Is Your Child's Cough a Concern? Understanding and Managing Pediatric Chronic Cough

• Pediatric chronic cough can occur due to infection, respiratory disease or environmental exposure to various pollutants. Symptoms can include a dry cough, hoarse cough, or productive cough with mucus. 
• Nasal irrigation serves as effective symptom management because it clears secretions in the nasal passages, thereby reducing the likelihood of cough. Additionally, the consistent use of medications prescribed by a doctor should be employed. Furthermore, being aware of and avoiding triggering factors is essential in order to prevent the exacerbation or recurrence of symptoms.

A pediatric chronic cough can disrupt sleep, disturb those nearby, and interfere with daily activities. Parents may be concerned when their child continuously coughs, even during sleep, and may wonder if it is due to a lung abnormality.

The causes of a chronic cough can be divided into two main categories:

1. Caused by infections: A chronic cough can result from infections that are able to spread to people nearby. Examples include viral infections, bacterial infections, or tuberculosis affecting the nose, airways, sinus cavity, or lungs.
2. Caused by other factors: A chronic cough that is not due to infection can be caused by a variety of factors, including pediatric allergic rhinitis, asthma, acid reflux, foreign objects in the airways, certain heart conditions, side effects of certain drugs, and airway sensitivities to environmental factors both inside and outside the home. These environmental factors include cigarette smoke, various fumes and chemicals, and many other possible triggers. 

Normally, when children have an infection in the respiratory system they can exhibit coughing for several weeks following the infection. The cough typically subsides within a month after the infection has completely cleared. However, if the cough persists for more than one month parents should take their child to see a healthcare professional to identify the underlying cause and receive appropriate treatment. For example, if the pediatrician finds signs of sinusitis, they may prescribe antibiotics, decongestants, or anti-inflammatory nasal sprays, or they may recommend nasal saline irrigation. In the case of asthma, pediatricians may prescribe inhaled corticosteroids to control airway inflammation and inhaled bronchodilators to manage airway constriction. 

The diagnostic evaluation of a pediatric chronic cough is of utmost importance. A chronic cough can manifest in two main forms: dry cough and productive cough with mucus. Parents should carefully observe their child’s symptoms and provide detailed information to the physician. This includes noting when the cough began, its duration, and whether it is dry or productive. Particular attention should be paid to the timing, location, and environmental factors that may have triggered the cough. 

Furthermore, it is essential that a comprehensive medical history of the patient be provided, including any history of respiratory conditions such as allergies or asthma, a family history of communicable diseases such as tuberculosis, exposure to household smoking, residence in an industrial area, or contact with any chemicals. This information assists the physician in conducting a thorough examination of both the upper and lower respiratory tract. 

If the patient’s medical history and a physical examination do not yield a definitive diagnosis, additional laboratory testing may be necessary. This can include blood tests, an assessment of nasal secretions or mucus, cardiac and vascular evaluations, chest X-rays, pulmonary function tests and respiratory allergy testing. 

The treatment of a chronic cough necessitates an understanding of the underlying causes that trigger the cough. Following a comprehensive review of the patient’s medical history and a detailed physical examination, the physician will be able to identify the root causes and contributing factors behind the cough. This enables precise and effective therapeutic interventions, ultimately leading to the resolution of chronic cough symptoms. Typically, with appropriate management and supportive care, chronic cough should improve within 1 to 3 weeks (depending on the severity and nature of the symptoms). 

• Ensure that the child consumes a nutritious and balanced diet, avoiding dry, crispy and fried foods.
• Encourage the child to drink warm or room-temperature water, avoiding cold beverages. Temperature variations can trigger airway constriction and coughing in children with hyperreactive airways. 
• Promote regular physical activity for the child, with at least 30 minutes of exercise per day. 
• Ensure the child gets adequate daily rest, with a minimum of 8 hours of sleep. 
• Inhabit a healthy environment with good ventilation, avoiding exposure to chemical pollutants, smoke, and toxins in the air. 

The primary factors leading to a cough in children often involve the dripping of nasal secretions into the bronchus. Therefore, performing nasal irrigation is advisable in order to prevent the accumulation of mucus in the nasal passages, thereby reducing the likelihood of cough. Additionally, consistent use of symptom-controlling medications should be employed. Furthermore, being aware of and avoiding triggering factors is essential in order to prevent the exacerbation or recurrence of symptoms. 

• For nasal irrigation in infants and young children, use 1-2 drops of saline solution in each nostril while elevating their head while they are lying on their back. Gently hold their face still as the saline solution flows, preventing the mucus from becoming sticky and helping it flow out naturally. If there is a significant amount of mucus, you may use a red rubber bulb syringe size 0-1 to gently suction mucus from the nostrils, inserting it approximately 1-1.5 cm. deep. In some cases, it may be necessary to go as deep as 3-4 cm., but this should only be done with caution. 
• For nasal irrigation in older children, if there is not a significant amount of mucus you can perform nasal irrigation while the child is sitting. Slightly tilt their head upward, and use 3-4 drops of saline solution in each nostril. Let it sit for a moment, then bend their head forward, open their mouth, and instruct them to blow their nose gently. Repeat this process several times until the nasal passages are clean. If there is a substantial amount of mucus, you can use a 10 ml syringe (without the needle). Gently push 5-10 ml of saline solution into the nostril while the child’s head is bent forward, making sure to have a receptacle ready to collect the drainage. There is no need to push strongly; the mucus will come out. Afterward, have the child blow their nose gently and repeat the process several times on each side until the nasal passages are clear. It is advisable that this procedure be performed in the morning and before bedtime at a minimum. If there is nasal congestion or excessive mucus during the day, you can repeat the nasal irrigation process during periods when the child’s stomach is empty. 

Most parents, along with the child, often report improved comfort, nasal clearance, better sleep quality, reduced coughing, and improved intake of milk and food after receiving regular nasal irrigation. For infants and young children, the gentle suctioning of nasal mucus is recommended. Older children do not require forceful nasal suctioning but can be instructed to blow their noses gently. This process can be repeated several times until the nasal passages are clear and there is no more secretion. As the saline solution closely resembles bodily substances, it is not harmful. Swallowing a small amount of the saline solution is also safe.

If a child experiences persistent coughing, even during sleep, that is disrupting their daily routine, it is advisable to seek medical attention promptly from a doctor in order to undergo a thorough examination to identify the underlying cause. Prolonged chronic coughing should not be left untreated, as it can impact a child’s learning and overall well-being.