What is the treatment for postnasal drip (PND) with continuous coughing in children?

Treatment of Post Nasal Drip with Continuous Coughing in Children

First-line treatment for post nasal drip (PND) with continuous coughing in children should include saline nasal irrigation and intranasal corticosteroids, with short-term use of first-generation antihistamine/decongestant combinations for symptomatic relief in children over 6 years of age. 1, 2

Diagnostic Considerations

Before initiating treatment, it's important to determine if the cough is related to post nasal drip or another condition:

• Evaluate for specific cough pointers (wet vs. dry cough, timing, associated symptoms) 2
• Consider chest radiograph and spirometry (when age-appropriate) to rule out other causes 2
• Assess for risk factors for asthma if clinically suspected 2

Treatment Algorithm for PND with Cough in Children

First-line treatments:

1. Saline nasal irrigation

   • More effective than sprays for clearing secretions 1
   • Can use isotonic or hypertonic solutions
   • Low-cost option, especially with homemade solutions
   • Safe for all age groups

2. Intranasal corticosteroids

   • Proper technique is essential: shake bottle well, look down by bending neck, insert nozzle just inside nostril 1
   • Continue for at least 2-8 weeks for effectiveness 1
   • Monitor for nasal irritation or bleeding

For symptomatic relief (children ≥6 years):

1. First-generation antihistamine/decongestant combinations

   • Only for short-term use (3 weeks maximum) 1
   • Examples: dexbrompheniramine maleate plus sustained-release pseudoephedrine sulfate 2
   • CAUTION: Avoid in children under 6 years due to safety concerns 2

2. Topical decongestants

   • Limit to 5-7 days maximum to prevent rhinitis medicamentosa 1
   • Use with caution in children under 1 year 2

For specific etiologies:

1. If allergic rhinitis is suspected:

   • Consider non-sedating antihistamines 2
   • Continue intranasal corticosteroids 2

2. If bacterial infection is suspected:

   • Consider antibiotics targeted to common respiratory bacteria if wet/productive cough persists >4 weeks 2
   • Reassess after 2 weeks of treatment 2

Important Cautions and Considerations

• Avoid empirical treatment for upper airway cough syndrome, gastroesophageal reflux disease, or asthma unless other features of these conditions are present 2

• OTC cough and cold medications are not recommended for children under 6 years due to potential toxicity and lack of efficacy 2

• Antihistamines have minimal to no efficacy in relieving cough in young children according to systematic reviews 2

• The concept of PND as a cause of cough in children is somewhat controversial, with some experts suggesting that increased post-nasal secretions and cough may both reflect co-existent airway pathologies 3

• If cough persists despite appropriate treatment for 4 weeks, further investigations should be considered 2

When to Refer to a Specialist

• Persistent symptoms despite appropriate treatment
• Unilateral symptoms or bloody discharge
• Signs of underlying structural abnormalities
• Cough lasting >8 weeks despite treatment

By following this structured approach to treating post nasal drip with continuous coughing in children, you can provide effective symptom relief while minimizing unnecessary medication use and potential adverse effects.