pediatrics
Cough in Children
Testing
Children with red flag findings should have pulse oximetry and chest x-ray. All children with chronic cough require a chest x-ray. Children with stridor, drooling, fever, and marked anxiety need to be evaluated for epiglottitis typically in an operating room by an ear, nose, and throat specialist prepared to immediately place an endotracheal or tracheostomy tube. If foreign body aspiration is suspected, chest x-ray with inspiratory and expiratory views should be done (or in some centers a chest CT). Children with TB risk factors or weight loss should have a chest x-ray and purified protein derivative (PPD) testing or an interferon-gamma release assay. Children with repeated episodes of pneumonia, poor growth, or foul-smelling stools should have a chest x-ray and sweat testing for cystic fibrosis. Acute cough in children with upper respiratory infection symptoms and no red flag findings is usually caused by a viral infection. Testing is rarely indicated unless it is necessary for infection control (eg, a COVID-19 outbreak in a school or day care center). Many other children without red flag findings have a presumptive diagnosis after the history and physical examination. Testing is not necessary in such cases; however, if empiric treatment has been instituted and has not been successful, testing may be necessary. For example, if allergic sinusitis is suspected and treated with an antihistamine that does not alleviate symptoms, a head CT may be necessary for further evaluation. Suspected Gastroesophageal Reflux in Infants unsuccessfully treated with an H2 blocker and/or proton pump inhibitor may require evaluation with a pH or impedance probe study or endoscopy. 