Management of a child with chronic nonspecific cough

This algorithm summarizes our clinical approach to a child with chronic nonspecific cough, ie, a dry cough with no symptoms or signs suggesting a specific cause of the cough after a full evaluation, including spirometry (if the child is able), exhaled nitric oxide fraction (if available), and chest radiograph.

* For details on evaluation for the cause of chronic cough and specific cough pointers, refer to UpToDate content and algorithm for evaluation of chronic cough in children.

¶ A child with a dry cough and no specific cough pointers can be safely watched without treatment (the watch-and-wait approach). The child should be followed and reevaluated in 2 to 4 weeks if the chronic cough does not resolve or if new symptoms emerge. Alternatively, a time-limited trial of asthma medications or acid-suppressing medications may be done; refer to UpToDate content for patient selection and precautions.

Δ If this step is reached during a high-risk period for respiratory infections (eg, winter months), it is reasonable to continue medications until a lower-risk period.

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Management of a child with chronic nonspecific cough