Chronic Cough: Evaluation and Management

Charlie Michaudet, MD; John Malaty, MD


Am Fam Physician. 2017;96(9):575-580. 

In This Article

Chronic Cough in Children

Chronic cough in children younger than 15 years is defined as cough lasting more than four weeks.[8] Chest radiography and spirometry should be considered initially in age-appropriate patients.[8] A watch-wait-review approach consisting of parental reassurance and observation for one to two weeks may be used in patients with a nonspecific cough.[8,42]

The most common causes of chronic cough in children six to 14 years of age are asthma, protracted bacterial bronchitis, and UACS.[4,6,42] Protracted bacterial bronchitis is characterized by isolated chronic cough, wet/moist cough, resolution of cough with antibiotic treatment, and absence of findings suggestive of an alternative cause. Treatment consists of a two-week course of an appropriate antibiotic, such as amoxicillin/clavulanate (Augmentin).[43,44]

UACS is rare in children younger than six years, and antihistamines and decongestants are not recommended.[44] GERD does not seem to be as common in children, and empiric proton pump inhibitors are not recommended in the absence of a specific diagnosis.[8] Exposure to tobacco smoke, pets, and environmental irritants should be minimized. Pertussis can be considered but is usually associated with other symptoms, such as a "whoop" sound, apnea, low-grade fever, or vomiting. Less common causes, such as foreign body aspiration, congenital conditions, cystic fibrosis, and immune disorders, should also be considered.