When Your Child’s Cough is No Longer Just a Cough

By Fairfax Neonatal Associates

Coughing is the most common symptom leading to medical office visits in pediatrics. It typically is self-limiting and caused by a respiratory virus, although it can often be a sign of underlying illness. What are some signs that your child’s cough needs to be evaluated further?

It is helpful to think of a cough in terms of the age of the child. The most common causes are different in newborns, toddlers, and adolescents. The nature and pattern of the cough, as well as the presence or absence of associated symptoms, will also help identify the cause of the cough.

Most children acquire at least 3-4 respiratory tract infections per year, and the cough can often linger up to 2 weeks with a standard viral infection. As these infections typically cluster during the fall/winter months, the cough can seem never-ending; but in actuality, the persistent cough represents a repeated pattern of viral infection. A young child in preschool during the winter months is a great example of this.

At times a prolonged cough, even in the setting of repeated infections, is a sign of an underlying process. Common causes of recurrent/persistent cough include asthma, upper airway cough syndrome, and protracted bacterial bronchitis. Less commonly, gastro-esophageal reflux, issues with the immune system, or structural airway lesions can be the culprit.

Typically, with asthma, there are patterns that suggest it as the cause. A cough that worsens with exertion, cold air, or allergic exposures is a common clue. Often with colds, there is a very prolonged pattern of cough, and a common quote from parents is, “Whenever he/she gets anything, it goes straight to the chest.” An asthmatic cough responds very well to as-needed inhalers, but often requires maintenance medicine to keep it at bay.

Upper airway cough syndrome is more commonly referred to as post-nasal drip. This can be caused by allergic or non-allergic rhinitis (nasal inflammation) and by chronic sinus disease. Nasal congestion, runny nose, and headaches are common co-complaints, and most often, the cough is worsened when lying down. Controlling the nasal symptoms with environmental modifications or nasal medicines often resolves the cough. Protracted bacterial bronchitis is something to consider if the cough is persistently wet-sounding and doesn’t respond to other therapies. Typically, there is a pattern of noisy breathing rather than classic wheezing.

Signs to look out for that the cough should be evaluated sooner rather than later are coexistent issues with difficulty gaining weight, impaired exercise tolerance, and a pattern of recurrent illnesses that continue to require antibiotics. Paying close attention to the cough pattern, and even at times keeping a cough journal, is a very helpful way to work with your healthcare provider in narrowing down the cause of the cough and identifying the best treatment strategy.

A pediatric pulmonologist can work with you and your primary care physician for coughs that are more difficult to figure out.