Chronic Cough in Children – Causes, Diagnosis, and Treatment

A cough that persists for more than 4 weeks is considered chronic. While cough is a symptom of common respiratory infections, it usually clears up soon without causing much distress to the child. In some cases, the cough persists for a month or more, causing concern for the parents, classmates, and other people who regularly interact with the child.

Cough, when left untreated, can lead to the worsening of the underlying condition and create long-term complications. If your child has had a persistent cough for more than a month, then this article might offer some clues to the conditions that usually cause a chronic cough.

What Is Chronic Cough? 

A cough is a natural reaction to an infection or blockage that irritates the passage from the lungs to the trachea, pharynx, larynx, or nasal passages. An acute cough that accompanies a cold or a respiratory virus clears up within a month. If the cough persists for longer than 4 weeks, it could mean a much more severe underlying issue.

Studies indicate that coughs caused by acute respiratory infections settle within 25 days in 90% of children. Therefore a cough that continues for more than a month is considered chronic and needs to be checked by a doctor. 

How Common Is Chronic Cough in Kids? 

According to surveys, chronic cough is relatively common, with the prevalence being high in children who live in areas with intense traffic. Some risk factors include children born before 37 weeks and with underlying medical conditions such as wheezing. 

Causes of Chronic Cough in Children 

Here are some of the most common conditions that can lead to chronic cough in children:

1. Allergies 

If you notice that your child gets cough, itchy eyes, and a running nose at the same time of the year, it is a sign of a seasonal allergy. They could be allergic to pollen, spores, or microbial allergens in the air at specific months every year. Allergies caused by pets or moving to a new place can also cause a chronic cough. 

2. Common Cold 

There are hundreds of viruses that can cause an infection of the upper respiratory tract leading to a cold and chronic cough. Most children can get close to ten colds a year, and most of them last from five to seven days. Sometimes when children have back-to-back colds caused by different viruses, the cough can persist for more than a month. 

3. Whooping Cough 

Pertussis, a bacterial infection, is commonly known as whooping cough. It causes people to cough uncontrollably. Whooping cough is a serious infection that can be life-threatening to children. The excessive cough often causes the person to go out of breath and make a whooping sound when they inhale. Some cases of chronic cough in a toddler can be caused by this disease, especially in communities that are not vaccinated against it. 

4. Blockage in the Airway 

Sometimes chronic cough in a child with no other symptoms can be because of foreign objects stuck in the airway. The object could continue to irritate the airway causing continuous cough without secondary symptoms. The asymptomatic period can stretch for weeks before any complications such as pneumonia. 

5. Asthma 

Asthma is often associated with wheezing and blocked airways that make breathing difficult. The condition can also present only as chronic cough in some children. If the child continues to cough even after falling asleep, it suggests chronic cough asthma children. This can happen because the cortisol levels decrease in the night leading to asthmatic bronchospasm.

6. Acid Reflux 

Although acid reflux is accompanied by gastrointestinal symptoms such as acidity, heartburn, and vomiting, a persistent dry cough can also be a symptom of the condition. Acid reflux by itself may not cause chronic cough but exacerbate an underlying upper respiratory tract infection and make the cough worse. Chronic cough associated with acid reflux is seen during daytime and when the child laughs excessively. GERD (gastroesophageal reflux disease), also characterized by acid reflux, is a chronic cough in infants causes. GERD causes infants to gag, spit-up, and act fussy, along with chronic cough. 

7. Aspiration 

Aspiration is frequent coughing while the child is eating or drinking. One of the other tell-tale signs is coughing with a history of pneumonia caused by foods that pass into the lungs. These children might suffer from neurological conditions that cause decreased sensation in the upper airway. Therefore the food or drink passes more easily into the lungs. 

8. Sinusitis 

Sinusitis is caused by the inflammation of the mucus lining of the sinus cavities. The symptoms can be persistent cough and thick yellow-green nasal discharges. In addition to chronic cough, it can also cause other symptoms such as bad breath, nasal drip, puffiness of the eyes, and low energy. 

9. Habit Cough 

This type of cough remains long after the original cause of the cough has resolved. The sound is different, and the “honking” sound stops when the child is distracted. 

Signs and Symptoms Chronic Cough in Kids 

Here are some of the frequently observed signs and symptoms of chronic cough in kids: 

• Runny nose and nasal congestion caused by phlegm 
• Shortness of breath caused by blocked nasal passages or inflammation 
• Wheezing – a high pitched sound that can be heard when the child breathes
• Post-nasal drip or the feeling that the child frequently feels like clearing the throat 
• Sore throat 
• Hoarseness of voice  

Chronic Cough Diagnosis 

The diagnosis of chronic cough is done through observational procedures and tests. They are as follows: 

• The doctor asks for the child’s medical history and the parents to look for underlying conditions that might give rise to chronic cough. 
• Observations regarding the duration of the cough, intensity of the cough, the characteristic sound are made. 
• They will ask the parents about the events leading up to the cough, the things that improve or worsen the cough, environmental factors, and the child’s health before the cough. 
• Imaging tests such as X-rays and CT scans may be performed to check for the health of the lungs and look for signs of pneumonia, lung infections, or sinus infections. 
• If asthma is suspected, pulmonary function tests such as spirometry may evaluate lung functioning. 
• The mucus would be tested for bacteria that can cause lung infections. 
• Bronchoscopy is an endoscopic technique used to look into the lungs using a small optical fiber endoscope containing a camera. The procedure would give the doctor a view into the lungs for diagnostic purposes. 

Medical Treatment for Chronic Cough in Kids 

Medical treatment for chronic cough involves treating the underlying condition that causes the cough. 

• Kids with asthma are treated with anti-inflammatory medication that aggressively treats the condition to ease the symptoms. 
• Acid reflux is treated using a combination of medication and posture improvements while feeding, sitting, and sleeping to reduce the chances of a spit-up. 
• Children who have sinusitis or respiratory tract infections are treated with antibiotics. 
• Nasal and airway blockages are treated decongestants to reduce postnasal drip and coughing. 

When to Call a Doctor? 

If the chronic cough is caused by seasonal allergies and appears to be getting better over time, it is not a cause to be alarmed. However, if the cough is accompanied by thick green mucus, fever, and lethargy, it is crucial to call the doctor. Breathing difficulties and vomiting after vigorous coughs are also warning signs that should not be ignored. 

Chronic cough can be a result of several underlying conditions. The treatment involves resolving the underlying condition or managing it to provide symptomatic relief. If the causes of chronic cough are seasonal allergies or infections, then it is possible to treat it at home. The sudden onset of the condition needs to be checked by a doctor. 

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