics

• Bronchiectasis: Recurrent wet cough, no antibiotic response

• Irritants: Smoke, reflux

History

• Duration (>4 weeks), nature (wet/dry, paroxysmal, night-time)

• Associated symptoms (fever, weight loss, poor feeding)

• Exposures (smoke, allergens, sick contacts), choking episode, vaccination status

• Family hx (asthma, CF), response to prior treatments

Management

• General: Treat underlying cause, avoid irritants, trial honey (>12 months), follow up 2–3 weeks

• PBB: Amoxicillin-clavulanate 3–4 weeks, reassess for resolution of wet cough

• Habit Cough: Distraction therapy, address stressors

• Persistent Symptoms:

  • Imaging: CXR (first-line)

  • Tests: Spirometry (if age-appropriate), nasopharyngeal swab (pertussis)

  • Bronchoscopy: Foreign body or inconclusive findings

When to Refer

• Poor weight gain, recurrent infections (e.g., CF)

• Cough with feeds (e.g., TOF, GORD)

• Clubbing, dyspnoea (e.g., bronchiectasis)

• PBB not resolving after antibiotics

• Habit cough >3 months or significant QoL impact

Notes

• Chronic cough: >4 weeks

• Postviral: Often resolves spontaneously by 8 weeks

• PBB: May require extended antibiotics (anaerobic involvement)

• Early bronchiectasis recognition prevents long-term damage