Cough In Children

Cough is initially a reflex that helps rid the airways of secretions and respiratory protection against aspiration of foreign bodies. but it can also be a symptom of a disease. Cough is one of the most common complaints that lead to physician visits in children. Etiology The causes of cough differ depending on the symptoms acute (<4 weeks) or chronic (> 8 weeks) may occur (see table: Some causes of cough in children) The most common cause of acute cough, viral infection of the upper respiratory tract The most common causes of chronic cough are: asthma (most common) Gastroesophageal reflux disease postnasal-drip syndrome Foreign body aspiration and diseases such as cystic fibrosis and primary ciliary dyskinesia are less common, although they can all lead to a persistent cough. Some causes of cough in children due suspects findings Diagnostic approach acute therapy bacterial tracheitis (rare) cold-like symptoms, stridor, barking cough, high fever, difficulty breathing, poisoning, purulent secretions anteroposterior and lateral radiographs of the neck may bronchoscopy bronchiolitis rhinorrhea, tachypnea, wheezing, crackling recoveries, expanses of Nasenl Öcher, possibly Post-tussive vomiting, paroxysmal cough in infants up to 24 months; most clinical in infants 3-6 months Review Sometimes chest x-ray Sometimes nasal swab for rapid viral antigen assay or viral culture Krupp cold-like symptoms, barking cough (deterioration at night), wheezing, fluttering of nostrils, retractions, tachypnea Clinical evaluation Sometimes anteroposterior and lateral radiographs the neck environmental lung damaging pollutants exposure to tobacco smoke, perfume, or other pollutants from the air Clinical evaluation Epiglottitis (rare) Abrupt beginning, high fever, irritability, recognizable panic, wheezing, shortness of breath, salivation, poisoning If the patient is stable, and a clinical suspicion can be excluded lateral radiograph of the neck Otherwise examination using direct laryngoscopy in the operating room foreign body sudden coughing and / or choking First, no fever No cold-like symptoms chest x-ray (inspiratory and expiratory) Possibly Bronchoscopy pneumonia (viral, bacterial) Viral: URI prodrome, fever, wheezing, staccato-like or paroxysmal cough, possible muscle pain or pleural chest pain Possible increased work of breathing, diffuse rales, wheezing or wheezing Bacterial: fever, poor appearance, chest pains, possible stomach pain or vomiting signs of focal consolidation, including localized crackles, wheezing, decreased breath sounds, Egophonie and dullness to percussion chest radiograph sinusitis cough at the beginning of sleep or in the morning with waking up sometimes nasal discharge, congestion; Pain on both sides of the nose; Pain in the forehead, in the upper jaw, the teeth or between the eyes; Headache and sore throat Clinical examination Occasionally CT infection of the upper respiratory tract rhinorrhea, red swollen nasal mucosa, possibly fever and sore throat, shotty cervical lymphadenopathy (many small non-painful lumps) Clinical evaluation Chronic * respiratory lesions (tracheomalacia, Tracheoösophagealfistel) tracheomalacia: congenital stridor or barking cough, dyspnea possible Tracheoösophagealfistel: history of polyhydramnios (if accompanied by esophageal atresia), coughing or shortness of breath at the F SHAKE, recurrent pneumonia tracheomalacia: Atemwegsfluoroskopie and / or bronchoscopy Tracheoösophagealfistel: attempt to place a catheter into the stomach (helps in diagnosing Tracheoösophagealfistel with esophageal atresia) chest X-ray contrast swallow study, including Ösophagographie bronchoscopy and endoscopy asthma Intermittent episodes of cough in motion , allergens, weather changes or cold symptoms Nocturnal cough incidence of asthma in the family history of eczema or hay fever Clinical evaluation experiment with drugs against asthma lung function tests Atypical pneumonia (My koplasmen, Chlamydia) Gradual onset of the disease headache, malaise, muscle pain may earaches, colds and sore throats may wheezing and creaking Persistent cough staccato-like chest radiograph PCR assays birth defects of the lung (eg. B. congenital adenomatoid malformation) Several episodes of pneumonia in the same part of the lungs chest x-ray Sometimes CT or MRI Cystic Fibrosis meconium ileus, recurrent pneumonia or wheezing, failure to thrive, foul-smelling stools, clubbing or cyanosis of the nail beds in prehistory sweat chloride test Molecular diagnostics