cough history taking pediatrics

What relieves the cough? Thus, adults with chronic cough now have a firm physical explanation for their symptoms … For example, if allergic sinusitis is suspected and treated with an antihistamine that does not alleviate symptoms, a head CT may be necessary for further evaluation. Management of cough in children The goal should always be to identify an underlying cause of cough in children. Review of systems should note symptoms of possible causes, including abdominal pain (some bacterial pneumonias), weight loss or poor weight gain and foul-smelling stools (cystic fibrosis), and muscle soreness (possible association with viral illness or atypical pneumonia but usually not with bacterial pneumonia). Some of these receptors are mechanosensitive and some are chemosensitive. Lung examination focuses on presence of stridor, wheezing, crackles, rhonchi, decreased breath sounds, and signs of consolidation (eg, egophony, E to A change, dullness to percussion). Is there evidence of fevers, failure to thrive or weight loss? Little evidence exists to support the use of cough suppressants and mucolytic agents. Coughing at the beginning of sleep and in the morning with waking usually indicates sinusitis; coughing in the middle of the night is more consistent with asthma. Chapter 24. Ensure you initially keep a comfortable distance, establishing eye contact and rapportwith the family. Laryngotracheobronchitis – barking cough, Paroxymal – pertussis and para-pertussis, Acute upper / lower respiratory tract infection (ARI), Inhalation injury (acute exposure to smoke or volatile substances), Interstitial lung disease (i.e. This site complies with the HONcode standard for trustworthy health information:   Is there any shortness of breath (dyspnea)? Not only does it cause discomfort for the child, cough also elicits stress and sleepless nights for their parents. Treatment. History of Presenting Complaint. Useful if suspicion for foreign body is high. Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data Danny Rivera Pediatric Cough Shadow Health Assessment Subjective Data ), For acute cough, the most common cause is, For chronic cough, the most common causes are. History taking should establish the severity and time course of the cough. , MD, Sidney Kimmel Medical College of Thomas Jefferson University. For example, antibiotics should be given for bacterial pneumonia; bronchodilators and anti-inflammatory drugs should be given for asthma. verify here. Is there increased work of breathing? He had been wheezing off and on for the past month and had visited the emergency department on one occasion. Past medical history should cover recent respiratory infections, repeated pneumonias, history of known allergies or asthma, risk factors for TB (eg, exposure to a person who has known or suspected TB infection, exposure to prisons, HIV infection, travel to or immigration from countries that have endemic infection), and exposure to respiratory irritants. A 6-month-old boy with 1-week history of dry cough that worsened at night. Abdominal examination should focus on presence of abdominal pain, especially in the upper quadrants (indicating possible left or right lower lobe pneumonia). • When do you cough? Merck & Co., Inc., Kenilworth, NJ, USA is a global healthcare leader working to help the world be well. The aetiology of coughing in children will cover a wide spectrum of respiratory disorders, … Symptoms are typically reported by a parent or guardian, who may not be able to accurately transmit the information from the child to … Are there adventitious sounds? Describe its location and quality (crackles, crepitations, wheeze). Chemoreceptors are sensitive to acid, heat, and capsaicin derivatives through the activation of type 1 vanilloid receptor (TRPV1) and are located mainly in the distal airways. CASE 1 | HISTORY. Is the child passively or actively exposed to smoke from tobacco, marijuana, cocaine, or wood-burning stove? Figure 1 – Cough reflex anatomy: Red dots represent the locations of the cough receptors. During the physical examination, you should pay attention to the following signs: Growth parameters – signs of poor growth and/or failure to thrive. 