Children's Cough: Causes and Treatments

  • Medical Author:
    John Mersch, MD, FAAP

    Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.

  • Medical Editor: David Perlstein, MD, MBA, FAAP
    David Perlstein, MD, MBA, FAAP

    David Perlstein, MD, MBA, FAAP

    Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.

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What are the common causes of chronic cough in children?

Many of the causes (etiologies) of acute cough discussed above may also persist greater than four weeks and thus be classified as chronic cough. Two causes of acute cough which generally have a shorter than four week lifespan include: upper repsiratory infections (generally a maximum of 2 week duration) and croup (generally 4 to 6 day duration). Some studies have estimated that 5% to 7 % of preschoolers and 12 to 15 percent of older children may have chronic cough. Males are more likely to have chronic cough than female,s and chronic cough is more likely in underdeveloped countries than in those more affluent.

Causes of chronic cough (in addition to those listed above for acute cough) include:

  1. Irritation of the airways: pollution, primary or secondhand smoke, and an allergen may also produce persisting cough. Elimination or reduction of the offending irritant is therapeutic.
  2. Increase in cough receptor sensitivity: Some children seem to have a more sensitive response to irritants than their peers. The mechanism for this increase in cough receptor sensitivity is not well defined at this time. Possibilities under consideration include inflammation, erosion of the surface cell layer of the airway or a sensitization of the airway. The diagnosis may be explored in research centers using a cough-inducing irritant (capsaicin) as a quantifiable stimulant. Interpretation of such data is in the infancy stage.
  3. Habit cough: This cough has both a psychological and physical component. While often triggered by the common upper repsiratory infection, the duration of cough symptoms far exceeds the duration of the viral infection. Parents will describe a distinctive quality of cough: short, dry, single episodes that may mimic a benign motor tic (see above). Unlike a tic, the cough may be quite loud and disruptive to the classroom setting. The cough is commonly present during a medical evaluation but it does not characteristically interfere with play, sleep, talking, or eating. No specific diagnostic evaluation exists and habit cough is a diagnosis of exclusion. Counseling is generally an effective management technique.
  4. Otogenic cough: A minority of individuals have a branch of the nerve used in the cough reflex lining the ear canal. Irritation of the canal (Q-tips, ear wax [cerumen], etc.) may cause irritation of this nerve and thus induce a persisting and non-productive cough. While this is a relatively rare cause of children's cough, removal of the offending agent is curative.
Medically Reviewed by a Doctor on 3/15/2016
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