Chronic cough in children — short-answer question

Part A — Definition, classification and pointers (10 marks)

a) Define chronic cough in children and state the diagnostic branch point (3 marks)

Chronic cough in a child is a daily cough persisting for more than four weeks — deliberately shorter than the eight-week adult threshold, because a child still coughing at a month usually has an identifiable, treatable cause rather than a viral tail. The first and most powerful classifying step is to decide whether the cough is wet or dry. ^[1]

b) Explain the classification by cough quality and by specific pointers (4 marks)

A wet or productive cough implies excessive airway secretions and suppurative disease, whereas a dry cough points to airway irritation or a sensitised reflex. The second axis is specific versus non-specific: a specific cough carries a pointer to underlying disease, while a non-specific cough is a dry cough in a well, thriving child with a normal examination and chest X-ray. This grid directs whether the child is investigated or observed. ^{[1] [2]}

c) List the specific-cough pointers you would seek (3 marks)

Wet or productive cough, cough from birth or the neonatal period, a choking episode suggesting foreign body, failure to thrive, digital clubbing, chest-wall deformity, exertional dyspnoea, haemoptysis, recurrent pneumonia, cardiac signs, and neurodevelopmental disease with aspiration risk. A single positive pointer converts observation into investigation. ^[1]