Cough Conundrums: A Guide to Chronic Cough in the Pediatric Patient

• According to grade 1 evidence, cough can be normal, but it is important to consider clues in either history or examination that can point to treatable causes. In most patients, cough is related to viral upper respiratory tract infection, and supportive measures alone will be sufficient. • According to grade 1 evidence, chest imaging should be obtained in the presence of nontraditional history or cough characteristics, lower respiratory tract symptoms, relentless progressive coughing, or hemoptysis. • According to grade 1 evidence, children with a history of cough with suspicion of foreign body should undergo urgent bronchoscopy. • According to grade 2 evidence, antihistamines and intranasal corticosteroids are helpful for allergic cough. • According to grade 1 evidence, over-the-counter cough suppressants are comparable to placebo and may have potential for adverse effects. According to grade 1 evidence, for children 14 years and younger with chronic cough without an underlying lung disease, treatment for gastroesophageal reflux disease should not be used when there are no clinical features of gastroesophageal reflux. According to grade 2 evidence, bronchodilators are not effective and should be avoided in nonasthmatic children. • According to grade 1 evidence, children should be removed from environmental tobacco smoke or pollutant exposure.