Has your child ever had a cough that just wouldn’t go away? Or maybe they seemed to get better, only to start coughing again, leaving you wondering if it’s the same illness or something new. Persistent coughs are common in children, especially after viral infections, but they can also be a sign of other underlying conditions. It’s helpful to understand the cause of your child’s cough and when it’s necessary to seek medical evaluation.
When is a cough considered chronic?
A cough is considered chronic if it lasts for more than four weeks in children or eight weeks in adults. While this might seem like an eternity, it’s important to remember that coughs are a typical part of many childhood illnesses, especially those involving the respiratory system. Most viral illnesses cause cough and congestion that worsen around days four to five of the illness and then gradually improve over the following weeks. If your child’s symptoms are improving, it’s generally okay to monitor the cough at home. However, if the cough persists beyond four weeks, it may be time to consider other potential causes.
Common causes of persistent coughs in children
Back-to-back illnesses: One of the most common reasons for a persistent cough in children is a series of back-to-back illnesses. Children, especially those in group settings like daycare or school, are frequently exposed to various viruses. It’s common for a child to catch one virus, start to recover, and then contract another, leading to a seemingly never-ending cough. In these cases, the cough lingers because the child is dealing with multiple illnesses back-to-back, making it seem like the cough never entirely goes away.
Asthma: Asthma is a prevalent cause of chronic cough in children of all ages. Typically, an asthma-related cough is dry, but if your child has a viral upper respiratory infection, the cough can sound wet. Asthma coughs often worsen at night or during physical exertion, and in some cases, the cough might be the only symptom of asthma. If your child’s cough is persistent, worsens when lying down, or is accompanied by wheezing or difficulty breathing, it’s important to consult your child’s clinician, as asthma might be the cause.
Allergies: Seasonal allergies can also trigger a persistent cough in children, usually due to increased congestion or postnasal drip. If your child’s cough is accompanied by other symptoms like itchy or watery eyes, sneezing, or a runny nose, seasonal allergies could be the cause. Some children may even experience both a viral infection and seasonal allergies simultaneously, complicating the diagnosis. A visit to your child’s clinician can help determine whether the cough is related to a virus, allergies, or a combination of both. This PedsDocTalk YouTube video has more information about seasonal allergies, including how they can be managed.
Habit or tic cough: A habit cough, also known as a tic cough, is a repetitive, persistent cough that often develops in children after a respiratory illness. It’s more common in children aged 4 to 18 and can worsen with anxiety or when attention is focused on the cough. The cough is typically dry and absent during sleep, but the child feels well between coughing episodes. Treatment for a habit cough usually involves reassurance, breaking the cycle with new habits, and positive reinforcement when the child isn’t coughing.
Gastroesophageal reflux disease (GERD): GERD, though less common, can cause a persistent cough in children. GERD occurs when stomach acid flows back into the esophagus, causing discomfort and sometimes triggering a cough. In infants, GERD may present with symptoms like fussiness during or after feeding, frequent spit-ups, or poor weight gain. This PedsDocTalk YouTube video has more information about infant spit-up vs. GERD. Older children might experience abdominal pain, chest pain after meals, or a dry cough that worsens when lying down. If GERD is suspected, your child’s clinician can offer guidance on management and treatment options. This PedsDocTalk YouTube video includes management tips for spit-up and GERD in infants.
When to seek medical evaluation
While many coughs can be monitored at home, there are specific signs and symptoms that warrant further medical evaluation. Keep an eye out for the following:
- Difficulty breathing: Signs include flaring nostrils, skill pulling in around the ribs, head bobbing with each breath, wheezing, noisy breathing, or a bluish tint around the lips or face.
- Wheezing: Any concern about wheezing should be evaluated by a healthcare professional.
- Persistent wet cough: A wet cough lasting more than four weeks should be assessed.
- Interference with daily activities: The cough affects your child’s ability to play, run, or engage in normal activities.
- Coughing up blood
- Barking or whooping cough: these types of coughs can indicate more serious conditions like croup or pertussis.
- Cough following choking: a chronic cough that begins after a choking episode should be evaluated for potential foreign body aspiration.
- Chronic cough with other concerning symptoms: weight loss, increased tiredness, or a noticeable decrease in appetite, etc.
Your child’s clinician may order tests like a chest x-ray or labs to rule out other causes of a chronic cough, such as foreign bodies, infections, or other underlying conditions.
A final note
Persistent coughs in children can be worrisome, but understanding the common causes and knowing when to seek medical help can give you the confidence to make informed decisions. Remember that while many coughs are related to viral illnesses and will resolve on their own, some may indicate underlying conditions that require further evaluation and management. By recognizing the signs and understanding the potential causes of a persistent cough, you can take proactive steps to support your child.
Watch the PedsDocTalk YouTube Video HERE!
