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


Cough is a common presenting complaint in primary care pediatrics. Following the maxim "think horses not zebras," it would have been logical for the nurse practitioner to have attributed this mother's concern about her child's cough to common etiologies, such as allergic rhinitis. The visit could have focused on reminding the mother that OTC cough medications are no longer recommended for young children and that giving siblings each other's medication is not advised. However, the child's unequal breath sounds, her unusual voice quality, a negative review of systems for other causes of chronic cough, maternal concern, and the child's previous episode of having ingested a foreign object prompted the nurse practitioner to order the chest radiograph at the initial clinic visit. An undiagnosed vascular ring was never considered in the differential diagnosis at the time of the initial office visit! The child's husky voice quality has persisted, but the cough and circumoral cyanosis resolved after the DAA was corrected.