7 Causes of Chronic Cough in Children

A chronic cough is typically defined as one that lasts more than four weeks. "It's the single most common reason that parents call my office for a new-patient evaluation," says Ray S. Davis, M.D., professor of clinical pediatrics in the division of allergy immunology and pulmonary medicine at Washington University School of Medicine in St. Louis. But what causes persistent coughs in children, particularly when no other symptoms are present? We've broken down seven possible triggers and explained treatment options for each one.

What Is a Chronic Cough?

As mentioned, a chronic cough is any type of cough which lasts more than four weeks. These coughs tend to be persistent and (in some cases) medication-resistant. They can occur with other symptoms—or in lieu of them—and chronic coughs, particularly in children, can be problematic, interrupting sleep patterns and daily lives.

What Causes Chronic Coughs In Children?

There are many reasons why your child may be coughing. Here, we've broken down a few of the most common causes.

Common Cold

The most common reason for chronic coughs in children are upper-respiratory infections. These can be caused by one of more than 100 cold viruses. "Children typically get about eight to ten colds a year, with most lasting five to seven days,'' says William Berger, M.D., clinical professor in the department of pediatrics at the University of California, Irvine. "Since kids are constantly swapping germs, it may seem like the same cold and cough is going on forever, when it's more likely that your child has a new cold and cough, back to back."

Symptoms: Your child may have a mild fever from the virus and develop a cough, explains Dr. Berger. As congestion builds and mucus drips down the throat, some kids can't cough it out, so they swallow it instead. All that mucus can also upset a child's stomach or trigger the gag reflex, which can cause them to throw up. He adds that the cough may last much longer than the runny nose after a common cold.

Treatment: In most cases, a cold needs to run its course. The American Academy of Pediatrics does not recommend cough and cold medications for kids under 6. Instead, try the following home remedies for chronic cough in children from a cold:

• Give your child lots of fluids like water, warm decaffeinated tea, and even popsicles. Stay away from carbonated drinks or citrus juice, which can irritate the throat.
• Turn on a cool-mist humidifier or vaporizer at night; the moisture will help open his airways.
• Use saline nasal spray or a suction syringe to clear nasal congestion.
• For children over 1 year old, offer 1/2 to 1 teaspoon of honey in tea or on toast as needed to help loosen the cough.

"Parents often worry when a cough is persistent, especially when it sounds harsh," explains Carrie Quinn, M.D., a pediatrician at the Kravis Children's Hospital at Mount Sinai in New York City. "But there are questions you should ask to determine how serious the cough is. Is he playing normally or is he lethargic? How is he eating?" See a healthcare professional if the cough is lingering after two to three weeks, or if your child experiences breathing difficulties, vomiting, or a spike in fever.

Sinusitis

If your child can't stop coughing and said cough lasts more than ten days, they may have sinusitis. This is an inflammation of the mucus lining of the nose and sinuses. It creates pockets of air along the brow, cheekbones, and the nose—and as congestion builds, sinuses become a breeding ground for bacteria, which results in a persistent cough and thick, yellowish-green nasal discharge.

Symptoms: In addition to a chronic cough, sinusitis may cause postnasal drip, bad breath, low energy, and puffiness and dark circles around the eyes. Older children also may complain of headache. Even a low-grade sinus infection can cause a seemingly never-ending persistent cough in children.

Treatment: A primary care doctor may prescribe an antibiotic to zap the infection and nasal sprays to ease symptoms. If your child doesn't seem better after a few days, they may need another round of antibiotics or a different medication. Acetaminophen, ibuprofen, and/or warm compresses can help with headaches or facial pain. A primary care provider may refer you to an otolaryngologist, who can examine your child's ears, nose, and throat with special instruments to see what's going on. They'll also be able to notice any structural issues, such as a deviated septum, that can make a child more susceptible to sinus problems.

Allergies

Allergies could be the culprit of your child's cough if it is accompanied by a drippy nose and itchy eyes or if it arrives around the same time every year, or after each visit to Grandma and her two dogs. They're simply the body's overreaction to a substance (allergen) that's usually harmless to most people. Allergic rhinitis can be seasonal (possibly caused by pollen from trees, weeds, grasses, and outdoor molds) or perennial (from year-round indoor allergens such as pets, dust mites, and indoor molds).

Symptoms: Allergens trigger the release of histamine and other biochemical substances, which cause inflammation and congestion, chronic postnasal drip, and a persistent, chronic cough in children.

Treatment: Saline nasal spray or an over-the-counter antihistamine may help dry up nasal secretions. If that doesn't work after a day or two, a health care provider may prescribe corticosteroid or antihistamine nasal sprays. Stay away from over-the-counter decongestants and cough medicines: Although a persistent cough can be a hallmark of nasal allergies, experts say there is no proof that the medications are effective in relieving a cough and may sometimes make symptoms worse.

If you suspect seasonal allergies are the trigger, try to keep your child inside during morning hours when pollen counts are highest. To combat a dust-mite allergy, there are several things you can try to allergy-proof your home:

• Buy a polyester/fiberfill pillow—not one with down feathers.
• Cover pillows and mattress in dust-mite-proof covers.
• Wash bed linens weekly.
• Clean stuffed animals often.
• Run an air conditioner instead of a fan.
• Use a dehumidifier—and clean the filters regularly!
• Don't smoke. Even if you smoke outside your home, the fumes stay on your clothes and will irritate a cough. Ditto for electronic cigarettes or vape pens.

