Cough In Children: Symptoms, Causes And Treatment

Cough is the most common complaint in children, especially during winters. It serves as a reflex to prevent the entry of foreign substances into the lungs. Pediatric cough can impact day-to-day activities, disrupt sleeping patterns, and may cause parental anxiety. Although the presentation of cough in children differs from that in adults, there may be some similarities (1). Cough is related to upper respiratory tract infections (URTI) and can also be chronic. Therefore, while managing cough attacks in children, underlying illnesses should be identified accurately (2).

Read about various types of coughs, their causes, associated risk and complications, and how to prevent and treat cough in children.

Types Of Cough In Children

Cough in children can be divided into several types depending on their duration and the quality of presentation (sound pattern and nature).

Depending on the duration of the cough in children, it can be divided as (3):

• An acute cough is the most observed symptom of respiratory infections in children that typically lasts for less than two weeks. Long-term effects of a previous viral infection or protracted bacterial bronchitis can cause a cough in children that lasts for about 4-8 weeks; it is a prolonged acute cough.

• Chronic cough, a persistent cough, lasts for more than four weeks in children and more than eight weeks in adults. However, some studies state that chronic cough in children may vary from 3-12 weeks. Chronic cough can be a symptom of various conditions and require accurate clinical assessment for early intervention and resolution.

Depending on the quality of the presentation of chronic cough, it can further be classified as per their sound pattern and nature of the cough (2).

Based on the sound pattern, coughs are classified into:

• Barking or brassy cough is caused due to the swelling of the upper respiratory tract and is mostly observed in young children (less than three years). Croup (swelling of the larynx), epiglottitis, tracheomalacia, and tracheitis could be the reasons for a barking cough (1).

• Barking or honking cough could be due to a habitual or psychogenic etiology (2).

• Whooping cough could be a result of pertussis (a lower respiratory tract infection). It is most common in children and adults who are non-immunized or under-immunized (1).

Based on the nature of the cough, it can be classified as (2) (4):

• Wet cough or productive cough is presented with mucus on coughing, indicating liquid (or phlegm) in the airway. Younger children rarely produce sputum. Respiratory tract infection is a possible cause of wet cough.

• Dry cough or hacking cough is presented with a consistent tone due to the absence of mucus in the airway. Mostly, a dry cough can indicate inflammation and irritation of the respiratory tract and a non-airway cause. Also, the ascent of airway secretion into pharynx can convert dry cough into wet cough.

Some other types of common cough may include (5):

• Wheezing cough is characterized by a wheezing sound following cough caused due to swelling of the respiratory tract or a foreign object stuck in the airway. It may also indicate an underlying cause, such as asthma, pneumonia, or bronchiolitis.

• Stridor cough is a hard-breathing sound accompanied by cough. It is caused by narrowing in the extrathoracic airway, indicating conditions, croup or laryngomalacia.

• Cough may also occur during the day (daytime cough) or night (nocturnal cough) and could be accompanied by other symptoms, such as cold, fever, or vomiting, depending on the underlying cause.

Common Causes Of Cough In Children

Some common causes of acute cough in children are (6):

• Common cold, characterized by stuffy or runny nose sneezing, cough, sore throat, etc. The cough frequency in the case of a common cold is higher during the winter season, especially in school-going children, and does not require any specific clinical evaluation (7).

• Viral upper respiratory infections (URIs) caused by common viral pathogens can cause cough in children. They may include rhinovirus, influenza and parainfluenza viruses, and respiratory syncytial virus (RSV) (1). Currently, in the COVID-19 pandemic, the SARS-CoV-2 virus has also been observed to cause cough in children (8).

• In some cases, lower respiratory tract infections (LRTIs).

• Inhaling a foreign object or irritants, such as smoke, dust, etc.

• Chronic pulmonary diseases.

In the case of chronic cough in children, the causes of specific and non-specific cough include (6):

• In specific cough, a child with chronic cough is presented with other signs and symptoms, also known as cough pointers. These include chest pain, dyspnea, progressive coughing, clubbing, swallowing difficulties, etc. Conditions, such as structural airway abnormalities, pneumonia, cardiac disease, congenital abnormalities, aspiration lung disease, bronchiectasis, and interstitial lung disease are associated with chronic specific cough.

• A non-specific cough includes chronic cough in the absence of an identifiable respiratory disease of known etiology and cough pointers. In most cases, a patient is presented with a dry cough that may resolve spontaneously. Asthma, post-infectious cough, and protracted bacterial bronchitis (PBB) are the most common causes of non-specific cough. However, other causes of non-specific cough, which are age-dependent, include:

• • Bronchiolitis and croup up to two years of age
  • Postinfectious and foreign body inhalation in preschool and school-going children
  • Psychogenic or habit cough in adolescents.

• Environmental factors, including exposure to tobacco smoke and other pollutants, can also result in a chronic pediatric cough.

