7 Causes of Chronic Cough in Children

It's inevitable: Kids will get sick. But while tummy aches, fevers, and sore throats tend to come and go, coughs often linger. Sometimes, a cough can persist even when your child has no other symptoms of an illness.

"[Chronic cough] is the single most common reason that parents call my office for a new-patient evaluation," says Ray S. Davis, MD, 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? Here, we break down the most common causes of chronic cough in kids and explain treatment options for each.

What Is a Chronic Cough?

A chronic cough is typically defined as any type of cough that lasts more than four weeks. These coughs tend to be persistent and in some cases medication-resistant. A chronic cough can occur with or without other symptoms. Chronic coughs can be problematic, interrupting sleep and daily lives.

"Parents often worry when a cough is persistent, especially when it sounds harsh," explains Carrie Quinn, MD, 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."

What Causes Chronic Coughs in Children?

There are many reasons why your child may be constantly coughing. Here, we've broken down a few of the most common causes of chronic coughs, with typical symptoms and helpful treatments.

Common cold

The most common reason for chronic coughs in children is upper respiratory infections. These infections can be caused by one of more than 100 cold viruses, and the cough that accompanies them can last longer than other telltale symptoms like a runny or stuffy nose.

"Children typically get about eight to 10 colds a year, with most lasting five to seven days,'' says William Berger, MD, 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."

Signs that your child's chronic cough is being caused by a cold include:

• Mild fever from the virus on the front end of the illness
• Nasal congestion
• "Tickle" feeling in the back of the throat from postnasal drip
• Throat clearing or even gagging from excessive mucus
  

In most cases, a cold needs to run its course. The American Academy of Pediatrics (AAP) and Food and Drug Administration (FDA) do not recommend cough and cold medications for kids under 4. Instead, try the following home remedies for chronic cough caused by a cold:

• Give your child lots of fluids like water, warm decaffeinated tea, and even popsicles made from 100% juice. 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 the airways.
• Use a 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 to soothe their throat and calm their cough.

Allergies

Allergies are another common culprit of chronic cough in kids. 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 pet dander, dust mites, and indoor molds).

Signs that allergies are causing your child's chronic cough include:

• Drippy nose and itchy eyes
• Chronic postnatal drip
• Dark circles under the eyes ("allergic shiners")
• Symptoms happening around the same time every year (seasonally)
• Symptoms happening in certain indoor environments

Saline nasal spray or an over-the-counter antihistamine may help dry up nasal secretions from allergies. If that doesn't work after a day or two, a health care provider may prescribe corticosteroid or antihistamine nasal sprays.

If you suspect seasonal allergies are the trigger for your child's chronic cough, try to keep your child inside during morning hours when pollen counts are highest. To combat an indoor allergy, you'll need to take preventative measures to reduce your child's exposure to the allergen.

For example, for a dust mite allergy, you can:

• Buy a polyester/fiberfill pillow instead of one with down feathers.
• Cover pillows and mattresses 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.

If none of these remedies work, talk to your pediatrician, who can evaluate your child and suggest kid-safe allergy medication or other treatment. If necessary, your doctor might refer your child to see an allergist for allergy testing to determine precisely what's triggering their symptoms.

Sinusitis

If your child can't stop coughing for over 10 days, they may have sinusitis. This is an inflammation of the mucus lining of the nose and sinuses. It creates air pockets along the brow, cheekbones, and nose—and as congestion builds, sinuses become a breeding ground for bacteria, resulting in a persistent cough and thick, yellowish-green nasal discharge.

Signs that a persistent cough is being caused by sinusitis include:

• Bad breath
• Puffiness and dark circles around the eyes
• Headache
• Postnasal drip
• Low energy
  

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 (Tylenol), ibuprofen (Advil or Motrin), and warm compresses can help with headaches or facial pain.

A primary care provider may also refer you to an otolaryngologist, who can examine your child's ears, nose, and throat with special instruments to see what's going on. During the exam, they'll look for any structural issues, such as a deviated septum, that can make a child more susceptible to sinus problems.

Asthma

Asthma is a respiratory condition affecting the tiny airways in the lungs, and it's a common trigger of chronic coughs in children. Some children have traditional asthma marked by recurrent trouble breathing, but many children only have a chronic cough, which doctors typically refer to as cough-variant asthma.

Signs that asthma is causing your child's chronic cough include:

• Wheezing or shortness of breath
• Tightness in the chest
• Eczema
• Recurrent ear infections

A health care provider will ask for a history of your child's symptoms as well as their family medical history. If your child is old enough, they may perform pulmonary function tests to make sure your child's lungs are healthy. Cough-variant asthma 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.

Whether it's classic asthma or cough-variant, it usually responds to the same treatments: bronchodilator and/or an inhaled corticosteroid medication. 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 condition under control.

Whooping cough

Whooping cough (pertussis) is a highly contagious bacterial illness of the airways and lungs. "It's often known as the 100-day cough," says Dr. Berger.

Signs that your child's chronic cough is being caused by whooping cough include:

• Cold-like symptoms (such as runny nose and sneezing) followed by short bursts of uncontrollable coughing
• Coughing that ends with an unmistakable "whoop" sound
• Vomiting and a blue pallor as they struggle for air

If your child is showing signs of whooping cough, call a health care provider as soon as possible to get it diagnosed and treated. Whooping cough requires antibiotics, and they're most effective when given in the first seven days of infection.

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).

GERD

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

Signs of a persistent cough caused by GERD include:

• Spitting up, gagging, or acting fussy during feedings (infants)
• Wheezing or coughing, especially when lying down at night (older children)
• Discomfort or pain in the chest or throat

To help, keep babies upright for 30 minutes after feeding and elevate the head of a child's mattress to minimize chronic coughing. For older kids, avoid meals and snack right before bedtime and cut back on foods that commonly 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 between the food they eat and their symptoms. If symptoms persist, have your child evaluated by a physician to discuss medication management.

Tic or “habit cough”

A "habit cough" is particularly difficult to diagnose and treat. It's usually only 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.

Sometimes, a "habit cough" 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 may keep it up.

Signs that a chronic cough is being caused by a tic or habit include:

• Cough goes away when a child is sleeping
• Complaints of a "tickle" in your child's throat
• Throat-clearing habit along with the cough

The act of coughing itself can irritate the throat and lead to a cycle of more coughing. To break the habit, offer a sip of water, a lollipop, or, for older kids, a cough drop to help suppress the urge to cough.

Some pediatric pulmonologists teach relaxation therapy to control tics. If nothing works, consult a child therapist to see if an underlying issue like school anxiety, shyness, or bullying is bothering them.

Who Can Help Treat a Chronic Cough in Children?

A primary care physician is your first stop for diagnosing and treating most kid coughs. If needed, 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.
• Pulmonologist: If your child's cough is not allergy-related, your doctor may refer your child to a pulmonologist take a closer look at the lungs and order a chest X-ray or lung function test to measure the pattern of airflow in and out of the lungs.
• Otolaryngologist (ENT): After taking a detailed history, an ear, nose, and throat (ENT) specialist will examine your child's nose and sinus cavities. An ENT might discuss surgery options for enlarged adenoids, enlarged tonsils, or ear tubes for children with hearing issues or frequent ear infections.

When To Contact a Health Care Provider

You should contact a health care provider for a chronic cough if your child is coughing and:

• Has a high fever
• Shows signs of respiratory distress (like wheezing sounds, flaring nostrils, or a bluish tint around mouth or fingernails)
• Is lethargic
• Is having trouble sleeping for more than a week
• Is struggling to consume enough calories