direct mutation analysis debris Acute onset of coughing and choking, followed by a period of persistent cough in the history of fever development possible No cold-like symptoms Small objects or toys in sewing the child’s chest x-ray e (inspiratory and expiratory) bronchoscopy Gastroesophageal Reflux infants and young children: Spit after feeding, irritability in animal feeding, and stiffening curvature of the back (Sandifer syndrome), failure to thrive, recurrent wheezing or pneumonia (s. Gastroösophogealer reflux in infants) Older children and adolescents. Chest pain or heartburn after eating and lying down, night coughing, wheezing, hoarseness, bad breath, increased salivation, nausea, abdominal pain, regurgitation (s Gastroösophogealer reflux in infants) Infants: Clinical Sometimes evaluation study of the upper gastrointestinal tract to determine the anatomy experiment with H2Blockern or a proton pump inhibitor Possible pH test of the esophagus or impedance probe study Older children: Clinical evaluation test with proton pump inhibitors if necessary H2Blockern or Endoscopy pertussis or parapertussis Catarrhal phase 1-2 weeks Intranasal with mild symptoms of an infection of the upper respiratory tract, progression to paroxysmal cough, difficulty eating, apneic episodes in infants, inspiratory whooping cough in older children and Post-tussive vomiting sample for bacterial culture and PCR hay fever with postnasalem dribble headaches, itchy eyes, sore throat, pale turbinates, cobblestoning the posterior oropharynx, history of allergy, and nocturnal cough test with antihistamine and / or intranasal steroids Possible trial of a leukotriene Inhib itors infection of the lower respiratory tract history of a respiratory infection, followed by a sustained staccato cough Clinical evaluation Primary ciliary dyskinesia history of repeated infections of the upper (otitis, sinusitis) and lower (pneumonia) respiratory chest X-ray radiograph of the sine or CT chest CT Microscopic examination of live tissue (usually from the sinus or respiratory mucosa) on cilia abnormalities psychogenic cough Persistent barking Huste n, possibly prominent v. a. disappeared during class and at play and at night Neither fever are other symptoms Clinical evaluation of tuberculosis (TB) history or risk of exposure immunodeficiency Sometimes fever, chills, night sweats, lymphadenopathy, weight loss p-Phenlyldiamin sputum culture (or gastric Aspiratkultur morning in children <5 years) interferon-gamma release assay (especially if there is a history of BCG vaccination) chest x-ray * All patients need a chest x-ray when they come for the first time with chronic cough in the treatment. TEF = tracheoesophageal fistula. Clarification History The history of the current disease should duration and quality of coughing (barking, staccato, paroxysmal) and the type of occurrence include (sudden or indolent). The doctor should ask about the associated symptoms. Some of these symptoms are universal (eg, runny nose, sore throat, fever.); others may point to a specific cause: headache, itchy eyes and sore throat (postnasal drip); Wheezing and cough with exertion (asthma); Night sweats (TB); and spitting, irritability or curvature of the spine after feeding in infants (gastroesophageal reflux). In children aged 6 months to 6 years, the doctor should ask the parents whether a possibility of foreign body aspiration is, even after older siblings and visitors with small toys, access to small objects or eating small, smooth foods (such. B . peanuts, grapes). A review of organ systems should be documented symptoms possible causes, including abdominal pain (some bacterial pneumonias), weight loss or failure to thrive and foul-smelling stools (cystic fibrosis) and muscle pain (possible association with viral disease, or atypical pneumonia, but usually not with a bacterial pneumonia). In the history of history, information on recent respiratory infections, repeated pneumonia, known allergies or asthma, risk factors for tuberculosis (z. B. exposure to a diseased with tuberculosis person, exposure to prisons, HIV infection, travel to countries or immigration from countries that are endemic), and added exposure to irritants werden.Körperliche investigation vital signs, including breathing rate, temperature and oxygen saturation are documented. Signs of respiratory distress (eg. As nostrils, pleura-recoveries, cyanosis, grunting, stridor, recognizable fear) must be observed. A study of head and neck should be based