A pediatrician once passed on this clinical pearl to me, and it has helped me in my 35 years of practice: get a chest radiograph if you ever have a young child with chronic cough (think neoplasm or foreign body). I will never forget a 3-year-old jumping actively in the office who had no active cough or wheeze but a mother who said that he coughed nightly for more than 3 weeks. It turned out that he had a nickel lodged near the bifurcation of his airway. When he was lying down, it would impinge the trachea and cause him to cough. I never would have guessed. He looked too well.—Cindy Baltrun, MSN, DNP, FNP Certified, Salado, Texas

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical pearl, submit it here.