Chronic Cough And Gastroesophageal Reflux In Children

Publication Date: April 1, 2019

Recommendations

1. For children aged ≤ 4-years with chronic cough (>4 weeks duration) without an underlying lung disease, we recommend that treatment(s) for GERD should NOT be used when there are no clinical features of gastroesophageal reflux such as recurrent regurgitation, dystonic neck posturing in infants, or heartburn/epigastric pain in older children. (1B)
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2. For children aged ≤14-years with chronic cough (>4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with gastroesophageal pathological reflux, we recommend that they be treated for GERD in accordance to evidence-based GERD-specific guidelines. (1B)
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3. For children aged ≤14-years with chronic cough (>4 weeks duration) without an underlying lung disease but who have symptoms and signs or tests consistent with gastroesophageal pathological reflux, we recommend that acid suppressive therapy should not be used solely for their chronic cough. (1C)
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4. For children with chronic cough (>4 weeks duration) who do not have an underlying lung disease but with gastrointestinal GER symptoms, we suggest that they be treated for GERD in accordance to evidence-based GERD-specific guidelines for 4-8 weeks and their response reevaluated. (U-CBS)
Remark: The agent used for the “trial of treatment” approach is dependent on the child’s age, feeding regimen, and symptoms. PPIs and H2 receptor antagonists should not be used for longer than 4 to 8 weeks without further evaluation.
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5. For children with chronic cough (>4 weeks duration) and without an underlying disease, if GERD is suspected as the cause based on GER symptoms, we suggest following the GERD guidelines for investigating children suspected for GERD. (U-CBS)
Remark: The workup suggested by the GERD guidelines is largely dependent on the child’s age and constellation of symptoms. In most situations, endoscopy is suggested before pHmetry or pH-MII.
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Recommendation Grading

Disclaimer

Overview

Title

Chronic Cough And Gastroesophageal Reflux In Children

Authoring Organization

Publication Month/Year

April 1, 2019

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

Whether gastroesophageal reflux (GER) or GER disease (GERD) causes chronic cough in children is controversial. Using the Population, Intervention, Comparison, Outcome (PICO) format, we undertook four systematic reviews. For children with chronic cough (> 4-weeks duration) and without underlying lung disease: (1) who do not have gastrointestinal GER symptoms, should empirical treatment for GERD be used? (2) with gastrointestinal GER symptoms, does treatment for GERD resolve the cough? (3) with or without gastrointestinal GER symptoms, what GER-based therapies should be used and for how long? (4) if GERD is suspected as the cause, what investigations and diagnostic criteria best determine GERD as the cause of the cough?

Target Patient Population

Children with chronic cough

Inclusion Criteria

Adolescent, Child

Health Care Settings

Ambulatory, Childcare center, Outpatient, School

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Management, Treatment

Diseases/Conditions (MeSH)

D010372 - Pediatrics, D003371 - Cough, D003933 - Diagnosis, D005764 - Gastroesophageal Reflux

Keywords

children, pediatric, gastroesophageal reflux disease (GERD), chronic cough