Cough in Children

 

Cough in Children: Causes, Warning Signs, and When to See a Doctor

Overview

A cough is an important protective reflex that helps clear materials from the airways and prevents them from reaching the lungs. These materials may include inhaled particles or substances originating from the lungs or airways.

The most common material expelled during coughing is sputum (also called phlegm), which is a mixture of mucus, debris, and shed cells from the lungs and respiratory tract.

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Types of Cough

• Productive cough: Produces sputum or phlegm.

• Dry (nonproductive) cough: Does not produce mucus.

• In some cases, coughing may be accompanied by blood, which requires medical attention.

Older children and adults usually expectorate sputum when coughing, whereas younger children often swallow it.

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Why Is Cough Common in Children?

Cough is one of the most common reasons parents take their children to a healthcare provider. Possible causes depend on the duration of the cough:

• Acute cough: Lasts less than 4 weeks

• Chronic cough: Lasts more than 4 weeks

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Common Causes of Cough

Causes of Acute Cough

• Viral upper respiratory tract infections (such as the common cold)

Causes of Chronic Cough

• Asthma (the most common cause)

• Gastroesophageal reflux disease (GERD)

• Postnasal drip

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Less Common Causes

Acute cough may also result from:

• Foreign body aspiration (such as food or small toy parts)

• Pneumonia

• Whooping cough (pertussis)

• Tuberculosis

Chronic cough may be caused by:

• Cystic fibrosis

• Primary ciliary dyskinesia (a congenital disorder affecting airway cilia)

• Inflammatory disorders involving the airways or lungs

• Stress-related cough (also known as habit cough or psychogenic cough)

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Warning Signs

The following symptoms are cause for concern and require immediate medical attention:

• Bluish discoloration of the lips or skin (cyanosis)

• Loud, high-pitched breathing noise during inhalation (stridor)

• Difficulty breathing

• The child appears seriously ill

• Severe, uncontrollable coughing fits followed by a high-pitched inspiratory sound

• Suspected inhalation of a foreign object

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When to See a Doctor

• Immediately if warning signs are present

• If parents suspect the child has inhaled a foreign object

• If the child has a recurrent barking or harsh cough

• If a chronic cough persists without improvement

Important note: The color or thickness of sputum (yellow, green, thick, or thin) does not reliably distinguish bacterial infections from other causes.

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How Doctors Evaluate Cough

Doctors begin by asking about the child’s symptoms and medical history, followed by a physical examination. Important details include:

• Time of day the cough occurs

• Factors that trigger or relieve the cough (cold air, body position, talking, eating, exercise)

• The sound and character of the cough

• Sudden or gradual onset of symptoms

• Presence of sputum or blood

Clues Based on Timing and Sound

• Nighttime cough: Often associated with asthma or postnasal drip

• Cough at sleep onset or upon waking: Commonly due to sinusitis

• Cough in the middle of the night: Strongly associated with asthma

• Barking cough: Suggests croup or a residual cough after a viral upper respiratory infection

• Sudden cough without other symptoms: Suggests foreign body aspiration

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Physical Examination and Tests

Doctors examine the chest by observing breathing, listening with a stethoscope, and tapping on the chest. They also check for signs of colds, swollen lymph nodes, and abdominal tenderness.

Diagnostic Tests

• Pulse oximetry to measure blood oxygen levels

• Chest X-ray

• Additional tests depending on findings from history and examination

Children without warning signs who have had a cough for 4 weeks or less and show typical cold symptoms rarely require testing, as the cause is usually viral. Testing may be considered in cases of suspected infections such as COVID-19 in schools or daycare settings.

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Treatment of Cough in Children

Treatment focuses on addressing the underlying cause, such as:

• Antibiotics for bacterial pneumonia

• Antihistamines for allergic postnasal drip

• Appropriate management of asthma or GERD

Home Remedies for Symptom Relief

• Breathing humidified air

• Ensuring adequate fluid intake

• Honey (plain or diluted) for children over 1 year of age to help reduce coughing

Although these remedies are generally safe, scientific evidence supporting their effectiveness is limited.

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Cough and Cold Medications: An Important Warning

• Over-the-counter cough and cold medications are not recommended for children under 4 years of age

• Cough suppressants (such as dextromethorphan and codeine) are generally not advised for children

• Cough is an important mechanism for clearing airway secretions, and suppressing it may be harmful

• These medications may cause side effects such as drowsiness or confusion, with little evidence of benefit

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Summary

Cough in children is usually a mild and temporary symptom, but in some cases, it may indicate a serious underlying condition. Paying attention to the duration, nature of the cough, and accompanying symptoms helps parents determine when medical evaluation is necessary.