2010 Jan; 188 Suppl 1:S33-40. Causes of cough differ depending on whether the symptoms are acute ( < 4 weeks) or chronic (> 4 weeks). Auscultate: is air entry symmetric? The concept of cough hypersensitivity has allowed an umbrella term that explains the exquisite sensitivity of patients to external stimuli such a cold air, perfumes, smoke and bleach. The Merck Manual was first published in 1899 as a service to the community. Signs of respiratory distress (eg, nasal flaring, intercostal retractions, cyanosis, grunting, stridor, marked anxiety) should be noted. These guidelines incorporate the recent advances in chronic cough pathophysiology, diagnosis and treatment. Coughing is an important mechanism for clearing secretions from the airways and can assist in recovery from respiratory infections. Inspect chest wall for signs of hyperinflation and deformities. What type of exposure triggers the cough? We do not control or have responsibility for the content of any third-party site. Children with stridor, drooling, fever, and marked anxiety need to be evaluated for epiglottitis, typically in the operating room by an ear, nose, and throat specialist prepared to immediately place an endotracheal or tracheostomy tube. Relevant past medical history: Asthma, atopy, drug allergies (always), currently taking or recently run out of any medications, exposure to TB or other infectious diseases? Should you wish to … Special features including diurnal variability, fever, colds, relation with meals and possible foreign body aspiration, habitual vomiting, production of sputum, risk of contact with tuberculosis or HIV, smoking behaviour of parents, possible allergies, and vaccination status, should be sought. Some of these symptoms are ubiquitous (eg, runny nose, sore throat, fever); others may suggest a specific cause: headache, itchy eyes, and sore throat (postnasal drip); wheezing and cough with exertion (asthma); night sweats (tuberculosis [TB]); and spitting up, irritability, or arching of the back after feedings in infants (gastroesophageal reflux). Introduce yourself, identify your patient and gain consent to speak with them. Infants may have a history of antecedent upper respiratory symptoms. Moist cough Suggestive of LRTI, COPD exacerbation or bronchiectasis; Dry Cough Suggestive of viral illness, asthma, GI reflux, restrictive lung disease or ACE inhibitors; Long paroxysms of ‘whooping’ Suggestive of pertussis (whooping cough) Sputum If the patient is infant, ask about perinatal history (caesarean section, twins, asphyxia, maternal infection like fever or UTI at birth, prematurity and birth weight). Mechanoreceptors are sensitive to touch or displacement and are located mainly in the proximal airway such as larynx and trachea. The pharynx should be checked for postnasal drip. Head and neck examination should focus on presence and amount of nasal discharge and the condition of the nasal turbinates (pale, boggy, or inflamed). Approach to Syncope: Is it Cardiac or Not? URI-like prodrome, stridor, barky cough, high fever, respiratory distress, toxic appearance, purulent secretions, Rhinorrhea, tachypnea, wheezing, crackles, retractions, nasal flaring, possible posttussive emesis, In infants up to 24 months; most common among those 3–6 months, Sometimes nasal swab for rapid viral antigen assays or viral culture, URI-like prodrome, barky cough (worsening at night), stridor, nasal flaring, retractions, tachypnea, Sometimes anteroposterior and lateral neck x-rays, Exposure to tobacco smoke, perfume, or ambient pollutants, Abrupt onset, high fever, irritability, marked anxiety, stridor, respiratory distress, drooling, toxic appearance, If patient is stable and clinical suspicion is low, lateral neck x-ray, Otherwise, examination in operating room with direct laryngoscopy, Chest x-ray (inspiratory and expiratory views), Viral: URI prodrome, fever, wheezing, staccato-like or paroxysmal cough, possible muscle soreness or pleuritic chest pain, Possible increased work of breathing, diffuse crackles, rhonchi, or wheezing, Bacterial: Fever, ill appearance, chest pain, shortness of breath, possible stomach pain or vomiting, Signs of focal consolidation including localized crackles, rhonchi, decreased breath sounds, egophony, and dullness to percussion, Coughing at the beginning of sleep or in the morning with waking, Sometimes nasal discharge, congestion; pain on either side of the nose; pain in the forehead, upper jaw, teeth, or between the eyes; headache and sore throat, Rhinorrhea, red swollen nasal mucosa, possible fever and sore throat, shotty cervical adenopathy (many small nontender nodes), Tracheomalacia: Congenital stridor or barky cough, possible respiratory distress, TEF: History of polyhydramnios (if accompanied by esophageal atresia), cough or respiratory distress with feeding, recurrent pneumonia, Tracheomalacia: Airway fluoroscopy and/or bronchoscopy, TEF: Attempt passage of a catheter into the stomach (helps in diagnosis of TEF with esophageal atresia), Contrast swallowing study, including esophagography, Intermittent episodes of cough with exercise, allergens, weather changes, or URIs, Atypical pneumonia (mycoplasma, Chlamydia), Possible ear pain, rhinitis, and sore throat, Birth defects of the lungs (eg, congenital adenomatoid malformation), Several episodes of pneumonia in the same part of the lungs, History of meconium ileus, recurrent pneumonia or wheezing, failure to thrive, foul-smelling