Persistent Coughs in Children

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Information on Persistent Coughs in Children

The most common symptoms reported by parents during their visit to the children's clinic pertaining to cough can be that their children are suffering from cough with or without phlegm.  Most children have viral upper respiratory infections (URTI) - the most prevalent of which is the common cold - during which they suffer from cough, running nose and mild fever and the symptoms of URTI normally do not last more than a week.  Persistent cough, on the other hand, is defined as cough that is present continuously for at least three weeks.  Preschool children have an average of six to eight attacks of viral URTIs per year, and the number may be more if they are attending daycare or nursery because the chances of them in contact with children already infected is greater.  Besides been an important factor in the spread of infection, persistent cough can also be an important defense mechanism to help clear excessive secretions and foreign material from airways.


Common Causes of Persistent Cough

In children, persistent cough is usually caused by cough with asthma and "cough-variant" asthma.  In older children and adults, either Post-Natal Drip (PND) Syndrome alone, or in combination with other conditions, is the single most common cause of persistent cough.  PND syndromes are second only to asthma as a cause of chronic cough in children and adults.  In children with a sensitive nose, PND can be irritating when it manifests itself with excessive mucus production that drips into the back of the nose and down into the throat and causing the child to constantly having to clear the throat.  The cough and persistent nose block occurs when the child lies down, usually at night.  This persistent nose block with cough and nasal discharge that persists for more than seven days.


There are also other common causes of cough such as the lower respiratory tract infections like bronchitis and pneumonia and gastro-esophageal reflux disease (GERD).  Less common causes of cough are congenital anomalies (birth defects) giving aspiration, environmental exposures, habitual coughing and psychogenic cough.


The link between GERD and Cough

Gastro-esophageal reflux disease (GERD) is common in patients who present themselves with a number of respiratory complaints, including chronic cough.  For children two years old or less, besides coughing bouts, those with GERD are more likely to present themselves with airflow symptoms-difficult and noisy breathing after feeding, cyanotic (blue) spells or difficulty in swallowing, poor growth and frequent vomiting.  With children above two years with GERD, they are more likely to present with airway irritation-frequent wheezing, throat clearing and choking after food.


Lower Respiratory Tract Infections and Cough

Lower respiratory tract infections like bronchitis, bronchiolitis and pneumonia are infections mostly of viral origin, but secondary bacterial superinfection often intercedes.  Note worthy non-viral conditions include Pertussis infection-which produces a cough that may last up to three months, hence the name "100 days cough".  As there are effective immunization of young infants, Pertussis is uncommon now.  However, most imported cases encountered by young babies usually occur when they are younger than three months.


Mycoplasma infection is the most common non-viral agent causing acute bronchitis, especially in children more than five years old, with minimal fever and a prolonged cough.


Pulmonary tuberculosis still exists and adults with untreated TB can usually infect children with PTB (chest tuberculosis).  Children with PTB usually have symptoms like prolonged fever, poor appetite, poor weight gain, with prolonged cough.


Persistent cough with fever and breathlessness may indicate complications such as pus in chest cavity or lung abscesses.


Cough with Asthma and "Cough-Variant" Asthma

Persistent cough due to underlying asthma occurs in the early morning and late night.  There may or may not be wheezing and the cough and breathlessness are aggravated by flu, vigorous exercise or smoky environment.


If cough-variant asthma is suspected, then an empiric trial of inhaled and/or oral corticosteroids may often be prescribed by the physician.


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