A chronic cough is typically defined as one that lasts more than four weeks. "It's the single most common reason that parents call my office for a new-patient evaluation," says Ray S. Davis, M.D., professor of clinical pediatrics in the division of allergy immunology and pulmonary medicine at Washington University School of Medicine in St. Louis. So what causes a chronic, persistent cough in children? We’ve broken down seven possible triggers and explained treatment options for each one.
After an evaluation of chronic cough in children, doctors will say the most common cause is an upper-respiratory infection from one of more than 100 cold viruses. "Children typically get about eight to ten colds a year and most last five to seven days,'' says William Berger, M.D., clinical professor in the department of pediatrics at the University of California, Irvine, and a Parents advisor. "Since kids are constantly swapping germs, it may seem like the same cold and cough is going on forever, when it's more likely that your child has a new cold and cough, back to back."
Symptoms: Your child may have a mild fever from the virus and develop a cough, explains Dr. Berger. As congestion builds and mucus drips down the throat, some kids can't cough it out, so they swallow it instead. All that mucus can also upset a child's stomach or trigger the gag reflex, which can cause her to throw up. He adds that the cough may last much longer than the runny nose after a common cold.
Treatment: In most cases, a cold needs to run its course. The American Academy of Pediatrics does not recommend cough and cold medications for kids under 6. Instead, try the following home remedies for chronic cough in children from a cold:
- Give your child lots of fluids like water, warm decaffeinated tea, and even popsicles. Stay away from carbonated drinks or citrus juice, which can irritate the throat.
- Turn on a cool-mist humidifier or vaporizer at night; the moisture will help open his airways.
- Use saline nasal spray or a suction syringe to clear nasal congestion.
- For children over 1 year old, offer 1/2 to 1 teaspoon of honey in tea or on toast as needed to help loosen the cough.
"Parents often worry when a cough is persistent, especially when it sounds harsh," explains Carrie Quinn, M.D., a pediatrician at the Kravis Children's Hospital at Mount Sinai in New York City. "But there are questions you should ask to determine how serious the cough is. Is he playing normally or is he lethargic? How is he eating?" See a doctor if the cough is lingering after two to three weeks, or if your child experiences breathing difficulties, vomiting, or a spike in fever.
If a chronic cough in children lasts more than ten days and shows no signs of getting better, and your child's nasal discharge is thick and yellowish-green, he may have sinusitis. This is an inflammation of the mucus lining of the nose and sinuses. It creates pockets of air along the brow, cheekbones, and the nose—and as congestion builds, sinuses become a breeding ground for bacteria.
Symptoms: In addition to a chronic cough, sinusitis may cause postnasal drip, bad breath, low energy, and puffiness and dark circles around the eyes. Older children also may complain of headache. Even a low-grade sinus infection can cause a seemingly never-ending persistent cough in children.
Treatment: Your primary-care doctor may prescribe an antibiotic to zap the infection and nasal sprays to ease symptoms. If your child doesn’t seem better after a few days, she may need another round of antibiotics or a different medication. Acetaminophen, ibuprofen, and/or warm compresses can help with headaches or facial pain. Your doctor may refer you to an otolaryngologist, who can examine your child's ears, nose, and throat with special instruments to see what's going on. He'll also be able to notice any structural issues, such as a deviated septum, that can make a child more susceptible to sinus problems.
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Allergies could be the culprit if the cough is accompanied by a drippy nose and itchy eyes—or if it arrives around the same time every year, or after each visit to Grandma and her two dogs. They’re simply the body's overreaction to a substance (allergen) that's usually harmless to most people. Allergic rhinitis can be seasonal (possibly caused by pollen from trees, weeds, grasses, and outdoor molds) or perennial (from year-round indoor allergens such as pets, dust mites, and indoor molds).
Symptoms: Allergens trigger the release of histamine and other biochemical substances, which cause inflammation and congestion, chronic postnasal drip, and a persistent cough in children.
Treatment: Saline nasal spray or an over-the-counter antihistamine may help dry up nasal secretions. If that doesn't work after a day or two, your doctor may prescribe corticosteroid or antihistamine nasal sprays. Stay away from over-the-counter decongestants and cough medicines: Although persistent cough can be a hallmark of nasal allergies, experts say there is no proof that the medications are effective in relieving a cough and may sometimes make symptoms worse.
If you suspect seasonal allergies are the trigger, try to keep your child inside during morning hours when pollen counts are highest. To combat a dust-mite allergy, there are several things you can try to allergy-proof your home:
- Buy a polyester/fiberfill pillow—not one with down feathers.
- Cover pillows and mattress in dust-mite-proof covers.
- Wash bed linens weekly.
- Clean stuffed animals often.
- Run an air conditioner instead of a fan.
- Use a dehumidifier (clean the filters regularly!)
- Don't smoke. Even if you smoke outside your home, the fumes stay on your clothes and will irritate a cough. Ditto for electronic cigarettes or vape pens.
If none of these remedies work, you should see an allergist/immunologist for a kid-friendly scratch test to determine precisely what's triggering the chronic cough. Left untreated, nasal allergies can lead to chronic sinusitis, ear infections, sleep disorders, and asthma, and may affect speech and language development as well. If your child is older than 5 and has not responded to traditional therapies, the next best option may be immunotherapy—a course of shots (for up to several years, depending on how well your child responds) that slowly bolsters the immune system's ability to fend off allergy symptoms.
