Coughing

Diagnostics of coughing

DO	Take a history and perform careful physical examination.
Consider	Consider additional investigations aimed at your differential diagnosis, keeping in mind therapeutic implications and burden on the child. Consider sputum culture if infection is suspected. Consider imaging studies if they have therapeutic implications. Consider speech therapy assessment for safety and effectiveness of swallowing.

Consider

In case of (suspected) bacterial infection, consider antibiotics.
For interstitial lung disease, consider corticosteroids.
For support in gastroesophageal reflux, consider raising the head of the bed.
For clinical signs of gastroesophageal reflux, consider acid inhibition or (trial treatment with a) prokinetic.
In cases of swallowing disorders, consider thickening nutrition or starting tube feeding.
In children with tube feeding, consider reducing portions, increasing feeding time or setting feeding time to continuous.
In pleural fluid, consider pleural puncture and (temporary) drainage.
In localised lesions, consider radiotherapy or chemotherapy.
In case of central lower airway obstruction, consider stent placement.
In case of side effects (hypersalivation), consider change of medication.
In heart failure, consider diuretics.
In case of posterior drooling, consider consultation with specialist on drug and possible surgical treatment options including pros and cons for the child.

Consider

Consider the advice of a physical therapist or bandage therapist for rib fractures caused by coughing and if analgesia is ineffective.

Consider

If coughing is productive, consider placing the child in a sitting or standing position.

Consider

Apply physical therapy techniques for sputum mobilization such as breathing exercises, air stacking, compression, cough machine "cough assist," postural drainage, PEP, and huffing.
Discuss with child and parents that physical therapy techniques should be discontinued if the child continues to weaken, and treatment becomes too burdensome.

Consider

DO	Start opioids orally or parenteral if coughing causes discomfort. Here, morphine is the first choice.
Consider	Consider noscapine or codeine. Effect has not been demonstrated in cough.

Consider

DO	Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.