Children's Cough: Causes and Treatments
John Mersch, MD, FAAP
Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
David Perlstein, MD, MBA, FAAP
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
- What is a cough?
- What are the common causes of acute cough in children?
- What are the common causes of chronic cough in children?
- How is the cause of childhood cough diagnosed?
- What are the various therapies and home remedies for childhood cough?
- When should I contact my doctor for childhood cough symptoms?
- Find a local Doctor in your town
What is a cough?
A cough is a critical reflex action designed to promote clearing of the upper airways. The material being coughed up may be as a consequence of many conditions - from a lung or sinus infection to an accidentally inhaled foreign object (for example, food or small toy). A cough may also be a symptom of compromised lung function (for example, wheezing) or reflect rare conditions (for example, anatomical malformations).
All children will cough occasionally but recurrent cough, difficulty breathing with cough or coughing up purulent or bloody material warrant a thorough and timely evaluation. A "wet" or "mucousy" cough will sound different than a "dry" or "scratchy" cough or a "barky" ("sounds like a seal") cough. It may be helpful to record the cough prior to an appointment with a child's doctor since a "picture" may be worth a thousand words.
Most pulmonary specialists will categorize cough symptoms as "acute" - those lasting less than four weeks vs. "chronic" - those lasting longer than four weeks.
What are the common causes of acute cough in children?
Since children's cough may be associated with a broad array of situations, it is helpful to consider possible causes under various categories. These would include:
- The number one cause of cough in children would the common cold (URI - upper respiratory infection). Generally this cough is secondary to drainage of mucous down the back of the throat, thus stimulating the cough reflex center. Most children less than eight years of age cannot "cough up" this material efficiently. Generally their cough pushes the drainage from one area of the back of the throat to another. Children commonly will swallow the mucous after coughing and during sleep. Children have been known to cough with such force that they may vomit up previously swallowed mucoid material.
- Irritation and swelling of the vocal cord region caused by a viral infection may produce a characteristic "barky" cough (sounding similar to that of a seal). Such a viral infection is termed croup.
- A sinus infection is generally a complication of a URI and may be associated with consistent thick and purulent (green or yellow) nasal drainage either onto the facial region or down the back of the throat. This drainage will also stimulate the cough center as described above.
- Lower airway infections (i.e. those inside the chest cavity) include viral illnesses (pneumonia, bronchitis, etc.) or bacterial causes (pneumonia, pertussis whooping cough), etc.).
The amount of watery nasal drainage produced as a consequence of nasal allergy may be considerable. The material may commonly drain down the back of the throat ("post nasal drainage") and trigger the cough center in the rear of the throat.
Any object that does not pass from the back of the mouth into the esophagus runs the risk of aspiration into the windpipe (trachea). This is most common in young toddlers due to their infatuation with smaller objects and their intense oral fixation. Any object that can pass through the opening of a vertically oriented toilet paper cardboard tube is considered a risk object. Older children or adults who incompletely chew food prior to swallowing may also aspirate material. Effective emergency treatment of such a situation may be learned in CPR classes commonly taught by either the Red Cross or your local hospital.
Narrowing the functional diameter of the smaller airways make it difficult to breath (exhalation worse than inhalation) and can cause a characteristic sound during respiration. Wheezing is a consequence of two phenomena - narrowing the airway secondary to tightening of the muscles that wrap around this lung region, as well as thickening of the lining of the airway as a consequence of inflammation. In children the most common trigger to produce these reactions is the virus that causes the common cold (URI). Certain viruses (for example, respiratory syncytial virus
Gastroesophageal reflux disease (GERD)
Regurgitation of stomach contents and/or acid may trigger a reflex cough and should be considered when the more common causes of cough have been eliminated. This is more common in infants and young children. These young children and infants may not have obvious spitting up of liquids or solids during such episodes; however, they become very irritable during such events.
Benign motor tic
Children may occasionally have repetitive throat clearing as manifestation of a tic. They do not seem to be in any distress during these episodes and the child may stop them voluntarily and they do not occur during sleep. Parents will often describe such cough as "she has a tickle in her throat".
Various rare causes of cough need to be considered when the more obvious or routine mechanisms have been eliminated. A partial listing includes: cystic fibrosis, congenital heart disease, heart failure, congenital malformations of the airway, lungs or major blood vessels of the chest, etc.
Find out what women really need.