Management of Cough with Vomiting in Pediatric Patients

Initial Clinical Assessment

The American Thoracic Society recommends considering pertussis as the primary diagnosis in children presenting with cough and vomiting, particularly if the cough is paroxysmal or post-tussive vomiting is present, and testing for Bordetella pertussis infection 1, 2, 3, 4
Severe dehydration or respiratory distress, indicated by a respiratory rate >70 breaths/min in infants or >50 breaths/min in older children, requires immediate attention 5
Oxygen saturation <92% is a critical threshold for intervention 5

For children over 1 year, the American Academy of Pediatrics suggests that honey provides more relief than diphenhydramine or placebo for cough 6
The American College of Chest Physicians recommends obtaining chest radiograph and age-appropriate spirometry for chronic cough (≥4 weeks) 1, 3, 4
Distinguishing between wet/productive versus dry cough is crucial for determining the diagnostic algorithm 2, 3

The European Respiratory Society advises against empirical treatment for asthma, GERD, or upper airway cough syndrome unless other features consistent with these conditions are present 1, 2, 3
For chronic wet cough without specific pointers, the American College of Chest Physicians recommends treating with 2 weeks of antibiotics targeting Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis (amoxicillin is first choice) 4, 6

The American Academy of Pediatrics recommends determining and advising cessation of environmental tobacco smoke exposure 1, 2, 3
Providing education on managing fever, preventing dehydration, and identifying signs of deterioration is essential 5
Ensuring adequate hydration to thin secretions is crucial 5
Using antipyretics to keep the child comfortable is recommended 7

Reviewing within 48 hours if symptoms are deteriorating or not improving is necessary 5
If cough persists beyond 3-4 weeks, transitioning to chronic cough evaluation with a systematic algorithm is recommended 5
The American College of Chest Physicians advises against routinely performing additional tests unless individualized based on clinical symptoms and signs 1, 3, 4

The American Thoracic Society warns against assuming adult cough etiologies apply to children without specific supporting features 1, 2, 3
Empirical treatment trials without a defined limited duration should not be used to confirm or refute the diagnosis 2, 3
Post-tussive vomiting should not be dismissed as simple gastroenteritis without considering pertussis 1, 2, 3, 4
Chest physiotherapy is not beneficial and should not be performed 7