Chronic Cough

     One of the most bothersome problems a child can have is a chronic cough. It is defined as cough lasting longer than three or four weeks. There are many reasons for a chronic cough, but it is never due to “chronic bronchitis” in children. There is always a reason for chronic cough and it needs to be investigated.

     A continuous or recurrent cough in the first 6 months of life is unusual. It often is caused by something wrong with the anatomy of the infant’s airway and a study of the lungs and airway is usually in order. If an infant gets an infection with a virus called RSV, the infant can have a long-term, recurring cough with wheezing every time he gets a new cold. These infants are often treated the same way we treat asthmatics.

     Under three years of age, a common cold can give a child a cough for two weeks, but usually not longer. In toddlers, a cough that comes on with a cold but then lasts well over two weeks after the cold could be asthma. The child may not have the classic wheeze of asthma, so he might not get diagnosed or treated as asthma. It is especially likely in a child whose family has a history of allergies, eczema and asthma. Asthma can also be a cause of “recurrent croup”. The child has croup symptoms with loud high-pitched sounds on breathing in (“stridor”). Again, because asthma is usually associated with wheezes when breathing out, the child may not be diagnosed. If a child “gets croup every time he gets a cold”, he probably has asthma.

     Another cause of chronic cough which develops after a child has a cold is a sinus infection. The child may or may not have thick mucous. The cough is more frequent in the morning and older children may complain of headache or facial pain. The diagnosis of a sinus infection is mostly made by history and looking up into the nose. The regular X-rays taken to diagnose sinus infection are unreliable.

     If more than one member of a family has a chronic cough, infection is the most likely cause. Pertussis (Whooping Cough) and Mycoplasma are common causes of long-term cough. Fungal infection is another infectious cause of long-term cough. And we should not forget tuberculosis which is just a few hours away by jet flight.

     In any child under three, a chronic cough can be caused by something stuck in the child’s airway. Any time a chronic cough has not responded to treatment for infection or asthma, there might be a foreign object in the breathing tube. This can be true even if the X-rays are normal.

     Cough that repeatedly occurs in an older child after 15 minutes of exercise can be “exercise induced asthma”. Breathing studies are used to make this diagnosis. Loud wheezing without much coughing after exercise is usually not asthma but a condition called “vocal cord dysfunction”. The same breathing study usually shows it.

     Reflux of stomach contents up the esophagus and into the airway can be a cause of chronic cough or asthma-like symptoms, but it is over-diagnosed, especially in infants. Before starting an infant on “anti-reflux” medication, careful evaluation is warranted.    

     Finally, children can get “habit cough”. It often occurs in high expectation/ high stress families. It can begin with a typical cold and cough, but then develops into a long-term, dry, hacking cough which can be so loud and bothersome that the child might be sent home from school because he is disrupting the classroom. It can also be chronic throat clearing. The cough goes away when the child sleeps (cough that wakes you up at night is not habit cough). We all manifest stress in some way and this is how these kids do it.

     Cough and cold medications and cough suppressant medications are rarely helpful in children and can be dangerous because it is hard to judge the correct dosage. Rather than treating the cough, talk with your caregiver and find out what is causing the cough.