GPAtlas🧭 When to suspect
An acute cough is one lasting less than 3 weeks, and in children it is usually a symptom of a self-limiting viral upper respiratory tract infection (URTI). Most affected children are systemically well, need no investigation and no antibiotic, and recover within a fortnight or so – although the cough itself can linger for up to 3 weeks.
The clinical skill is twofold: confidently recognise the well child with a simple viral cough – who needs explanation, supportive care and safety-netting – and never miss the smaller number with a serious cause, chiefly pneumonia, bronchiolitis, croup, an inhaled foreign body, or, increasingly in the UK again, whooping cough. A sudden-onset cough in a previously well toddler should always raise the possibility of an inhaled foreign body.
| Likely cause (typical age) | Distinguishing features |
|---|---|
| Viral URTI (any age) | Coryza, sneezing and a mild cough in a well child; little or no fever; settles within around 3 weeks. |
| Community-acquired pneumonia (any age) | Fever (often ≥38.5°C), tachypnoea, increased work of breathing and focal chest signs (bronchial breathing or localised crackles); may have chest or abdominal pain. |
| Bronchiolitis (under 1 year; peak 3–6 months) | Coryzal prodrome, then cough, wheeze and fine bilateral crackles, with feeding difficulty and respiratory distress; usually RSV in winter. |
| Viral-induced wheeze (6 months–5 years) | Wheeze occurring only with viral infections, with no symptoms between episodes; a distinct entity from asthma. |
| Croup (6 months–3 years) | Barking, seal-like cough with stridor and a hoarse voice, typically worse at night following a coryzal prodrome. |
| Inhaled foreign body (any; usually toddlers) | Sudden onset, often with a choking episode; may have unilateral wheeze or reduced air entry; symptoms can fluctuate. |
| Whooping cough (pertussis) (any; most dangerous in young infants) | Paroxysmal coughing fits, an inspiratory "whoop", post-tussive vomiting, and apnoea or colour change in young infants; consider during the current UK resurgence. |
Source: NICE NG143 · British Thoracic Society · UKHSA
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