Chang A.B. et al, published a paper to collate the pediatric components of the CHEST chronic cough guidelines to aid the medical practitioners in the evaluation and management of children with chronic cough.

These guidelines include children less than/equal to 14 years of age with chronic cough (> 4 weeks duration). The guidelines are listed as follows-

1. For children aged ≤ 14 years, we suggest defining chronic cough as the presence of a daily cough of more than 4 weeks in duration (Ungraded Consensus-Based Statement).
2. For children aged ≤ 14 years, we recommend that (a) common etiologies of chronic cough in adults are not presumed to be common causes in children and (b) their age and the clinical settings (eg, country and region) are taken into consideration when evaluating and managing their chronic cough (Grade 1B).
3. For children aged ≤ 14 years with chronic cough, we recommend using pediatric-specific cough management protocols or algorithms (Grade 1B).
4. For children aged ≤ 14 years with chronic cough, we recommend taking a systematic approach (such as using a validated guideline) to determine the cause of the cough (Grade 1A).
5. For children aged ≤ 14 years with chronic cough, we recommend basing the management or testing algorithm on cough characteristics and the associated clinical history such as using specific cough pointers like the presence of productive/wet cough (Grade 1A).
6. For children aged ≤ 14 years with chronic cough, we recommend that a chest radiograph and, when age-appropriate, spirometry (pre and post b2 agonist) be undertaken (Grade 1B).
7. For children aged > 6 years and ≤ 14 years with chronic cough and asthma clinically suspected, we suggest that a test for airway hyper-responsiveness be considered (Grade 2C).
8. For children aged ≤ 14 years with chronic cough, we recommend not routinely performing additional tests (eg, skin prick test, Mantoux, bronchoscopy, chest CT); these should be individualized and undertaken in accordance with the clinical setting and the child’s clinical symptoms and signs (Grade 1B).
9. For children aged ≤ 14 years with chronic cough, we suggest undertaking tests evaluating recent Bordetella pertussis infection when pertussis is clinically suspected (Ungraded Consensus-Based Statement).

Remarks: CHEST guidelines3 suggested that clinicians consider cough could be considered caused by pertussis if there is post-tussive vomiting, paroxysmal cough or inspiratory whoop.

10. For children aged ≤ 14 years with chronic cough, we recommend basing the management on the etiology of the cough. An empirical approach aimed at treating upper airway cough syndrome due to a rhino sinus condition, gastroesophageal reflux disease and/or asthma should not be used unless other features consistent with these conditions are present (Grade 1A).

Source:

Chang, AB, Oppenheimer, JJ, Irwin, RS. Managing Chronic Cough as a Symptom in Children and Management Algorithms CHEST Guideline and Expert Panel Report, CHEST 2020; 158(1):303-329.