Prather Pediatric and Allergy Center - Ask Doctor Brent

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Title: Chronic Cough in Children - Causes and Treatment

Category: Child Care


There are numerous causes of chronic cough in children and the cause of this worrisome symptom can sometimes be difficult to diagnose and treat. Probably the most common cause of chronic recurrent cough in children is bronchial asthma. This will typically by found in a child whose family tree has a history of allergies. The child may have other forms of allergies such as hay fever or eczema. The child will usually be worse with exercise, exposure to cold air, at bedtime and following viral respiratory infections. Your doctor can easily diagnose asthma with special tests and by observing the response to special treatments. The ideal treatments include inhaled medicines called bronchodilators and inhaled anti-inflammatory medicines. With the proper combinations of these medicines, the asthma can be well controlled and the chronic cough will disappear.

A second common cause of chronic cough is sinusitis. This also occurs commonly in an allergy prone patient but can occur in anyone whose nasal mucous membranes are irritated. This usually occurs following viral upper respiratory infections or the common cold that leads to blockage in the sinus cavities with fluid and pus formation in the sinuses. As the fluid and pus drips in the back of the throat, a cough is triggered. The patient usually has a noticeable post nasal drip which is yellow or green in color and may have a foul odor. There is frequently headache or facial pain, sore throat or bad breath. Once the diagnosis of sinusitis is made by the doctor's exam in the office or by sinus X-rays or CAT-Scans, treatment (primarily with antibiotics and other supportive measures) should clear this condition and reverse the common cough.

Other infections which can cause chronic cough include several types of pneumonia, including viral pneumonia, mycoplasma pneumonia (common in children over five), chlamydial pneumonia (which is common in infants, three to sixteen weeks of age), whooping cough (which should not occur if we properly immunize all of the children in our society but does still occur occasionally) and rarely, bacterial pneumonia. All of these types of pneumonia can be diagnosed by your physician with specific lab tests and chest X-rays and treated with the appropriate medicines including antibiotics. Once the infection has either been adequately treated or run its course, the cough should disappear. Following certain types of pneumonia, particularly viral pneumonia, the cough may linger for several weeks and, occasionally, several months because of irritation to the lining of the bronchi.

Another cause of chronic cough can be foreign body aspiration. This means that the child choked on a small object such as a peanut or some other food product or piece of plastic or even a vitamin. The material gets lodged somewhere in the bronchial tree leading to wheezing, shortness of breath and poor air exchange with retractions or sucking in of the ribs between breaths. The patient may also have a change in their voice quality. They may be hoarse. They may have stridor which is a barking sound on inspiration typical of croup. They may be truly blue in color because of poor air exchange. This diagnosis should ideally be made as quickly as possible so that the foreign body can be taken out of the bronchial tree by a procedure called bronchoscopy. This is done in the hospital by an experienced person and will usually lead to a cure for the condition and a resolving of the cough.

Another cause of chronic cough is the disease cystic fibrosis. Typically, a patient with cystic fibrosis will have chronic lung disease with recurrent pneumonia, poor weight gain, and other signs and symptoms. The diagnosis is made by a positive sweat test. This disease is not curable but can be well controlled with all of today's medical advances and the cough can be somewhat controlled but not cured.

Another cause of chronic cough is habit cough. This occurs usually in children over five years of age and is an explosive noisy, honking type of cough brought on by suggestion and easily reproduced on command by the patient. The patient seems to not respond to any treatment and the ultimate cure involves psychologically convincing them they are controlling the cough and that they can cure themselves through the power of their mind.

Cigarette smoke exposure or any other irritant from indoor or outdoor pollution can cause chronic cough in susceptible individuals. Finally, a rare cause of chronic cough in children includes congenital anomalies. This means abnormalities in the development of the upper bronchial tree, larynx or trachea or blood vessels in the upper chest. Once this specific diagnosis is made, surgical treatment can usually correct it.

In summary, there are numerous causes of chronic cough in children but by far the most common causes are allergies with sinus infections, asthma and upper respiratory infections. If your child has a chronic cough and you have not been able to determine the cause of it, please see your pediatrician for help in making the proper diagnosis and establishing a corrective treatment.