⏳ Onset & Duration:
- When did the cough start? Sudden (FB aspiration) vs gradual (infection, asthma).
- Acute (<3 wks), Subacute (3–8 wks), Chronic (>8 wks).
🔊 Character of Cough:
- Dry (asthma, ILD, ACEi) vs productive (infection, bronchiectasis, COPD).
- Barking 🐶 (croup), “Whoop” 😮 (pertussis), nocturnal (asthma/GERD).
- Post-prandial/lying flat (GERD).
🤝 Associated Symptoms:
- Fever 🌡️ → pneumonia/URTI.
- Wheeze/SoB 🫁 → asthma, bronchiolitis.
- Nasal congestion 🤧 → viral/allergic rhinitis.
- Chest pain ❤️‍🔥 → pneumonia, pleuritis.
- Vomiting after cough 🤮 → pertussis, GERD.
- Choking episode ⚠️ → FB aspiration.
📜 Past Medical History: asthma, recurrent infections, eczema/atopy, smoke exposure 🚬.
💉 Vaccination Status: Pertussis, influenza, pneumococcal up-to-date?
🏠 Family/Social: Family history (asthma, TB), sick contacts (school, daycare).

👀 Physical Examination

General: Distress, fatigue, ability to talk/feed.
Respiratory: Auscultate for wheeze, crackles, ↓ breath sounds; stridor; observe effort (nasal flaring, recessions, grunting).
Vitals: Fever, tachypnoea, O₂ sats.
ENT: Nasal congestion, throat erythema, postnasal drip.
Cardiovascular: HR/rhythm; signs of cardiac failure (hepatomegaly, oedema).

📊 Causes of Cough (Paediatric/General)

Cause	📋 Key Clinical Clues	🔎 Diagnostics	💊 Management
🤧 Viral URTI	Cough, rhinorrhoea, sore throat, low fever	Clinical	Supportive (fluids, rest, paracetamol)
🫁 Asthma	Recurrent cough, nocturnal, wheeze, atopy	Spirometry ± trial of bronchodilator	SABA, ICS, trigger avoidance, action plan
🦠 Bacterial Pneumonia	Cough, fever, pleuritic pain, tachypnoea, crackles	CXR (consolidation), blood/sputum cultures	Antibiotics, O₂/IV fluids, admit if severe
🤒 Pertussis	Paroxysmal “whoop”, post-tussive vomiting	PCR (nasopharyngeal swab)	Macrolides, isolation, notify public health
⚠️ Foreign Body Aspiration	Sudden onset cough/choke, unilateral wheeze	CXR, bronchoscopy	Remove FB via bronchoscopy
🐶 Croup	Barking cough, stridor, worse at night	Clinical	Dexamethasone; nebulised adrenaline if severe
🌼 Allergic Rhinitis / Postnasal Drip	Chronic cough, sneezing, itchy eyes, nasal blockage	Clinical ± allergy testing	Antihistamines, nasal steroids, allergen avoidance
🍽️ GERD	Chronic cough after feeds/lying down, hoarseness	Clinical; pH probe if unclear	Lifestyle, thickened feeds, PPI if persistent

🔬 Investigations (If Indicated)

🩻 Chest X-ray → pneumonia, FB, chronic lung disease.
📉 Spirometry/peak flow → asthma.
🧪 Nasopharyngeal PCR → pertussis, viral infections.
🩸 CBC/CRP → if bacterial cause suspected.
🌿 Allergy testing → allergic rhinitis/asthma.

🛠️ Management Principles

💧 Supportive: Hydration, rest, paracetamol for fever.
🎯 Treat the cause:
- Antibiotics for bacterial pneumonia/pertussis.
- Inhalers for asthma.
- Steroids/humidified air for croup.
- Bronchoscopy for foreign body.
👨‍👩‍👦 Education: Safety-netting, red flags, medication use, prevention (vaccination, smoke avoidance).

🚩 Red Flags (Need Urgent Attention)

Severe respiratory distress (nasal flaring, retractions, cyanosis).
Persistent high fever, lethargy, or sepsis features.
Stridor or suspected airway obstruction.
Haemoptysis or weight loss.
O₂ saturations <92% on air.

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Cough (Child)

📝 History Taking

👀 Physical Examination

📊 Causes of Cough (Paediatric/General)

🔬 Investigations (If Indicated)

🛠️ Management Principles

🚩 Red Flags (Need Urgent Attention)

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