If none of these remedies work, you should see an allergist/immunologist for a kid-friendly scratch test to determine precisely what's triggering their cough. Left untreated, nasal allergies can lead to chronic sinusitis, ear infections, sleep disorders, and asthma, and may affect speech and language development as well. If your child is older than 5 and has not responded to traditional therapies, the next best option may be immunotherapy—a course of shots (for up to several years, depending on how well your child responds) that slowly bolsters the immune system's ability to fend off allergy symptoms.

Asthma

Asthma is a respiratory condition affecting the tiny airways in the lungs, and it's a common trigger of chronic coughs in children. Symptoms can be brought on by an upper-respiratory infection, inhaled allergens, irritants such as secondhand smoke, cold and dry air, exercise, and even a temper tantrum.

Symptoms: Your child may wheeze or have shortness of breath, a tight feeling in his chest, or a cough. Typically, children with asthma cannot stop coughing. However, not every child with asthma wheezes or gasps for air. Many only have a chronic cough, which doctors typically refer to as cough-variant asthma. This can go unrecognized for years because standard diagnostic tests that measure lung capacity may turn out normal or the child may be too young (under 6) to properly perform the breathing test. "If a parent tells me that their child gets one cold after another that settles in their chest and leads to recurrent bouts of croup or bronchitis, often the underlying cause of all that misery is cough-variant asthma," says Dr. Davis.

Treatment: The health care provider will ask for a history of your child's symptoms (eczema and recurrent ear infections as a baby are clues) as well as their family medical history. If your child is old enough, the health care provider may perform pulmonary function tests to make sure their lungs are healthy. Pay attention to what sets off the cough: Does allergy season do it? Are they out of breath barely five minutes into their soccer game? Or does your child wake up in the middle of the night with an uncontrollable cough? Taken together, all of these signs make a health care provider suspicious of asthma.

Whether it's classic asthma or cough-variant, it usually responds to the same treatments: bronchodilator and/or anti-inflammatory medications. One is a "rescue" medication for the moment an attack (or coughing fit) begins, and the other is a daily "controller" medication to keep the disease under control.

Whooping Cough

Whooping cough (pertussis) is a highly contagious bacterial illness of the airways and lungs.

Symptoms: Whooping cough starts with cold-like symptoms (runny nose and sneezing) followed by short bursts of uncontrollable coughing that sometimes end with an unmistakable whoop. Children may throw up and turn blue as they struggle for air. "It's often known as the 100-day cough," says Dr. Berger.

Treatment: Call a health care provider ASAP, since your child needs antibiotics. They're most effective when given in the first seven days of infection—but can also be given to other family members at a later point to prevent the disease from spreading. Older children and adults with pertussis may have only a mild cough, but pertussis can cause life-threatening complications in babies who are too young to be vaccinated or haven't had all doses of DTaP (a vaccine that also protects against tetanus and diphtheria). Adults who work closely with infants should get Tdap, the whooping cough booster, and pregnant people must get Tdap between the 27th and 36th week of each pregnancy.

GERD

When acid from the stomach backs up into a child's throat due to weak esophageal or stomach muscles, the result can be GERD (gastroesophageal reflux disease).

Symptoms: Babies can't tell you they have heartburn, but GERD can make them spit up, gag, or act fussy during feedings. Older kids may wheeze and cough—especially at night when they're lying down—or complain of pain in the chest or throat. GERD is usually diagnosed based on a history of symptoms and trial-and-error lifestyle changes, but it may require a consultation with a pediatric gastroenterologist.

Treatment: Keep babies upright for 30 minutes after feeding and elevate the head of a child's mattress to minimize chronic coughing. For older kids, cut back on foods that typically set off symptoms of GERD, such as citrus fruits, tomatoes, chocolate, peppermint, and anything spicy. Keep a record of what your child eats to see whether there's a correlation. Try not to feed older kids right before they go to bed and cut back on foods known to trigger the condition.

Tic or “Habit Cough”

A "habit cough" is particularly difficult to diagnose and treat. It's usually mentioned after all other reasonable diagnoses have been excluded. Your child may have had a cold or flu that left them with a telltale cough. Even though the cold is gone, the cough isn't—except when they're sleeping. "Your child probably isn't doing this on purpose," says Dr. Berger. "They may tell you they feel a tickle in their throat, or not even realize they're coughing." Sometimes, the tic is anxiety-driven and can become habitual. In other cases, kids just get in the habit of coughing to clear their throat. If they get attention for it, they keep it up.

Treatment: Simply reassuring a child that they're no longer sick might be enough. You may need to get a doctor to say this. However, the act of coughing itself can irritate the throat and lead to a cycle of more coughing. To break it, offer a sip of water, a lollipop, or, for older kids, a cough drop to help suppress the urge to cough. Praise and positive reinforcement when they resist coughing may also help. Some pediatric pulmonologists teach relaxation therapy to control tics. If nothing works, consult a child therapist to see if an underlying issue—perhaps a school phobia, shyness, bullying—is bothering them.

Who Can Help a Chronic Cough in Children?

A primary care physician is your first stop for diagnosing and treating most coughs. They'll recommend a trial of over-the-counter and prescription medications, or they'll refer you to one of the following specialists:

• Allergist: These doctors can administer skin tests to pinpoint what your child is allergic to. Still inconclusive? An allergist may order a chest X-ray or lung function test to measure the pattern of airflow in and out of the lungs or refer you to a pulmonologist for a closer look at the lungs.
• Otolaryngologist (ENT): After taking a detailed history, an ear, nose, and throat specialist will examine your child's nose and sinus cavities. They may need to surgically correct chronically infected tonsils, adenoids, or sinuses.