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Chronic Cough in Children

 

This guideline applies to children under the age of 16 years.  For adults aged 16 and over please refer to Chronic non-productive cough

 

Introduction

  • Chronic cough is defined as any cough lasting more than 4 weeks in a child.
  • Triggers include viral infections, exposure to cigarette smoke and environmental pollutants
  • Causes of coughs in children are different to adult causes therefore management is likely to differ. 

 

In scope   

  • Cough in children lasting more than 4 weeks

 

Not in scope    

  

Red Flag Features

  • systemic features (such as weight loss; night sweats; persistent fever; clubbing)
  • poor weight gain
  • haemoptysis
  • neonatal onset
  • cough with feeding/affecting feeding   

 

Investigations required prior to referral

Most cases of chronic cough do not require investigation in the absence of any red flags and can be managed in primary care.

 

Management optimisation

  • Establish if this is a recurrent cough or chronic cough (continuous cough for more than 4 weeks)?
  • Is this a post viral cough?
  • Parental smoking cessationis effective in improving respiratory symptoms in children.

 

Recurrent Cough

  • Viral infections are the most common cause of a cough in a well child.
  • Recurrent coughs are common and can occur 7-10 times per year in school age children.
  • In most case of recurrent coughs, reassure parents/carers that no investigation is required in the absence of growth/weight gain problems or systemic signs and symptoms.

 

Chronic Cough

Manage according to cause, common causes of chronic cough include:

Post viral cough

  • In infants, post-bronchiolitic cough can persist for up to a month
  • In school age children, cough associated with viral upper/lower respiratory tract infections mostly improve by 14 days (although it may sometimes take up to 8 weeks).

 

Persistent bacterial bronchitis (PBB)

  • A continuous chronic wet / productive cough (>4 weeks) without any signs / symptoms suggestive of other causes of wet / productive cough that resolves with 2 to 4 weeks of antibiotics
  • Almost exclusive to children between 1 to 6 years age
  • Usually improves temporarily with antibiotics. 
  • Obtain sputum culture before antibiotics if possible.
  • A trial of 2 weeks Co-amoxiclavis advised if PBB suspected.  If allergic to Penicillin use Clarithromycin
  • Consider a CXR if cough persists despite antibiotics. 
  • Do not prescribe repeated courses of antibiotics for PBB, refer if concern of recurrence of PBB (can be a precursor to bronchiectasis)

 

Asthma

 

Inhaled foreign body

  • Suggestive history and a sudden-onset cough in otherwise healthy pre-school child
  • Examination may reveal persistent focal signs

 

Gastro-oesophageal reflux disease (GORD)

  • Suggestive history of reflux- see GORD page
  • Do not routinely offer anti-acid therapy for chronic cough with no other features of GORD

 

Postnasal drip (PND)

 

Habit cough (somatic cough syndrome)

  • A diagnosis of exclusion.  Typically, the child can be distracted. 

 

Rare causes:  cystic fibrosis, tuberculosis or immune deficiency.

 

Advice and Guidance

Please send advice and guidance to Paediatrics via eRS. 

 

Referral

Emergency and red flags

  • In the event of a suspected inhaled foreign body, to attend ED

 

Refer to on-call Paediatrician: if cough present more than 4 weeks AND one or more of: 

  • systemic features (such as weight loss; night sweats; persistent fever; clubbing)
  • poor weight gain
  • haemoptysis
  • neonatal onset
  • cough with feeding/affecting feeding  

 

Routine Referral

  • GORD, Asthma, PBB- refer to Paediatrics
  • Post Nasal Drip- refer to ENT

 

Supporting Information

For professionals

 

For patients         

 

References                

  • GIRFT

 

Page Review Information

 Review date

25 November 2025

Next review date

25 November 2027

Clinical editor

Dr Melanie Schick

Contributors

Dr Chris Williams, Consultant Paediatrician RCHT