alluded to above, include the quality of the cough (e.g., paroxysmal, barking), associated stridor, associated choking or emesis, and the findings of lower respiratory tract signs or fever ( Fig 19.1 ) Most patients with cough of acute onset will have a simple URI, asthma, bronchiolitis, or pneumonia Although rales, decreased breath sounds, or focal wheezing are signs associated with pneumonia, some patients with pneumonia may not have any findings by auscultation Therefore, in cases of significant cough, especially in very young children and those with high fever or elevated white blood cell counts, a chest radiograph may be useful to exclude the diagnosis of pneumonia Children with chronic cough are likely to have reactive airway disease, allergic rhinitis, or sinusitis In young children with failure to thrive or recurrent pulmonary infections, cystic fibrosis (see Chapter 99 Pulmonary Emergencies ) should be considered Chronic cough with a history of recurrent pneumonias or chronic bronchitis can also be suggestive of immunodeficiency or anatomic lesions (see Chapters 99 Pulmonary Emergencies , 124 Thoracic Emergencies ) Choking with feeding or emesis followed by cough or wheezing in young infants is typical of gastroesophageal reflux Newborns who exhibit a cough deserve special consideration for airway anomalies, atypical pneumonias, and congestive heart failure (see Chapters 94 Infectious Disease Emergencies , 99 Pulmonary Emergencies , and 118 ENT Emergencies ) Persistent cough during the day that stops with distraction or sleep is supportive of a psychogenic cause TREATMENT The primary goal should be to treat the underlying process rather than to attempt to suppress the cough Patients with any distress or hypoxia need supplemental oxygen and immediate assessment of the airway and breathing Wheezing from asthma is primarily treated with inhaled beta-2 agonists (see Asthma, Emergent Care Pathway https://www.chop.edu/clinical-pathway/asthma-emergent-careclinical-pathway , Chapter 84 Wheezing , and Chapter 99 Pulmonary Emergencies ) The treatment for bronchiolitis is mainly supportive, including nasal suctioning, ensuring hydration, and providing supplemental oxygen as needed The 2014 American Academy of Pediatrics Clinical Practice Guideline for bronchiolitis recommends against a trial of a bronchodilator in infants with bronchiolitis However, a carefully monitored trial of a bronchodilator may be beneficial in some infants but should always be accompanied by an objective assessment of response after administration If there is no improvement, these agents should be stopped (see Bronchiolitis, Emergent Evaluation Pathway https://www.chop.edu/clinical-pathway/bronchiolitis-emergent-evaluation-