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
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
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
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
Persistent cough with fever and
breathlessness may indicate complications such as pus in chest cavity
or lung abscesses.
Cough with Asthma and "Cough-Variant"
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.