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. 2002 May;52(478):401–409.

The natural history of acute cough in children aged 0 to 4 years in primary care: a systematic review.

Alastair D Hay 1, Andrew D Wilson 1
PMCID: PMC1314298  PMID: 12014540

Abstract

Professional and parental uncertainty regarding the natural history of cough and respiratory tract infection (R77) in pre-school children may in part be responsible for the high consultation, reconsultation, and antibiotic prescribing rates in this age group. The aim of the study was to review the evidence about the natural history of acute cough in children aged between 0 and 4 years presenting to primary care in terms of illness duration and complications. The study was a systematic review, with qualitative and quantitative data synthesis, of control and placebo arms of systematic reviews, randomised controlled trials (RCTs), and cohort studies set in primary care. Searches were done of MEDLINE (between 1966 and June 1998), EMBASE (between 1988 and September 1998), and the Cochrane Library databases, using the MeSH terms 'respiratory tract infection, 'cough, and 'bronchitis, and the textwords 'cough' 'bronchitis, and 'chest infection, limited to children aged between 0 and 4years, and English language articles. Eight RCTs and two cohort studies met the review criteria. At one week, 75% of children may have improved but 50% may be still coughing and/or have a nasal discharge. At two weeks up to 24% of children may be no better. Within two weeks of presentation, 12% of children may experience one or more complication, such as rash, painful ears, diarrhoea, vomiting, or progression to bronchitis/pneumonia. This review offers parents and clinicians more prognostic information about acute cough in pre-school children. Illness duration may be longer and complications higher than many parents and clinicians expect. This may help to set more realistic expectations of the illness and help parents to decide when and if to reconsult. This information may be useful to those designing patient information and self-help resources.

