Pediatric chronic cough

What is a pediatric chronic cough?

A cough is a reflex to clear the airways of irritants, infections or mucous in the respiratory tract. While it’s not unusual to have a cough multiple times throughout the year, when it interferes with everyday activities and/or sleep or lasts more than a month, your child’s pediatrician will want to find out the root cause.

What are the different types of pediatric chronic coughs?

Coughs can be categorized as “wet” or “dry” depending on what type of illness causes them.

• Wet cough - A wet cough is a productive cough that brings up mucous. Many children have difficulty coughing the mucous all the way out, however, and will often cough it up to the level of the throat and then swallow it, where it will be passed through the gastrointestinal tract.

• Dry cough - A dry cough doesn’t produce mucous and feels more like an irritation or tickle in the throat. One type of dry cough is a “barking cough,” which can be caused by croup (a viral infection that causes swelling of the vocal cords), allergies or acid reflux. Some parents describe the cough as sounding like a seal’s bark.

How are pediatric chronic coughs diagnosed?

Your child’s health care provider will listen to the type of cough and ask questions about it to narrow the causes.

The provider will want to know:

• How it sounds

• How long it's been going on

• What triggers it or makes it better

• When it occurs

• Whether it's been treated yet with any medications

• Whether someone in the house smokes

What are the causes of a pediatric chronic cough?

• Viral infections, including colds, are the most common cause of a cough. Bacterial infections, such as bacterial bronchitis and sinusitis, can also cause a chronic cough. Sometimes a cough lasting more than a month is simply due to back-to-back viral infections, especially during the fall and winter seasons.

• Whooping cough (pertussis) is another infection that can cause a chronic cough. Pertussis is characterized by coughing spells ending with a deep breath that makes a “whooping” sound. Babies and young children may not produce the whooping sound and may have only the coughing fits, or rarely, have pauses in breathing or turning blue.

• Asthma - Cough occurs in response to airway irritants or inflammation. Cough due to asthma is most commonly triggered by exercise, cold air, weather changes or exposure to airway irritants, such as secondhand smoke or other strong smells (perfumes, cleaning supplies).

• Allergies - Cough occurs due to postnasal drip (mucous from the nose draining down the back of the throat) or from irritated or swollen airways. Allergies tend to flare in spring and fall, depending on what a child is allergic to, but can occur year-around due to allergens like dust mites, cat and dog dander.

• Gastroesophageal reflux disease (GERD) - Also called heartburn or acid reflux - When stomach acid comes back up from the stomach, it irritates the throat and can cause a cough. Reflux is typically worst at night or right after a meal.

• Irritants - Exposure to secondhand smoke or other household chemicals can lead to coughing even in otherwise healthy children.

• Pneumonia - Pneumonia can be bacterial or viral, and is usually diagnosed on a chest X-ray.

• Foreign body - the presence of a foreign object in the airway, most commonly a small toy or particle of food that a child chokes on and accidentally inhales into his airways. The child then coughs to try to clear the object from his lung.

• Habit cough - a cough without any infectious cause or other explanation, which typically starts when a child is sick but then persists after the illness resolves. The cough occurs when the child is thinking about or focusing on the cough, but goes away when he is distracted or asleep. This diagnosis is fairly common but can only be made by ruling out other causes of cough.

• Other illnesses - In some cases, a cough can indicate a more serious illness, such as cystic fibrosis (CF) or other genetic conditions that affect the respiratory system. However as of 2009, CF is on the newborn screen in all 50 states, so if your child was born after that and had a normal newborn screen, CF is much less likely.

• Age - The age of the child also plays a role in the diagnosis and cause.

  • Younger children are more prone to foreign body aspiration and abnormalities in the respiratory tract.

  • For older children, cough is more likely to be caused by asthma, post-nasal drip and GERD. Nonetheless, viral infections are the most common cause of cough in all ages.

How is a pediatric chronic cough treated?

Treatment depends on the cause of the cough. If the cough is due to an irritant, the best treatment is to remove or better control the irritant in the home. 

• Medications may include antihistamines, antibiotics or acid blockers, depending on the diagnosis. In addition, asthma medicines such as inhaled steroids can control airway inflammation, while bronchodilators help relax the breathing tubes to improve airflow.

• Bronchoscopy - Foreign bodies require a bronchoscopy, a quick procedure done under anesthesia with a scope to remove the foreign object from the airway.

• Other - Our pulmonary specialists rarely recommend cough suppressants since they only suppress the symptom of the cough. In young children, studies have shown that cough suppressants are rarely effective and tend to cause more side effects than benefits.

For children over age 1, honey can be used to help soothe the throat and reduce cough.