GPAtlas🧭 When to suspect
In children, a cough is chronic once it has persisted for more than 4 weeks – a deliberately shorter threshold than the 8 weeks used in adults, because the paediatric causes and risks differ. Most chronic cough in young children follows a viral infection and is self-limiting, but a minority signal a specific, treatable, or serious underlying cause.
The single most useful step is to characterise the cough – is it wet (productive) or dry? – and to map that pattern onto a likely diagnosis. A persistent isolated wet cough in an otherwise well, thriving child is protracted bacterial bronchitis (PBB) until proven otherwise; a recurrent dry cough with multiple triggers raises the possibility of asthma. Throughout, two skills govern the consultation: screen for red flags, and use a targeted trial of treatment as a diagnostic tool rather than over-investigating a well child.
| Cough pattern | Think of | First action |
|---|---|---|
| Isolated wet cough, child well & thriving | Protracted bacterial bronchitis (PBB) | 14-day co-amoxiclav, then review |
| Wet cough + faltering growth or clubbing | Bronchiectasis (incl. CF, PCD) | Chest X-ray + specialist referral |
| Dry, post-viral, gradually settling | Post-infectious cough | Reassure, time, safety-net |
| Recurrent dry cough + multiple triggers (± wheeze) | Possible asthma | 8–12 week ICS trial |
| Sudden choking or onset, focal/unilateral signs | Inhaled foreign body | Same-day assessment |
| Dry, absent in sleep, unusual character | Habit (psychogenic) cough | Reassurance, distraction |
Source: BMJ 2024 · ERS
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