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Selected References

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  1. Ackerman B. D. Treatment of undifferentiated respiratory infections in infants. Clin Pediatr (Phila) 1968 Jul;7(7):391–395. doi: 10.1177/000992286800700707. [DOI] [PubMed] [Google Scholar]
  2. Ayres J. G., Noah N. D., Fleming D. M. Incidence of episodes of acute asthma and acute bronchitis in general practice 1976-87. Br J Gen Pract. 1993 Sep;43(374):361–364. [PMC free article] [PubMed] [Google Scholar]
  3. Bain J. Treatment of acute otitis media: are children entered into clinical trials representative? Br J Gen Pract. 2001 Feb;51(463):132–133. [PMC free article] [PubMed] [Google Scholar]
  4. Cornford C. S., Morgan M., Ridsdale L. Why do mothers consult when their children cough? Fam Pract. 1993 Jun;10(2):193–196. doi: 10.1093/fampra/10.2.193. [DOI] [PubMed] [Google Scholar]
  5. Davy T., Dick P. T., Munk P. Self-reported prescribing of antibiotics for children with undifferentiated acute respiratory tract infections with cough. Pediatr Infect Dis J. 1998 Jun;17(6):457–462. doi: 10.1097/00006454-199806000-00004. [DOI] [PubMed] [Google Scholar]
  6. Del Mar A. R. Recorded consultations for children under 5 have increased considerably in general practice. BMJ. 1996 Nov 23;313(7068):1334–1334. doi: 10.1136/bmj.313.7068.1334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fahey T., Stocks N., Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child. 1998 Sep;79(3):225–230. doi: 10.1136/adc.79.3.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Gulbrandsen P., Fugelli P., Kvarstein G., Moland L. The duration of acute respiratory tract infections in children. Scand J Prim Health Care. 1989 Dec;7(4):219–223. doi: 10.3109/02813438909088668. [DOI] [PubMed] [Google Scholar]
  9. HARDY L. M., TRAISMAN H. S. Antibiotics and chemotherapeutic agents in the treatment of uncomplicated respiratory infections in children; a controlled study. J Pediatr. 1956 Feb;48(2):146–156. doi: 10.1016/s0022-3476(56)80160-1. [DOI] [PubMed] [Google Scholar]
  10. Hart C. A. Antibiotic resistance: an increasing problem?. It always has been, but there are things we can do. BMJ. 1998 Apr 25;316(7140):1255–1256. doi: 10.1136/bmj.316.7140.1255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Holme C. O. Incidence and prevalence of non-specific symptoms and behavioural changes in infants under the age of two years. Br J Gen Pract. 1995 Feb;45(391):65–69. [PMC free article] [PubMed] [Google Scholar]
  12. Hope-Simpson R. E., Miller D. L. The definition of acute respiratory illnesses in general practice. Postgrad Med J. 1973 Nov;49(577):763–770. doi: 10.1136/pgmj.49.577.763. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Howie J. G., Hutchison K. R. Antibiotics and respiratory illness in general practice: prescribing policy and work load. Br Med J. 1978 Nov 11;2(6148):1342–1342. doi: 10.1136/bmj.2.6148.1342. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Howie J. G., Richardson I. M., Gill G., Durno D. Respiratory illness and antibiotic use in general practice. J R Coll Gen Pract. 1971 Nov;21(112):657–663. [PMC free article] [PubMed] [Google Scholar]
  15. Hutton N., Wilson M. H., Mellits E. D., Baumgardner R., Wissow L. S., Bonuccelli C., Holtzman N. A., DeAngelis C. Effectiveness of an antihistamine-decongestant combination for young children with the common cold: a randomized, controlled clinical trial. J Pediatr. 1991 Jan;118(1):125–130. doi: 10.1016/s0022-3476(05)81865-7. [DOI] [PubMed] [Google Scholar]
  16. Kai J. Parents' difficulties and information needs in coping with acute illness in preschool children: a qualitative study. BMJ. 1996 Oct 19;313(7063):987–990. doi: 10.1136/bmj.313.7063.987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Kai J. What worries parents when their preschool children are acutely ill, and why: a qualitative study. BMJ. 1996 Oct 19;313(7063):983–986. doi: 10.1136/bmj.313.7063.983. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Lilford R. J., Jackson J. Equipoise and the ethics of randomization. J R Soc Med. 1995 Oct;88(10):552–559. [PMC free article] [PubMed] [Google Scholar]
  19. Little P., Gould C., Williamson I., Warner G., Gantley M., Kinmonth A. L. Reattendance and complications in a randomised trial of prescribing strategies for sore throat: the medicalising effect of prescribing antibiotics. BMJ. 1997 Aug 9;315(7104):350–352. doi: 10.1136/bmj.315.7104.350. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Majeed A., Moser K. Age- and sex-specific antibiotic prescribing patterns in general practice in England and Wales in 1996. Br J Gen Pract. 1999 Sep;49(446):735–736. [PMC free article] [PubMed] [Google Scholar]
  21. Margolis P., Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA. 1998 Jan 28;279(4):308–313. doi: 10.1001/jama.279.4.308. [DOI] [PubMed] [Google Scholar]
  22. Monto A. S. Studies of the community and family: acute respiratory illness and infection. Epidemiol Rev. 1994;16(2):351–373. doi: 10.1093/oxfordjournals.epirev.a036158. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Morrell D. C. Symptom interpretation in general practice. J R Coll Gen Pract. 1972 May;22(118):297–309. [PMC free article] [PubMed] [Google Scholar]
  24. Munro J., Nicholl J., O'Cathain A., Knowles E. Impact of NHS direct on demand for immediate care: observational study. BMJ. 2000 Jul 15;321(7254):150–153. doi: 10.1136/bmj.321.7254.150. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Pencheon D. Matching demand and supply fairly and efficiently. BMJ. 1998 May 30;316(7145):1665–1667. doi: 10.1136/bmj.316.7145.1665. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Shann F. How often do children cough? Lancet. 1996 Sep 14;348(9029):699–700. doi: 10.1016/S0140-6736(05)65602-4. [DOI] [PubMed] [Google Scholar]
  27. Smith R. The NHS: possibilities for the endgame. Think more about reducing expectations. BMJ. 1999 Jan 23;318(7178):209–210. doi: 10.1136/bmj.318.7178.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Stott N. C. Management and outcome of winter upper respiratory tract infections in children aged 0-9 years. Br Med J. 1979 Jan 6;1(6155):29–31. doi: 10.1136/bmj.1.6155.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. TOWNSEND E. H., Jr Chemoprophylaxis during respiratory infections in a private pediatric practice. AMA J Dis Child. 1960 May;99:566–573. doi: 10.1001/archpedi.1960.02070030568002. [DOI] [PubMed] [Google Scholar]
  30. TOWNSEND E. H., Jr, RADEBAUGH J. R. Prevention of complications of respiratory illnesses in pediatric practice. A double-blind study. N Engl J Med. 1962 Apr 5;266:683–689. doi: 10.1056/NEJM196204052661401. [DOI] [PubMed] [Google Scholar]
  31. Taylor B., Abbott G. D., Kerr M. M., Fergusson D. M. Amoxycillin and co-trimoxazole in presumed viral respiratory infections of childhood: placebo-controlled trial. Br Med J. 1977 Aug 27;2(6086):552–554. doi: 10.1136/bmj.2.6086.552. [DOI] [PMC free article] [PubMed] [Google Scholar]
  32. Taylor J. A., Novack A. H., Almquist J. R., Rogers J. E. Efficacy of cough suppressants in children. J Pediatr. 1993 May;122(5 Pt 1):799–802. doi: 10.1016/s0022-3476(06)80031-4. [DOI] [PubMed] [Google Scholar]
  33. Todd J. K., Todd N., Damato J., Todd W. A. Bacteriology and treatment of purulent nasopharyngitis: a double blind, placebo-controlled evaluation. Pediatr Infect Dis. 1984 May-Jun;3(3):226–232. doi: 10.1097/00006454-198405000-00009. [DOI] [PubMed] [Google Scholar]
  34. Vinson D. C., Lutz L. J. The effect of parental expectations on treatment of children with a cough: a report from ASPN. J Fam Pract. 1993 Jul;37(1):23–27. [PubMed] [Google Scholar]

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