Chronic Cough in Children
Understanding persistent cough, what causes it, and when to seek help
Coughing is a common symptom in children and is typically associated with mild respiratory infections. However, when a cough lasts for weeks, it may be a sign of an underlying condition that requires medical attention.
Chronic cough in children is defined as a persistent cough lasting more than four weeks. While most coughs resolve on their own, a cough that lingers can disrupt sleep, affect daily life, and cause concern for parents.
What causes a chronic cough in children?
The most common causes of chronic cough in children include:
1. Post-viral cough
After a cold or viral infection, the airways can remain sensitive, leading to a lingering cough that may last for weeks, even after other symptoms have resolved.
2. Asthma
Asthma is a common cause of chronic cough in children. It may present with wheezing, shortness of breath, or a cough that is worse at night, with exercise, or in cold air. In some children, cough is the only symptom – this is known as cough-variant asthma.
3. Allergic rhinitis and postnasal drip
Allergies can cause mucus to drip from the back of the nose into the throat, triggering a chronic cough, especially at night or when lying down.
4. Gastro-oesophageal reflux (GOR/GERD)
Acid reflux can irritate the airway and lead to a chronic dry cough. It may be worse at night or after meals.
5. Protracted bacterial bronchitis
This condition causes a persistent wet cough due to a low-grade bacterial infection in the airways. It often improves with a course of targeted antibiotics.
6. Foreign body aspiration
If a child inhales a small object (such as food or a toy part), it can cause a persistent cough. This is more common in toddlers and young children.
7. Environmental irritants
Exposure to second-hand smoke, air pollution, or strong fumes can lead to ongoing coughing.
8. Less common causes
Conditions such as bronchiectasis, primary ciliary dyskinesia, cystic fibrosis, or airway abnormalities can also present with chronic cough. These are rare but important to investigate in children with persistent or unexplained symptoms.
Types of chronic cough
- Wet or productive cough – Brings up mucus or phlegm. Often due to infection or airway inflammation.
- Dry cough – No mucus. It may be due to asthma, reflux, or postnasal drip.
- Night-time cough – Often seen in asthma or postnasal drip; worsens when lying down.
- Cough with exertion – Can suggest exercise-induced asthma.
- Habit cough – A repetitive dry cough that persists despite normal tests, often disappears when the child is asleep or distracted.
Warning signs to look out for
You should seek medical advice if your child:
- Has a cough that lasts longer than 4 weeks
- Has difficulty breathing, noisy breathing, or shortness of breath
- Wheezes or uses chest muscles to breathe
- Has a cough that wakes them at night
- Has fever, weight loss, or poor appetite
- Coughs up blood or has chest pain
- Had a choking episode before the cough started
- Has a history of recurrent chest infections
How is a chronic cough diagnosed?
Diagnosis often begins with a thorough history and physical examination. Your healthcare provider may ask about:
- Duration and nature of the cough (wet or dry)
- Triggers (e.g. exercise, cold air, night-time)
- Associated symptoms (fever, wheeze, weight loss)
- Environmental exposures (e.g. smoke)
- Family history of asthma or allergies
Investigations may include:
- Chest X-ray
- Lung function testing
- FeNO testing (to assess airway inflammation)
- Allergy testing
- Sputum cultures
- Bronchoscopy or CT scan (in selected cases)
Treatment of chronic cough
Treatment depends on the underlying cause:
- Asthma – Inhaled corticosteroids or bronchodilators
- Postnasal drip – Antihistamines, nasal sprays, or allergy treatment
- Reflux – Acid suppressants and dietary modifications
- Bacterial bronchitis – Prolonged course of appropriate antibiotics
- Foreign body – Urgent removal by bronchoscopy
Cough suppressants are generally not recommended for young children, especially in cases where coughing helps clear mucus or infection. Over-the-counter cough medications should not be used without guidance from a healthcare professional.
What can parents do at home?
- Keep your child well hydrated
- Use a cool-mist humidifier in dry environments
- Avoid smoke exposure at home or in the car
- Use prescribed medications as directed
- Encourage rest and monitor symptoms
When to seek help
You should see a respiratory paediatrician if your child’s cough:
- Lasts more than four weeks
- It is associated with breathing difficulty, fever, weight loss, or poor growth
- Is affecting sleep or school attendance
- Sounds unusual (e.g. whooping, barking, or wheezy)
- Occurs after choking or swallowing something
Early diagnosis and appropriate treatment can help your child recover more quickly and minimise complications.
If you are concerned about your child’s chronic cough, our specialist paediatric respiratory team is here to help. We offer comprehensive assessment and tailored treatment plans to support your child’s respiratory health.
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