Chronic Cough

Causes of Chronic Cough in Children

• Asthma
• Allergic rhinitis and rhinosinusitis (Upper airway cough syndrome)
• Anatomical abnormalities of airway
• Gastroesophageal Reflux Disease (GERD)
• Foreign Body Aspiration
• Protracted bacterial bronchitis
• Post viral cough may sometimes last beyond 3 weeks
• Habit cough
• Chronic suppurative lung diseases- cystic fibrosis, primary ciliary dyskinesia (less common)

In addition to the persistent cough, children may experience other associated symptoms that can help pinpoint the cause. These can include:

• Wheezing or laboured breathing
• Runny nose or nasal congestion, particularly if caused by allergies or sinusitis
• Chest tightness or discomfort
• Reflux, particularly after a heavy meal
• History of sudden choking

Red flags that must alert parents to seek urgent medical attention:

• Persistent wet cough
• Poor weight gain
• Blood in sputum
• Bluish discolouration of skin or nails
• Coughing or choking while feeding
• Repeated infections at other sites e.g loose stools, boils on skin etc.

Evaluating chronic cough in children

Diagnosing the cause of chronic cough in children typically involves a comprehensive medical evaluation, which may include:

1. Detailed medical history and physical examination
2. Chest X-rays ± CT scan of the chest 
3. Pulmonary function tests (PFTs) such as spirometry measure lung function and help to identify the type of problem.
4. Allergy testing: Skin tests or blood tests can identify specific allergens contributing to the child’s symptoms.
5. pH probe or endoscopy: If GERD is suspected, a pH probe or upper gastrointestinal endoscopy may be performed to assess the presence of acid reflux.

Treatment of Chronic Cough in Children
Treatment depends on the underlying cause. Parents should seek medical advice if their child’s cough persists for more than a few weeks or is accompanied by other concerning symptoms.