Chronic Cough And Gastroesophageal Reflux In Children
Publication Date: April 1, 2019
Last Updated: March 14, 2022
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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Title
Chronic Cough And Gastroesophageal Reflux In Children
Authoring Organization
American College of Chest Physicians
Publication Month/Year
April 1, 2019
Last Updated Month/Year
January 30, 2024
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