Chronic cough in children

A child coughing is not always a cause for concern. However, if your child has a persistent cough lasting longer than four weeks, it may be time to speak to a specialist.

What is a chronic cough?

The cough reflex is a vital protective action of the body to clear the airways of irritants and mucus.

A ‘dry cough’ is a tickly, irritating cough that does not produce any phlegm (thick mucus or sputum). A ‘chesty’ or ‘wet’ cough is a cough that is associated with the production of phlegm.

Most coughs clear up within three to four weeks and don’t require any treatment.

The most common definition of chronic cough in children is one that has lasted longer than four weeks.

What are the common causes of a chronic cough in children?

A chronic cough may be caused by a number of underlying health conditions.

Almost all health conditions affecting the upper respiratory tract (ear, nose and throat), larynx (voice box), airways and lung problems can lead to a chronic cough.

Common problems causing chronic coughs include:

• infection of the upper airways (such as cold, flu, laryngitis, sinusitis or whooping cough)
• infection of the lower airways (for example bronchiolitis, bronchitis, tuberculosis or pneumonia)
• asthma
• allergies including hay fever
• foreign body inhalation
• gastric reflux

Exposure to irritation in the form of chemicals and smoke is another possible cause, which it’s important to take into account when any child presents with a chronic cough.

What are the less common causes of paediatric chronic coughs?

In rare cases, a chronic cough can indicate the presence of very serious underlying problems, such as cystic fibrosis, congenital lung and airway problems, underlying immunity problems, or interstitial lung disease.

Occasionally, a chronic cough may indicate the presence of underlying psychological problems, or be the manifestation of tics (this is often referred to as a habit cough).

On some occasions, despite an extensive search, no underlying cause can be found. This is classed as a chronic refractory cough.

What should I do if I think my child has a chronic cough?

Because a chronic cough in a child is usually a symptom of an underlying health problem, it’s important that the issue is addressed promptly. If a cough has lasted more than four weeks, speak to your GP or a specialist to arrange a thorough assessment.

As well as identifying the cause of your child’s cough, this assessment looks to exclude potentially dangerous underlying health conditions.

With a long-lasting cough, delays in seeking medical help are often associated with delayed diagnosis and even permanent damage to the respiratory organs.

How will my child’s cough be diagnosed?

A senior paediatrician specialising in paediatric respiratory medicine (pulmonology) is usually best placed to arrange a comprehensive evaluation.

The evaluation will involve taking a detailed medical history, a thorough investigation, and a comprehensive set of investigations that usually include:

• imaging (X-Ray and CT scan of the chest)
• allergy and immunology investigations
• bronchoscopy (where a special camera is used to view the windpipe)

If necessary, we may advise other, more specialist investigations and tests too.

How is a chronic cough treated?

The best treatment for a chronic cough will depend on the underlying cause. For example, bronchitis and other treatable infections have very specific treatments that work to clear them. Asthma too has specific and very successful treatments available.

If the cough is caused by hay fever or other allergies, antihistamines, allergen avoidance and topical steroids remain the cornerstone of treating these issues.

Other underlying causes may need a coordinated approach from a number of professionals and specialities, including psychologists, dieticians and gastroenterologists.

If you are at all worried about your child’s cough, the best thing to do is get in touch with your paediatrician as soon as possible.