Differential Diagnosis for a 2-Year-Old Child with a 6-Week History of Coughing
Single Most Likely Diagnosis
- Viral upper respiratory tract infection (URTI): This is the most common cause of chronic cough in children, often resulting from a viral infection that can persist for several weeks. The long duration of symptoms and the age of the child make this a likely diagnosis.
Other Likely Diagnoses
- Asthma: A common condition in children that can cause chronic cough, especially if it's associated with wheezing, shortness of breath, or cough that worsens at night or with activity.
- Allergic rhinitis: Allergies can cause chronic cough due to postnasal drip, and this condition is common in children.
- Pertussis (whooping cough): Although less common due to vaccination, pertussis can still occur, especially if the child is not fully vaccinated or if there's a waning immunity.
- Reactive airway disease: Similar to asthma but might not have all the classic symptoms of asthma, still causing cough and wheezing.
Do Not Miss Diagnoses
- Pneumonia: Bacterial pneumonia can cause a prolonged cough, and while less likely than viral causes, missing this diagnosis could lead to severe consequences.
- Tuberculosis (TB): Although rare in many areas, TB is a critical diagnosis not to miss due to its potential severity and the need for specific treatment.
- Foreign body aspiration: This is an emergency that can cause cough and respiratory distress, especially if the object is lodged in the airway.
- Congenital heart disease: Certain heart defects can lead to chronic cough due to pulmonary congestion.
Rare Diagnoses
- Cystic fibrosis: A genetic disorder that leads to persistent lung infections and cough, among other symptoms.
- Primary ciliary dyskinesia: A rare genetic disorder affecting the cilia in the respiratory tract, leading to chronic respiratory infections and cough.
- Habit cough: A psychological condition where the cough is a habit and not due to any underlying organic cause.
- Gastroesophageal reflux disease (GERD): Can cause cough due to acid reflux irritating the respiratory tract, though less common as a sole cause of chronic cough in children.