Complications Associated With Cough In Children

Cough in children can result in various potential risks and complications, disrupting the quality of life in children and their parents. Some common complications include (9):

• Insomnia (difficulty in sleeping)
• Headaches
• Hoarseness
• Subconjunctival hemorrhages, in rare cases, result in bloodshot eyes.
• Urinary incontinence
• Chest pain

Signs To See A Doctor

As a parent, seeing your child coughing can make you anxious and distressed. Check with the doctor (10) if your child is exhibiting the following signs and symptoms along with cough:

• Wheezing
• Whooping sound or stridor after coughing
• Producing thick phlegm
• Coughing blood
• Breathing faster than usual
• Difficulty in breathing
• Fever
• Weak, fatigued or is under-immunized or non-immunized
• Dehydrated
• Cranky or irritated
• Persistent vomiting
• Experiencing chest pain when breathing
• Runny nose for more than two weeks
• Coughing for more than three weeks
• Allergy-related symptoms

In case of the following, contact emergency care services:

• Severe difficulty breathing
• Unconscious or stopped breathing
• Lips and face turn bluish
• Choking

Diagnosis Of Cough In Children

Since coughing could be presented as a symptom of an illness, accurate diagnosis and clinical evaluation of different types of cough in children are essential for the appropriate intervention and early resolution of cough and its associated symptoms (11).

The primary diagnosis includes assessing the child’s general health, height and weight, nutritional status, and ENT examination.

Also, physical examination and detailed history, including the cough duration, nature, and quality of the cough, associated symptoms, triggering factors, family history, medications the child is taking, or any environmental exposure (such as smoke), is considered for the diagnosis of cough in children.

Other diagnostic tests to identify the cause of cough in children may include (6):

• Bronchoscopy if a child has inhaled any foreign object
• Chest radiograph, including computed tomography (CT) or magnetic resonance imaging (MRI) depending on the suspected etiology.
• Spirometry with or without bronchodilator responsiveness (BDR) or bronchial hyperreactivity (BHR) tests
• Allergy testing (skin prick or RAST specific testing)
• Sputum culture

Treatment For Cough In Children

The treatment management of cough in children is different for acute and chronic cough.

Correct identification and diagnosis of the underlying cause are essential for managing acute pediatric cough (11) (2).

• Cough associated with URTIs may require supportive measures (such as antipyretics for fever, adequate fluid intake, and saline washes).

• Over-the-counter (OTC) cough medications, including antitussives, antihistamines, and decongestants, are not much effective and are associated with multiple side effects. So their use should be restricted and taken only after recommendation by your doctor.

• Recent studies show an increasing interest in using honey for the treatment of acute cough in children. But, do not use it for babies younger than one year (6).

• During pollen season, intranasal steroids can help children with allergic rhinitis who have a cough (under prescription).

• Specific causes of acute cough (such as asthma, croup, bronchiolitis, and community-acquired pneumonia) should be treated according to evidence-based guidelines for such entities.

• Parental and community education is recommended to raise awareness of the natural course and supportive measures for acute cough caused by URTI in young children.

• In non-asthmatic children presenting with acute cough, bronchodilators are ineffective and should be avoided.

• Antibiotic treatment is ineffective in most cases and should be avoided in children with acute cough due to a viral URTI.

For chronic cough in children, a specialized care plan has to be implemented. A systematic approach helps improve clinical outcomes, including earlier cough resolution and improved parental life quality (11) (2).

• In treating particular causes of chronic cough in children (such as asthma, cystic fibrosis, primary ciliary dyskinesia, immunodeficiency, and tuberculosis), evidence-based guidelines are effective.

• Most non-specific persistent cough cases in otherwise healthy children are self-limiting and can be managed with supportive treatment.

• Empirical therapy for specific chronic cough conditions (such as asthma, allergic rhinitis, and gastroesophageal reflux) is not advised.

• Psychotherapy, such as counseling or behavioral therapy, can help children with a psychogenic/habit cough.

Prevention Of Cough In Children

Healthy children experience acute cough caused by URTIs several times a year, which resolves within one to three weeks, and chronic cough lasts for more than four weeks, requiring various treatment methods. The preventative strategies for cough in children may include (12):

• Taking plenty of rest
• Including nutritious food, along with fruits and vegetables to enhance child’s immune system
• Practicing hand-washing hygiene

Preventative strategies for chronic cough in children mainly include (13):

• Reduced exposure to infectious agents, such as tobacco smoke, pollutants, and irritants
• Use of adequate antibiotics depending on the underlying reason for chronic cough
• Timely immunization
• Easy access to health care systems

Cough is the most common presenting symptom, especially during winters. However, the presentation of cough in children differs from that in adults. Therefore, early assessment and management can establish a diagnosis and identify an appropriate therapy. Cough prevention in children has always been the best medicine, which involves getting enough rest, strengthening the child’s immune system, and practicing good hand-washing hygiene.

References

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