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Asthma is a respiratory condition affecting the tiny airways in the lungs, and it’s a common trigger of chronic cough in children. Symptoms can be brought on by an upper-respiratory infection, inhaled allergens, irritants such as secondhand smoke, cold and dry air, exercise, and even a temper tantrum.
Symptoms: Your child may wheeze or have shortness of breath, a tight feeling in his chest, or a cough. However, not every child with asthma wheezes. Many only have a chronic cough, which doctors typically refer to as cough-variant asthma. This can go unrecognized for years because standard diagnostic tests that measure lung capacity may turn out normal or the child may be too young (under 6) to properly perform the breathing test. "If a mother tells me her child gets one cold after another that settles in his chest and leads to recurrent bouts of croup or bronchitis, often the underlying cause of all that misery is cough-variant asthma," says Dr. Davis.
Treatment: Your doctor will ask for a history of your child's symptoms (eczema and recurrent ear infections as a baby are clues) as well as your family's medical history. If your child is old enough, the doctor may perform pulmonary-function tests to make sure his lungs are healthy. Pay attention to what sets off the cough: Does allergy season do it? Is he out of breath barely five minutes into his soccer game? Does he wake up coughing in the middle of the night? Taken together, all of these signs make a doctor suspicious of asthma.
Whether it's classic asthma or cough-variant, it usually responds to the same treatments: bronchodilator and/or anti-inflammatory medications. One is a "rescue" medication for the moment an attack (or coughing fit) begins, and the other is a daily "controller" medication to keep the disease under control.
Whooping cough (pertussis) is a highly contagious bacterial illness of the airways and lungs.
Symptoms: Whooping cough starts with cold-like symptoms (runny nose and sneezing) followed by short bursts of uncontrollable coughing that sometimes end with an unmistakable whoop. Children may throw up and turn blue as they struggle for air. "It's often known as the 100-day cough," says Dr. Berger.
Treatment: Call the doctor ASAP, since your child needs antibiotics. They're most effective when given in the first seven days of infection—but can also be given to other family members at a later point to prevent the disease from spreading. Older children and adults with pertussis may have only a mild cough, but pertussis can cause life-threatening complications in babies who are too young to be vaccinated or haven't had all doses of DTaP (a vaccine that also protects against tetanus and diphtheria). Adults who work closely with infants should get Tdap, the whooping cough booster, and pregnant women must get Tdap between the 27th and 36th week of each pregnancy.
When acid from the stomach backs up into a child's throat due to weak esophageal or stomach muscles, the result can be GERD (gastroesophageal reflux disease).
Symptoms: Babies can't tell you they have heartburn, but GERD can make them spit up, gag, or act fussy during feedings. Older kids may wheeze and cough—especially at night when they're lying down—or complain of pain in the chest or throat. GERD is usually diagnosed based on a history of symptoms and trial-and-error lifestyle changes, but it may require a consultation with a pediatric gastroenterologist.
Treatment: Keep babies upright for 30 minutes after feeding and elevate the head of a child's mattress while she sleeps to minimize chronic coughing. For older kids, cut back on foods that typically set off symptoms of GERD, such as citrus fruits, tomatoes, chocolate, peppermint, and anything spicy. Keep a record of what your child eats to see whether there's a correlation. Try not to feed older kids right before they go to bed and cut back on foods known to trigger the condition.
Tic or “Habit Cough”
A “habit cough” is particularly difficult to diagnose and treat. It's usually mentioned after all other reasonable diagnoses have been excluded. Your child may have had a cold or flu that left her with a telltale cough. Even though the cold is gone, the cough isn't—except when she's sleeping. "Your child probably isn't doing this on purpose," says Dr. Berger. "She may tell you she feels a tickle in her throat, or not even realize she's coughing." Sometimes, the tic is anxiety-driven and can become habitual. In other cases, kids just get in the habit of coughing to clear their throat. If they get attention for it, they keep it up.
Treatment: Simply reassuring a child that she's no longer sick might be enough. (You may need to get your doctor to say this.) However, the act of coughing itself can irritate the throat and lead to a cycle of more coughing. To break it, offer a sip of water, a lollipop, or, for older kids, a cough drop to help suppress the urge to cough. Praise and positive reinforcement when she does resist coughing may help. Some pediatric pulmonologists teach relaxation therapy to control tics. If nothing works, consult a child therapist to see if an underlying issue—perhaps a school phobia, shyness, bullying—is bothering her.
Who Can Help a Chronic Cough in Children?
Your primary-care physician is your first stop for diagnosing and treating most coughs. She'll recommend a trial of OTC and Rx medications, or she’ll refer you to one of the following specialists.
An Allergist. She can administer skin tests to pinpoint what your child is allergic to. Still inconclusive? The doctor may order a chest X-ray or lung-function test to measure the pattern of airflow in and out of the lungs, or refer you to a pulmonologist for a closer look at the lungs.
An Otolaryngologist (ENT). After taking a detailed history, the ear, nose, and throat specialist will examine your child's nose and sinus cavities. He may need to surgically correct chronically infected tonsils, adenoids, or sinuses.