Chronic Cough in Young Children

Sesame Street Gang... children just love them!

Courtesy: Philip diResta



Most primary care doctors (that I know of) who come across young children with cough will not look or let alone examine their chest. They would ask the mother/father a few short questions and immediately write out a prescription, usually consisting of decongestant (if above 2 years old), secretolytic ( decrease mucus thickness), antipyretic if there is fever and vitamin.

In most occasion, the children would recover not so much due to the medicine as to the self-limiting nature of the viral infection. There are however cases of children who continue to cough week after week and the mother would always return to the clinic on the basis that the medication has run out and they need a replenishment! Unfortunately in some instances, the children are again prescribed the same medication especially the cough mixtures. And they continue to cough causing great concern to the family.

Chronic cough here is defined as frequent daily cough for more than three weeks.

I have come across children like this. They keep coming to the clinic but never get better. One of these children was a five year old child whose mother had brought him to see a Paediatrician on two occasion and when the child still did not get better and instead became worse, the mother brought him to the clinic. I noted that his breathing was rather rapid as he walked in slowly. When I examined his chest, there was wheezy and coarse sound indicating an abnormal breathing. A chest Xray was immediately ordered and true enough, he had a pneumonia! I gave a course of antibiotic and a bronchodilator and after about one week the child came rushing in excitedly into my clinic. The mother was smiling broadly and was very grateful.

Last week another three year old male child was brought in with a similar history, cough for more than one month and had seen two different doctors. He however appeared more active and breathing rate was normal. According to the mother the child had been taking medicine but have had no effect. I asked her when did the cough get worse, was it in the evening or when he was actively running around. She replied the latter. And was there a wheezy sound? Yes, there was.

The child's chest examination revealed that wheezy sound (rhonchi in medical jargon). As he had been coughing for more than one month, I prescribed an antibiotic and a bronchodilator to reduce his bronchospasm (wheezy sound). I told the mother to stop all cough mixtures. In fact prolong use of cough mixture will worsen and prolong the cough!

Today the smiling mother and her child came for review and she reported that he no longer cough and the child was running around the clinic and not coughing. His chest was clear on auscultation.

This group of children usually starts off with a viral respiratory tract infection which somehow does not go away and is secondarily infected with bacteria progressing to irritation of their lung (bronchioles) causing spasm and coughs. The infection needs to be treated and the lung complication ameliorated. Most of these children would have a family history of asthma, either the father or mother or one of the siblings. It is important to manage them well so that they will not continue to be asthmatic in their adult life.

And as doctors, faced with this kind of cases, we need to take a good history and look for and hear those chest sounds!