Chronic Cough

Cough is a symptoms and not an illness in itself. It occurs due to some irritation from causes anywhere along the respiratory tract staring from the nose, sinuses, throat, wind pipe, small airways to the lung spaces called as alveoli.

Cough in children usually is acute and short lasting for 5-10 days.

What are the common causes acute cough in children?
Viral respiratory tract infections are very common in children and are the leading cause of cough. It usually presents with a cold, runny nose and some fever along with cough. This episode usually lasts for 5-7 days. No specific treatment is required.

Sometimes children can have cough due to tonsillitis, pneumonia or wheezing.

What is chronic cough?
Cough lasting for more than 4 weeks is called as chronic cough.

What are the causes of chronic cough in children?

  • The causes of chronic cough in children are different from adults. The more common causes are asthma, post nasal drip, whooping cough, and tuberculosis.
  • Less common causes includes foreign body aspiration, cystic fibrosis, suppurative lung disease, congenital lung diseases, habit cough, etc. Children with these less common causes often have certain red flag signs or indicators of a possible serious cause of chronic cough.

What are the red flag signs or indicators of a possible serious cause of chronic cough?

  • Duration of cough >6 months
  • Daily moist or productive cough
  • Child not gaining adequate weight or weight loss
  • Presence of blood in the sputum (Haemoptysis)
  • Recurrent pneumonia
  • Difficulty in breathing (dyspnoea) at rest or during exercise
  • Recurrent infections at other body sites like skin, abdomen etc.
  • Swallowing problems
  • Chest Xray showing patches or pneumonia

How do we investigate a child with chronic cough?

  • Initially we would take a detailed history and examine the child. This would be followed by review of all old records and chest xrays if any.
  • Initial investigations would include a chest x-ray (if not already done), x-ray of sinuses and a spirometry/lung function tests.
  • Some children might need further investigations like a CT scan of chest or sinuses, investigations for Gastro-esophageal reflux, flexible bronchoscopy, sweat chloride test, etc.

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