By Greg Dworkin, MD

Chronic Cough In Children

A chronic cough is one that lasts for more than two weeks. Unlike an acute cough, which is usually infectious and self-limited in nature, chronic coughs may indicate the presence of an underlying problem which is responsible for the cough.

The most common reason for a chronic cough in childhood is asthma. This recurrent airway problem is characterized by coughs that are triggered by colds, allergies, exercise, cold air, or exposure to cigarette smoke. The cough is usually worse at night, often between midnight and 5 am, and like most coughs, does not respond to cough medicine. There is often a family history of asthma or chronic bronchitis. In fact, chronic bronchitis in children is more often than not related to asthma (and some experts feel that chronic bronchitis in children is almost always asthma). Specific asthma medicines are needed to control an asthma cough.

The next most common reason for chronic cough in children is rhinitis and post-nasal drip. The suffix “itis” added on to an anatomical term indicates inflammation, and in the case of rhinitis, inflammation of the nose (as in “rhinoceros”). The timing of this cough is often at bedtime and upon awakening. The underlying culprit here is often allergies, and both allergy testing and anti-inflammatory nasal sprays may be recommended by your doctor.

Less common than either asthma or rhinitis, gastroesophageal reflux may also cause chronic cough. While you may think of this as common “heartburn,” the stomach acid that refluxes back into the esophagus may cause irritation that in turn can cause either pain or cough. This cough is unresponsive to asthma or rhinitis medicines, and may require the reflux to be brought under control (usually with medication) before the cough goes away.

Although the above three entities are responsible for most chronic coughs, one other infectious illness should be mentioned. Pertussis, or whooping cough, is still prevalent in our community, and can cause a paroxysmal cough which can affect any age child or young adult, and which can last up to three months. In an earlier era, this was known as the “100 Day Cough,” because that is how long the cough can last. Immunization against pertussis (the P in the DPT shot) protects infants from getting a severe case when they are most vulnerable, and should be recommended for everyone with rare exception. Your doctor can culture your child if pertussis is suspected.

Treating chronic cough can be very rewarding once the underlying problem is identified, and nighttimes are certainly more pleasant for everyone once your child stops coughing. If you have questions about your child’s cough, ask your doctor or medical caregiver for advice.

Dr Dworkin is a pediatric pulmonologist at Danbury Hospital and medical advisor to the Open Airways program.