Merck Manual

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Some Causes and Features of Cough in Children

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 culture of mucus from the nose (taken with a swab) to identify the virus

COVID-19

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

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 4 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

Culture 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

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

If an abnormal trachea is suspected, also 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 4 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

* 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.