7 questions about coughing with a pediatric pulmonologist

If your kiddo has a cough they can’t seem to kick, they’re in good company.

“We see tons of kids in our clinic for chronic cough. It can be really tough for families to see, and hear, their children coughing for weeks on end,” said Dr. Drew Barber, pulmonologist.

Why is chronic cough so common and when should kids see a doctor? Dr. Barber explains.

What is a chronic cough?

We typically characterize chronic cough as a cough lasting 4 weeks or longer.

What causes chronic cough in kids?

There are numerous causes of chronic cough in children. One reason it’s so common is that kids frequently get viral infections (colds, flu, etc.), especially if they’re in school or daycare. These viral infections often occur back-to-back, particularly in the fall and winter, which can make a cough linger much longer than anticipated.

Another reason we see so many kids with chronic cough is because it can be a sign of asthma, which is a common condition in children. There are several other conditions that can cause a chronic cough, including:

• Protracted bacterial bronchitis – infection producing increased mucus
• Aspiration – a foreign body breathed into the lungs
• Reflux – stomach acid backing up into the throat
• Primary ciliary dyskinesia – defect in the tiny structures that move fluid/particles through the airways
• Cystic fibrosis – disease that causes sticky, thick mucus

When all are considered together, it’s no wonder these ongoing coughs can be so common.

Why doesn’t cough medicine help a chronic cough?

Viral infections are the most common reason for kids’ coughs, and there are no medications that have been shown to help a cough due to a viral illness. Over-the-counter cough medicines don’t make any difference, which can be frustrating for families who want their kids to feel better quickly.

The key to determining whether another medication may help or not is to determine the underlying cause of the cough. If the cough is due to viral infections alone, there are no medications that will help and we need to wait for the child to recover from the virus. If the cough is caused by asthma, a “controller” inhaler may help. There are various other treatments that can be helpful for other underlying causes of cough.

When do you recommend families seek medical attention for their child’s cough?

I recommend seeking medical advice if your child has a cough that’s persistent and lasting longer than 4 weeks. It’s also important to check in with a health care provider if your child has associated symptoms like wheezing, difficulty breathing or exercise intolerance. We always want to address issues that impact the ability to breathe.

Coughs sometimes raise questions of pneumonia. When is this a concern?

I’ll typically think more about the possibility of pneumonia if a child also has a fever, along with other symptoms such as fast breathing and/or chest pain. It’s appropriate to keep an eye on this at first, but again, if there are any signs of respiratory distress you want to seek medical care right away. For the fever component, if it’s going on longer than 3 days, it’s a good idea to have your child evaluated by their pediatrician.

When families come to you, how do you get to the bottom of what’s causing their child’s cough?

My approach is first to get a detailed history and physical exam. I ask various questions to determine the quality, timing and frequency of the cough. Some clues that the cough may be asthma related include a family history of asthma (in an immediate family member), a personal history of eczema or allergies, a dry cough, frequent nighttime cough even when not sick (i.e., no runny nose or other signs of illness), a history of wheezing and/or improvement with steroids. Other characteristics can point us toward another diagnosis – for example a persistent, daily wet cough for more than 4 weeks could suggest protracted bacterial bronchitis. In kids who are old enough (typically 5 years old or older) we often do lung function testing, which can sometimes help point us toward a specific cause.

Is there anything you recommend families doing or NOT doing to help a child’s cough until it gets better or they see a doctor?

The usual supportive care measures we provide our kids when they’re sick, such as making sure they’re staying hydrated and getting plenty of rest, are good in the case of cough as well. For kids older than one year of age, a small amount of honey can help soothe a sore throat from cough while waiting for a viral illness to run its course or for a diagnosis of another cause. Honey should NOT be given to children younger than one due to the small but serious risk of botulism infection.

I do not recommend treating kids with cough suppressants. There is no good evidence that they help in any way.

Find out about all the care available for kids with respiratory conditions at CHoR.