Chronic cough is defined as cough which occurs every day for a duration more than 3 to 4 weeks. It is a very common symptom in children. Most of the times, cough is not due to any serious or worrisome illnesses, however it can be irritating and can interfere with the childâ€™s normal activities and could be a challenge to treat. It is a common and could be the only manifestation of asthma or hyper reactive airway disease. With this overview, we will discuss the likely diagnoses when children, who otherwise appear to be healthy, have troublesome coughing.
It is most important to define the severity of cough precisely and objectively. This could be done as follows:
To give an example, one could have a 6 year old male child with symptoms of cough which occur in bouts lasting 2 to 3 minutes, averagely 5 to 6 times a day, almost daily for the previous 20 days. These are more at night time but not associated with any food intake. Child does not have any wheezing or fever. So the most likely diagnosis becomes an allergic cough. If there is a history of repeated such episodes especially associated with seasonal change then the diagnosis is an allergic cough likely childhood asthma. If associated with frequent episodes of running nose or sneezing, it would mean childhood asthma with allergic rhinitis.
|Isolated cough: otherwise healthy child||Isolated cough : significant underlying cause|
|Recurrent viral bronchitis||Chronic suppurative lung disease|
|Post-infectious cough||Cystic fibrosis|
|Pertussis-like illness||Immune deficiencies|
|Cough variant asthma||Primary ciliary dyskinesia|
|Postnasal drip||Recurrent pulmonary aspiration|
|Psychogenic cough - Habit (â€śticâ€ť like); Bizarre honking cough||Retained inhaled foreign body|
|Gastro-oesophageal reflux||Chronic bronchitis|
|TOF=tracheo-oesophageal fistula.||Airways lesion|
|Compression, e.g. tuberculous gland|
|Malacia, often with viral infection, e.g. TOF cough|
Viral infections, asthma and post infectious cough are the most common causes of isolated cough episodes. Cough could be psychogenic if the child is under any form of stress and needs immediate care and attention. Cough with expectoration could mean serious underlying diseases like cystic fibrosis. Tuberculosis is an important cause of chronic cough and needs to be ruled out.
In case your infant or child has chronic cough, do consult your pediatric pulmonologist for a complete checkup and investigations, and appropriate treatment.