Clinical Review

Childhood cough

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1177 (Published 06 March 2012) Cite this as: BMJ 2012;344:e1177
  1. Malcolm Brodlie, academic clinical lecturer in paediatrics12,
  2. Chris Graham, general practitioner registrar3,
  3. Michael C McKean, consultant respiratory paediatrician2
  1. 1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2Department of Paediatric Respiratory Medicine, Great North Children’s Hospital, Newcastle upon Tyne, UK
  3. 3Northumbria Vocational Training Scheme, Postgraduate School of Primary Care, Northern Deanery, Newcastle upon Tyne, UK, UK
  1. Correspondence to: M Brodlie, Old Children’s Outpatients Department, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK malcolm.brodlie{at}ncl.ac.uk
  • Accepted 7 February 2012

Summary points

  • Acute cough usually resolves within three to four weeks, whereas chronic cough persists for longer than eight weeks

  • Most cases of acute cough in otherwise normal children are associated with a self limiting viral infection of the upper respiratory tract

  • Cough is a non-specific symptom, and in children the differential diagnosis is wide; however, careful systematic clinical evaluation will usually lead to an accurate diagnosis

  • It is crucial to hear the cough because parents’ reports of the nature, frequency, and duration of coughing are often unreliable

  • Isolated cough without wheeze or breathlessness is rarely caused by asthma

  • Adult cough algorithms are not useful when assessing children

Children often present with cough,w1 and over the counter cough remedies are among the most common drugs given to children, despite lack of evidence to support their use.1 Questionnaire based surveys of parents suggest that the prevalence of persistent cough in the absence of wheeze in children is high and ranges from 5% to 10% at any one time.2 Cough is an important physiological protective reflex that clears airways of secretions or aspirated material. As a symptom it is non-specific, and many of the potential causes in children are different from those in adults.3

Sources and selection criteria

We based this review on British Thoracic Society guidelines published in 2008. We also consulted an evidence based review of the management of chronic non-specific cough in childhood, Cochrane reviews, and our personal archive of references. Clinical guidelines have also been published in America and Australia in recent years. All published guidelines agree on the current lack of good quality evidence on which to make evidence based statements for the diagnosis, investigation, and treatment of cough in children.

Chronic cough in a child may generate parental anxiety and disrupt other family members’ sleep.4 Lessons at …

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