Kids Coughs: 5 Reasons Why Your Child May Be Coughing So Much

As a pediatric lung specialist, the most common worry I hear from parents is about their child’s cough. Coughing can occur for various reasons in healthy children, but before we delve into that, we must first understand why we cough.

Coughing is a natural reflex to protect the airways carrying air into the lungs. When we breathe in something that could irritate or harm the lungs, the body senses that and reacts by coughing. Think about the times you walked through a dusty area under construction, or when you drank water that accidentally went down the wrong tube—coughing in these situations is a natural response, and it goes away once the irritation is gone.

Common Reasons Why Kids Cough

The Common Cold

Cold viruses (upper respiratory infections) are one of the most common causes of cough in healthy children. Children ages 6 and younger could have up to 8 colds in a year, while older children can have up to 4 colds per year. Symptoms include congestion, runny nose, sneezing, sore throat, low-grade fever, headaches, and body aches. These symptoms might seem to get worse in the first three days of illness but will show improvement in the next 1-2 weeks. The best thing you can do is keep your child hydrated and comfortable while their body recovers.

Seasonal or Environmental Allergies

Approximately 10-30 percent of people in the U.S. are affected by allergies, but it’s rare in children younger than 2. Allergies and common cold may look similar, however allergies involve itchiness of the eyes, nose, or mouth area and do not cause fevers. In these cases, an allergic cough in children occurs due to postnasal drip from the allergies. Some children have these symptoms during specific seasons with high pollen counts while other children have symptoms year-round if they are allergic to an indoor allergen. Identifying and removing the allergic triggers and taking allergy medications will help alleviate the symptoms.

Childhood Asthma

Coughing, not wheezing (a musical whistling noise in the chest), is the most common symptom of asthma. An asthma cough is usually a dry cough, kids cough more at night, and can last for a few weeks or even longer. Weather changes, exposure to cold air, exercise, strong emotions, or allergens can worsen the cough. Viral upper respiratory infection is the most common trigger of childhood asthma symptoms. During flare-ups, the cough could become more wet sounding and may be associated with wheezing. Nebulizer treatments or inhalers with albuterol several times a day relieves the cough. If the cough is persistent, your doctor may start your child on inhaled or oral steroid medication to help control the symptoms.

Pneumonia

This infection in the lungs often starts as an upper respiratory tract infection later progressing to sudden onset of cough and fever. Some children may breathe faster or look very sick. Cough is often wet, and the doctor may hear crackle sounds in the lungs. The most common cause of childhood pneumonia is viral, which doesn't require antibiotics. Children with bacterial pneumonia usually have high fever and more severe symptoms and generally respond well with antibiotic treatment.  School-age children may have a type of pneumonia commonly called “atypical” or “walking” pneumonia, which involves mild body aches and headaches, with associated sore throat, a dry cough in kids, wheezing, or rash. The body is usually able to fight this infection without antibiotics, but if your child has persistent cough and/or fever, it would be worth an evaluation.

Aspiration

Choking on liquids can also cause cough. When this happens repeatedly, a wet cough develops with chest congestion. It’s often seen in children who have swallowing issues or developmental delays. This could lead to repeated lung infections over time. Recurrent aspiration of liquids can be managed by adjusting the thickness of liquids, feeding therapy, or finding another means to feed. If a wet cough persists despite therapies, or is associated with noisy breathing, your child may benefit from a bronchoscopy evaluation by a pulmonologist.

A more serious type of aspiration occurs when a young child accidentally chokes on a piece of food, item, or toy, resulting in this “foreign body” blocking the airways (aka foreign body aspiration). Coughing occurs immediately as the body’s response to get rid of the blockage. You may also hear noisy breathing, called stridor. In these situations, immediate emergency department evaluation is warranted.

When should my child see a doctor for their cough?

Although these are some of the common causes of cough in children, there are still many other less-common causes. A child’s cough should get better over time or with proper medications. So, when should you be worried about your child’s cough? As a general guide, your child should see a doctor or specialist if the cough has any of these qualities:

• Persists more than 4 weeks, without a day of no symptoms
• Interrupts sleep at least 3-4 times a month
• Limits physical activity or worsens with activity
• Occurs only while drinking and eating
• Associated with fevers and not getting better with medications

You know your child best, so if you notice any concerning signs in your child, don’t hesitate to discuss with your pediatrician.

Written by Linda Chen, D.O., pediatric pulmonologist at the Children’s Hospital of Brooklyn at Maimonides Medical Center