DEPARTMENT Case Study—Acute & Specialty Care An Uncommon Cause for a Preschool Child’s Chronic Cough Beverly P. Giordano, MS, RN, CPNP, PMHS, Sanjeev Y. Tuli, MD, & Sonal S. Tuli, MD KEY WORDS Chronic cough, double aortic arch CASE PRESENTATION A 2½-year-old white girl presented to the clinic with a 2-month history of coughing and parent-perceived ‘‘wheezing.’’ Her mother reported that the cough had developed after the child underwent a tonsillectomy and adenoidectomy (T & A) for obstructive sleep apnea (OSA) 2 months earlier. The cough was described as ‘‘wet and not croupy,’’ and it interfered with the child’s sleep. She also had activity-induced daytime coughing. The mother had tried ‘‘home remedies’’ (e.g., over-the- counter dextromethorphan preparations and the sib- ling’s nebulized albuterol) and reported that these interventions had little effect on the child’s cough. MEDICAL HISTORY The child’s neonatal course was unremarkable for feeding or respiratory problems. At 18 months of age, she under- went rigid esophagoscopy and diagnostic laryngoscopy for removal of a coin. A sleep study at 24 months of age demonstrated moderate OSA, which prompted the T & A at 29 months of age. Immunizations were up to date as per the recommendations of the Centers for Disease Control and Prevention. She had never had emergency department visits or clinic visits for wheezing. FAMILY/SOCIAL HISTORY The family history was positive for intermittent wheez- ing in the child’s sister but negative for congenital heart disease, arrhythmia, cardiomyopathy, sudden death, and tuberculosis. The child was in day care at the time she presented with the prolonged cough history. She lived with her mother, maternal grandmother, and older sister. There was no suspected exposure to tuberculosis at home or day care. REVIEW OF SYSTEMS The mother noted that the child had had a ‘‘raspy’’ voice since birth. The child’s appetite had been slightly Section Editors Karin Reuter-Rice, PhD, CPNP-AC, FCCM Corresponding Editor Duke University Durham, North Carolina Terea Giannetta, DNP, RN, CPNP California State University Children’s Hospital Central California Fresno, California Maureen A. Madden, MSN, RN, CPNP-AC, CCRN, FCCM Rutgers Robert Wood Johnson Medical School New Brunswick, New Jersey Bristol Myers Squibb Children’s Hospital New Brunswick, New Jersey Beverly P. Giordano, Pediatric Nurse Practitioner, Department of Pediatrics, University of Florida, Gainesville, FL. Sanjeev Y. Tuli, Associate Professor, Department of Pediatrics, University of Florida, Gainesville, FL. Sonal S. Tuli, Associate Professor, Department of Ophthalmology, University of Florida, Gainesville, FL. Conflicts of interest: None to report. Correspondence: Beverly P. Giordano, MS, RN, CPNP, PMHS, Department of Pediatrics, University of Florida, PO Box 100383, Gainesville, FL 32610; e-mail: bgiordano@peds.ufl.edu. J Pediatr Health Care. (2014) 28, 267-271. 0891-5245/$36.00 Copyright Q 2014 by the National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved. Published online December 19, 2013. http://dx.doi.org/10.1016/j.pedhc.2013.10.003 www.jpedhc.org May/June 2014 267