stools, clubbing or cyanosis of nail beds, Molecular diagnosis with direct mutation analysis, History of acute onset of cough and choking followed by a period of persistent cough, Presence of small objects or toys near child, Infants and toddlers: History of spitting up after feedings, irritability with feeding, stiffening and arching of the back (Sandifer syndrome), failure to thrive, recurrent wheezing or pneumonia (see Gastroesophageal Reflux in Infants), Older children and adolescents: Chest pain or heartburn after meals and lying down, nighttime cough, wheezing, hoarseness, halitosis, water brash, nausea, abdominal pain, regurgitation (see Gastroesophageal Reflux Disease), Sometimes upper gastrointestinal study for determination of anatomy, Trial of H2 blockers or a proton pump inhibitor, Possible esophageal pH or impedance probe study, Trial of H2 blockers or proton pump inhibitors, 1–2 weeks catarrhal phase of mild URI symptoms, progression to paroxysmal cough, difficulty eating, apneic episodes in infants, inspiratory whoop in older children, posttussive emesis, Intranasal specimen for bacterial culture and polymerase chain reaction testing, Headache, itchy eyes, sore throat, pale nasal turbinates, cobblestoning of posterior oropharynx, history of allergies, nighttime cough, Trial of antihistamine and/or intranasal corticosteroids, Possible trial of a leukotriene inhibitor, History of respiratory infection followed by a persistent, staccato cough, History of repeated upper (otitis media, sinusitis) and lower (pneumonia) respiratory tract infections, Microscopic examination of living tissue (typically from sinus or airway mucosa) for cilia abnormalities, Persistent barky cough, possibly prominent during classes and absent during play and at night, Sometimes fever, chills, night sweats, lymphadenopathy, weight loss, Sputum culture (or morning gastric aspirate culture for children < 5 years), Interferon-gamma release assay (especially if there is a history of bacille Calmette-Guérin [BCG] vaccination). Bronchodilators)? Examine for edema, cyanosis, clubbing of fingers/toes, and skin lesions. History Taking for USMLE Step 2 CS, A Simplified Approach.mp4 - Duration: 20:17. J Pediatr. Ask about the age/duration of onset (congenital cause). • Do you bring anything up? Cough is a reflex response to airway irritation. Is there a family history of atopy (eczema, allergies, asthma), cystic fibrosis, and/or primary ciliary dyskinesia? Nighttime cough can indicate postnasal drip or asthma. 7. Treatment of cough is management of the underlying disorder. It focuses on common pediatric problems, including the most pertinent topics in child healthcare with regard to both acute and chronic complaints, offering more than 30 “history stations,” each station followed by key points underpinning important points in the history. Failure to thrive or weight loss can occur with TB or cystic fibrosis. Examination of extremities should note clubbing or cyanosis of nail beds (cystic fibrosis). Paediatric history taking- Introduction Obtaining an accurate history is the critical first step in determining the etiology of a patient's problem A large percentage of the time, you will actually be able to make a diagnosis based on the history alone The value of the history will depend on your ability to elicit relevant information Children with repeated episodes of pneumonia, poor growth, or foul-smelling stools should have a chest x-ray and sweat testing for cystic fibrosis. 7. 2010 Mar; 156 (3): 352-8. Not only does it cause discomfort for the child, cough also elicits stress and sleepless nights for their parents. Children with red flag findings should have pulse oximetry and chest x-ray. Vital signs, including respiratory rate, temperature, and oxygen saturation, should be noted. The first step in the treatment of acute cough is to determine if the cause of the cough is one of these serious conditions or an acute upper respiratory infection (i.e., common cold), lower respiratory tract infection, or an exacerbation of a pr… (modified from Chung KF, Pavord ID. Prevalence, pathogenesis, and causes of chronic cough. Lancet. Apr 19 2008;371(9621):1364-74). Each cough is elicited by the stimulation of the cough reflex arc. Chest radiograph can provide you with additional information, such as infiltrations/ consolidations, hyperinflation, peribronchial thickening, hyperinflation, atelectasis and chronic lung changes. Each symptom and review each system to localize the source of the more common symptoms of children medical! Necessary to rule-in and rule-out cardiac pathology bring cough history taking pediatrics children to a third-party website medication... Recent advances in chronic cough in pediatrics: ACCP evidence-based clinical practice guidelines indication! 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