An Uncommon Cause for a Preschool Child's Chronic Cough

Beverly P. Giordano, MS, RN, CPNP, PMHS; Sanjeev Y. Tuli, MD; Sonal S. Tuli, MD; Karin Reuter-Rice, PhD, CPNP-AC, FCCM; Terea Giannetta, DNP, RN, CPNP


J Pediatr Health Care. 2014;28(3):267-271. 

In This Article

Physical Examination

The child actively explored the examination room during the visit, but she did not cough. She weighed 15.3 kg (86th percentile), her height was 91 cm (40th percentile), and her body mass index was 18.54 kg/m2. Her vital signs were as follows: temperature, 36.7°C; heart rate, 101 beats per minute; respiratory rate, 22 breaths per minute; blood pressure, 77/60 mm Hg; and oxygen saturation, 95% on room air. Findings of the examination of her head, eyes, ears, and nose were unremarkable. Her oropharynx examination revealed faint circumoral cyanosis but pink mucosa, a pink tongue, and a pharynx without tonsils. Her trachea was midline, and her neck was supple without masses or lymphadenopathy. Her skin was warm and dry. Nail beds were pink and normally shaped. Her voice quality was raspy, and the pitch was deeper than expected for age. Her chest was symmetrical with equal rise upon breathing. She had slightly diminished breath sounds in the left lung, but no wheezing, stridor, rhonchi, crackles, or retractions were appreciated. She had prominent upper airway inspiratory noise, similar to that heard in persons with laryngomalacia. Findings of cardiovascular and abdominal examinations were unremarkable. She had scattered red macules and papules in the diaper area. Findings of her neurologic examination were normal for her age.