If your kiddo has a cough they can’t seem to kick, they’re in good company. We see tons of kids in our clinic for chronic cough this time of year.
Why is chronic cough so common?
A chronic cough is typically characterized as a cough lasting four weeks or longer. There are numerous causes of chronic cough in children. One reason it’s so common is that kids frequently get viral infections (colds, flu, etc.), especially if they’re in school or daycare. These viral infections often occur back-to-back, particularly in the fall and winter, which can make a cough linger much longer than anticipated.
Another reason we see so many kids with chronic cough is because it can be a sign of asthma, which is a common condition in children. Asthma causes the airways to swell and constrict, which can make the lungs more reactive to triggers such as indoor and outdoor allergens, smoke, fumes, hot or cold air, and even exercising or laughing. Coughing is the body’s way of trying to rid the body of irritants.
There are several other conditions that can cause a chronic cough, too, including:
Protracted bacterial bronchitis: an infection producing increased mucus
Aspiration: a foreign body breathed into the lungs
Reflux: stomach acid backing up into the throat
Primary ciliary dyskinesia: a defect in the tiny structures that move fluid/particles through the airways
Cystic fibrosis: a disease that causes thick, sticky mucus
When all are considered together, it’s no wonder these ongoing coughs can be so common.
When should I seek medical attention for my child’s cough?
We recommend seeking medical advice if your child has a cough that’s persistent and lasting longer than four weeks. It’s also important to check in with a health care provider if your child has associated symptoms like wheezing, difficulty breathing, or exercise intolerance. It’s always important to quickly address issues that impact the ability to breathe.
When kids come to me with a cough, I first get a detailed history and physical exam. I ask various questions to determine the quality, timing, and frequency of the cough. Some clues that the cough may be asthma-related include a family history of asthma (in an immediate family member), a personal history of eczema or allergies, a dry cough, frequent nighttime cough even when not sick (i.e., no runny nose or other signs of illness), a history of wheezing, and/or improvement with steroids. Other characteristics can point us toward another diagnosis – for example, a persistent, daily wet cough for more than four weeks could suggest protracted bacterial bronchitis. In kids who are old enough (typically 5 years old or older), we often do lung function testing, which can sometimes help point us toward a specific cause.
What can be done to help?
I do not recommend treating kids with over-the-counter cough medicines. There is no good evidence that they help in any way, which can be frustrating when you want your child to feel better quickly. It can be tough to see and hear your child coughing for weeks on end.
The key to determining whether another medication may help or not is to identify the underlying cause of the cough. If the cough is due to a viral infection alone, there are no medications that will help, and we need to wait for the child to recover from the virus. If the cough is caused by asthma, a “controller” inhaler may help. There are various medical treatments that can be helpful for other underlying causes of cough.
The usual supportive care measures we provide our kids when they’re sick, such as making sure they’re staying hydrated and getting plenty of rest, are good in the case of a cough as well. For kids older than 1 year of age, a small amount of honey can help soothe a sore throat from coughing while waiting for a viral illness to run its course or for a diagnosis of another cause. Honey should not be given to children younger than 1 year old due to the small but serious risk of botulism infection.
