Some Causes and Features of Cough in Children
Cause | Common Features* | Tests |
|---|---|---|
Acute cough (lasting less than 4 weeks) | ||
At first, symptoms of a cold Wheezing and, if bronchiolitis is severe, rapid breathing, with flared nostrils, and difficulty breathing Possibly vomiting after coughing Typically in infants up to 24 months old, most often in those 3–6 months old | A doctor’s examination Sometimes a chest x-ray and testing of mucus from the nose (taken with a swab) to identify the virus | |
Fever, cough, runny nose, rapid breathing, sore throat, shaking chills, headache, loss of taste or smell, vomiting, diarrhea, belly pain, rash, red eyes Particularly when there are known cases in the community | Sometimes testing with a nasal swab Sometimes chest x-ray | |
At first, symptoms of a cold Then a frequent, barky cough (worse at night) and, when croup is severe, a loud squeaking noise when the child breathes in (stridor) and rapid breathing, with flared nostrils Typically in children 6 months to 3 years old | A doctor’s examination Sometimes a neck and chest x-ray | |
A foreign object in the windpipe (trachea) or larger airways of the lungs (bronchi) | Cough and choking that begin suddenly No fever initially No symptoms of a cold Typically in children 6 months to 6 years old | A chest x-ray Sometimes bronchoscopy |
Pertussis (whooping cough) | Mild coldlike symptoms for 1–2 weeks, followed by coughing fits Infants: Coughing fits that may be associated with a blue tint to the lips or skin (cyanosis), vomiting after coughing, or pauses in breathing (apnea) Older children: Coughing fits that may be followed by a prolonged, high-pitched sound (called the whoop) Cough that may persist for several weeks | Testing of a sample of mucus taken from the nose |
Typically fever Sometimes wheezing, shortness of breath, and chest pain Cough that is sometimes productive | A doctor's examination Often a chest x-ray | |
Coughing at the beginning of sleep or in the morning with waking Sometimes chronic discharge from the nose | A doctor's examination Sometimes CT of the sinuses | |
Upper respiratory infections (most common) | A runny nose and nasal congestion Possibly fever and sore throat Possibly small, nontender, swollen lymph nodes in the neck | A doctor’s examination |
Chronic cough† (lasting 4 weeks or more) | ||
Periodic attacks of coughing in response to a trigger (such as pollen or other allergens), exposure to cold air, or exercise Coughing during the night Sometimes family members who have asthma | A doctor’s examination Treatment with asthma drugs to see whether symptoms are relieved Breathing tests to evaluate lung function (pulmonary function tests) | |
Birth defects affecting the lungs | Several episodes of pneumonia in the same part of the lungs | Chest x-ray Sometimes CT or MRI |
Birth defects affecting the windpipe (trachea), esophagus, or both | Vary by defect Typically in newborns or infants If the trachea has not developed normally, possibly a loud squeaking noise when the child breathes in (stridor) or a barky cough and difficulty breathing If there is an abnormal connection between the trachea and esophagus (tracheoesophageal fistula), a cough or difficulty breathing when the child is fed and frequent bouts of pneumonia | Chest x-ray Sometimes bronchoscopy and endoscopy Sometimes CT or MRI |
A blockage in the intestine by thick secretions (meconium ileus) detected shortly after birth Frequent bouts of pneumonia, sinusitis, or both Not growing as expected (failure to thrive) Enlargement of the fingertips or a change in the angle of the nail bed (clubbing) and nail beds that are tinted blue | A sweat test Possibly genetic testing to confirm the diagnosis | |
A foreign object in the lung or airways | Cough and choking that began suddenly Resolution of choking but cough that persists or progressively worsens over several weeks Possibly a fever No symptoms of a cold Typically in children 6 months to 6 years old | Chest x-rays while breathing out and breathing in Bronchoscopy |
Infants: Fussiness, spitting up after feedings, arching of the back, or crying after feedings and a cough when lying down Poor weight gain Older children and adolescents: Chest pain or heartburn after meals and when lying down and possibly wheezing, hoarseness, nausea, and regurgitation Cough that is often worse at night | A doctor's examination Infants: Sometimes an x-ray of the upper digestive tract after barium is given by mouth to determine whether anatomy is normal Treatment with histamine-2 (H2) blockers (if symptoms are relieved, the cause is probably gastroesophageal reflux disease) Sometimes a test to measure acidity or reflux episodes in the esophagus (called a pH probe or an impedance probe) or x-rays taken after formula is given by mouth (gastric emptying scan) to determine the frequency and severity of reflux episodes Older children: Treatment with H2 blockers or proton pump inhibitors to see whether symptoms are relieved Possibly endoscopy | |
Postnasal drip | Headache, itchy eyes, a mild sore throat particularly in the morning, and coughing at night and when waking up A history of allergies | Treatment with an antihistamine or a corticosteroid nasal spray (if symptoms are relieved, the cause is an allergy) Possibly x-rays or CT of the sinuses |
Psychogenic or habit cough | May develop in children after a cold or other airway irritant Frequent (may be up to every 2–3 seconds), harsh, or honking cough when awake, possibly lasting for weeks to months Cough that stops completely when the child falls asleep Lack of fever or other symptoms | A doctor's examination Sometimes chest x-rays to look for other causes |
Recent contact with an infected person Usually a weakened immune system (immunocompromise) Sometimes fever, night sweats, chills, and weight loss | A chest x-ray A tuberculin skin test or a blood test | |
* Features include symptoms and the results of the doctor's examination. Features mentioned are typical but not always present. | ||
† Children with disorders that cause chronic cough may also be brought to a doctor before 4 weeks. A chest x-ray is always done when children with a chronic cough are first evaluated. | ||
CT = computed tomography; MRI = magnetic resonance imaging. | ||