on the presence and amount of nasal discharge and the state of the turbinates (pale, thickened or inflamed) focus. The throat should be checked for nasal secretions. The areas of the cervical spine and upper clavicle are examined and palpated on lymphadenopathy out. The examination of the lungs is focused on the presence of stridor, wheeze, rattles, wheezing, decreased breath sounds and signs of consolidation (z. B. perkutatorische attenuation change from E to A, dull sound when tapping). The abdominal examination focuses on the presence of abdominal pain, especially in the upper quadrant (indicating a left- or right-sided pneumonia). In an examination of the extremities on clubbing or cyanosis of the nail beds (cystic fibrosis) should be taken. Warnings The following findings are of particular importance: cyanosis or hypoxia on pulse oximetry wheezing breathlessness poisoning Abnormal lung examination interpretation of the findings Clinical findings often suggest a specific cause (see Table: Some causes of cough in children); particularly useful is the distinction between acute and chronic cough, although it is important to note that many diseases that cause chronic cough, begin acutely and may present the patient before four weeks have passed. Other features of the cough are important, but less specific. Barking cough indicates Krupp or tracheitis, but he can also psychogenic cough or a persistent cough after an infection of the lower respiratory tract be characteristic A staccato-like cough may be a sign of a viral or atypical pneumonia. A paroxysmal cough characteristic of pertussis or certain viral pneumonias (adenovirus). Failure to thrive or weight loss may occur in connection with tuberculosis or cystic fibrosis. Night cough may indicate postnasal-drip syndrome or asthma. Cough falling asleep and waking up in the morning indicates sinusitis; Cough in the middle of the night rather indicates asthma. In young children with sudden cough without fever or cold symptoms of suspected foreign body aspiration is obvious. Testing children with serious findings should get a pulse oximetry and a chest radiograph. All children with chronic cough need a chest x-ray. Children with stridor, drooling, fever and recognizable afraid to be tested for epiglottitis to place usually in the operating room by an ENT doctor who is immediately ready for an endotracheal tube. If a foreign body is suspected, a (expiratory) chest X-ray should be performed. In children with tuberculosis risk factors or weight loss, a chest radiograph and a PPD test for tuberculosis should be carried out. Children with repeated episodes of pneumonia, failure to thrive or malodorous chairs, a chest radiograph and a sweat test should be made on cystic fibrosis. Acute cough in children with cold symptoms and no serious findings is usually caused by a viral infection. In this case, special tests are displayed rare. Many other children without serious findings have a diagnosis by history and physical examination. Tests are not necessary in such cases. However, if an empirical treatment was not successful, testing may be required. If z. B. Suspicion of allergic sinusitis is and is treated with an antihistamine which does not improve the symptoms, a CT scan of the head may be useful for further evaluation. If unsuccessfully treated for suspected gastroesophageal reflux disease with an H2 blocker and / or proton pump inhibitor, the evaluation may require pH or impedance probe study or endoscopy. Treatment The treatment for cough is to treat the underlying causes. Thus, should. B. antibiotics are given for bacterial pneumonia, bronchodilators and anti-inflammatory drugs in asthma. Children with viral infections should be treated supportive, u. a. as required with oxygen and / or bronchodilators. There is little evidence to support use of cough relievers and expectorant agent. Coughing is an important endogenous mechanism to remove secretions from the respiratory tract and can help treat respiratory infections. By the application of non-specific drugs to suppress cough in children is not recommended. Conclusion The clinical diagnosis is often sufficient. The possibility of a foreign body must be considered essential if patients 6 months to 6 years old. The effect of cough medicines and mucolytics has not been established in the rule. A chest radiograph is snapped, if the patients have symptoms of the warnings or chronic cough.

Health Life Media Team

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