Child with Acute Cough (<3 weeks)

Check how serious

the illness is!
No Fever, No Tachypnea Fever! Tachypnea!
No need Suspect
for CXR bacterial
pneumonia
URTI Symptoms No URTI CXR: Normal Do CXR! CXR: Abnormal
(coryza, rhinitis, sore throat) Symptoms

Croup Foreign Body Bacterial Pneumonia Atypical or viral

3mon-3yrs old Aspiration CXR: consolidation pneumonia
URTI Asthma Bronchiolitis Foreign body Viral URTI Infection of Child looks unwell CXR: diffuse white
Cough due to Cough worse at Wheeze and/or aspiration prodrome occluded airway Organisms: Strep fluffy changes
post-nasal drip night, on exertion, and crackles on History of Sudden, night- can cause fever pneumo, Grp A Strep, H. Atypical bacteria:
Normal chest after URTI auscultation choking/ time barky cough Tx: flu, Staph aureus (if <2 or mycoplasma or
auscultation Wheeze and/or Very common in aspirating? Hoarseness bronchoscopy immuno-compromised) chlamydia
Infectious crackles on kids <2, due to RSV Normal CXR Tx: Abx (i.e. macrolide) If viral, child may
auscultation infection does NOT r/o Bronchiolitis If pneumonia is look less sick
contacts
Symptoms subside aspiration Mild Fever, if any recurrent, and X-rays
VIRAL URTI =
Tx: URTI Sx (rhinitis, coryza) always the same, suspect
MOST COMMON with bronchodilators
(i.e. SABAs) bronchoscopy Wheeze + crackles on congential abnormality or
CAUSE OF
auscultation foreign body!
ACUTE COUGH
Very common in kids
Watch out for acute respiratory failure: <2, due to RSV infection
Appearance: X-ray could also show Cough pathophysiology:
Fatigued, gasping, anxious hyperinflation Cough is a symptom:
A physiological lung defense mechanism
Somolence/lethargy = severe
Under voluntary and involuntary control
Breathing:
Triggered by stimulation of cough receptors on
Tachypnea (severe = irregular, apneic breathing) pharynx, larynx, and large airways
Work of breathing ↑ (chest wall retractions/ Phases of cough:
indrawing, nasal flaring, grunting, head bobbing) Inspiration – to take in enough air to cough
O2 sat ↓ (<90% on room air) Expiratory muscles rapidly squeezes lungs, with
Circulation: glottis closed.
Pale, waxen, cyanotic look After pressure builds up, glottis opens and air is
Level of Consciousness ↓ Yan Yu, 2012 (www.yanyu.ca)
explosively released out of airway.