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.

What are the usual causes of 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. The important issues is to be sure that the child does not have a tonsillitis or a pneumonia or wheezing in the chest.

What is chronic cough?

Cough lasting for more than 4 weeks is defined as a chronic cough in children.

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, tuberculosis, etc.
  • Less common causes includes foreign body, cystic fibrosis, suppurative lung disease, congenital lung diseases, habit cough, etc.

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

  • Duration of cough >6 months
  • Daily moist or productive cough
  • Failure to thrive or child not gaining adequate weight
  • Low grade fever, weight loss, loss of appetite
  • Digital clubbing
  • Presence of blood in the sputum (Haemoptysis)
  • Recurrent pneumonia
  • Difficulty in breathing (dyspnoea) at rest or during exercise
  • Cardiac abnormalities (including murmurs)
  • Immune deficiency
  • Swallowing problems
  • On examination of chest presence of wheeze, crackles, differential breath sounds on the two sides of chest.

How do we evaluate 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, x-ray of sinuses and a spirometry (breathing test).
  • Some children might need further investigations like a CT scan of chest or sinuses, investigations for Gastro-esophageal reflux, flexible bronchoscopy, etc.

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