The long and winding cough

The Pediatric Insider

© 2011 Roy Benaroch, MD

Ilana wrote in, “My child has had a cough for at least a year. It comes and goes, but it’s almost always there. I don’t know if she needs a specialist or what, but we’re tired of the cough! What can we do?”

Chronic or frequent coughing is a fairly common complaint, and working out the why’s-she-coughing and the how-to-stop it isn’t always simple. Some of the most common causes I see are:

Asthma—far and away the most common cause of frequent or prolonged cough. Asthma can be a tricky diagnosis to confirm, but it’s easy to treat: so often we treat it if the history and exam are suggestive of asthma. If the child gets better, that confirms the diagnosis.

One cold after another—very common, especially in day care kids. What is perceived as one long, forever cough is really a bunch of cold viruses stacked one after another. Frustrating for all!

Allergies—more commonly causes congestion/sneezing/itchy nose, but many kids w/ allergies also cough. “Testing” for allergies has many false positives and negatives, so the best “test” is a history and physical exam.

Chronic or recurrent sinusitis—both the most undertreated and overtreated condition I see. I know that sounds weird, but it’s true. Sinusitis causes a cough from mucus drip.

Habit cough—common! Sometimes also called “psychogenic cough,” this is the cough that disappears when kids fall asleep.

Reflux—Gastroesophageal reflux can be sneaky, and can trigger a cough that’s especially bad at night, even without obvious symptoms like heartburn.

Pertussis—In many communities, “whooping cough” is making a comeback, thanks in part to families who choose not to immunize. Protect yourself and your children from this “100 day cough”—though the vaccine isn’t 100% effective, it’s the best protection we’ve got. Once the cough of pertussis sets in, no treatment is effective.

There are many other causes of cough, but almost all chronic/frequent cough in kids is from one of these things. The key to the diagnosis is almost always in the history. To help figure out the cause of cough, the most important “test” is a good, careful log. Keep track of when the cough occurs, what time of day or night, and what your child is doing during the cough. What makes it better? What makes it worse? What other symptoms might be going on, like fever, nasal drip or congestion, abdominal pain, shortness of breath? Go over the details with your pediatrician to help figure out the most-likely culprit.

Sometimes, fancier tests can help. These might include a chest x-ray, blood tests, or endoscopy. If your child does undergo these or other tests, keep track of the results to share with other specialists that might get involved. Depending on the initial impression, helpful specialists to assist with a cough workup include pulmonologists (lung specialists), ENTs (ear, nose, throat), or allergy/immunologists.

Meanwhile, help a coughing child feel better with some comfort care. Though OTC cough meds and rubs probably don’t work very well, steamy showers, a humidifier, or honey can help. Whatever the cause, coughing can irritate the throat, leading to more mucus production, more swelling, and more cough—so soothing lozenges (for older kids), popsicles, or ice cream can be far more effective than any medication. Stay away from regular use of narcotic-based prescription cough syrups, which can be habit-forming and potentially dangerous especially in young children. A cough can linger and annoy, but don’t choose a remedy that’s worse than the disease.

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Tags: chronic cough, cough, whooping cough

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