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Chronic cough in children: Something to worry about?

SPRINGFIELD It's a known fact that a chronic cough in children may be more of a problem for parents who suffer from the additional stress and worry it brings beyond the normal challenges of parenting. "An occasional cough, often associated with the common cold, doesn't necessarily mean there is an underlying problem," said Dr. Robert Kaslovsky, chief, Pediatric Pulmonology, Baystate Children's Hospital. Coughing serves as a healthy mechanism protecting a child's body by removing mucus, irritating substances and infections from the child's respiratory tract. But a child's cough that doesn't go away after three weeks or more could be a reason for concern and for a visit to the pediatrician's office, because the cough may be symptomatic of other disorders, noted the Baystate Children's Hospital pulmonologist. He noted, however, no matter how short or long the cough has been around, if it is accompanied by coughing up blood, severe chest pain and shortness of breath, you should have your child evaluated promptly by a pediatrician. While there are many reasons for a child's chronic cough, the most common things doctors look for when a young child has been coughing for several weeks or months are infections such as sinusitis, bronchiolitis or pneumonia, as well as allergies and asthma. "Chronic cough is a difficult diagnostic challenge for a pediatrician," said Dr. Kaslovsky, "but it is often the first manifestation of asthma." Dr. Kaslovsky noted a chronic cough accompanied by symptoms such as wheezing, chest tightness and shortness of breath, and especially a nighttime cough, are good reasons to suspect your child might have asthma. "It is key before treating any child with a chronic cough that you have the correct diagnosis. Doctors may order a number of tests such as a chest X-ray or spiromety," he said. Spirometry, available at Baystate Children's Hospital, is a quick, simple, painless test involving taking a deep breath then exhaling into the mouthpiece of a machine called a spirometer. The test measures lung function (how much air can be exhaled, and how fast the air comes out) and can assist in the diagnosis of asthma, and other conditions which can result in a chronic cough. "This helpful test to measure pulmonary function is best given only to those at least five or six years of age, particularly because of the need to be able to understand and follow directions when taking the test," said Dr. Kaslovsky. And, if a child's X-ray is normal, his or her cough may be caused by exposure to secondhand smoke, reflux disease, postnasal drip, bacterial infection of the lower airway, or it may be a post-viral cough following a viral respiratory infection. Children with chronic coughs may also have a swallowing disorder or may have inhaled a foreign body such as toys or food which can cause a cough to continue for weeks or months. "If your child is still crawling, he or she can easily swallow something that has fallen on the floor. If the object is in the lungs it may or may not be visible on an X-ray, because plastics and food don't show up on an X-ray," said Dr. Kaslovsky. If all testing fails to find the cause for the prolonged cough, it may be that there is no physical cause for a child's persistent cough. This may result in it being labeled as a "habit" or "tick" cough. "A good test is to watch children when they are asleep, because a habit cough occurs only while they are awake," said Dr. Kaslovsky. Often more prominent in girls but occurring in both sexes, Dr. Kaslovsky said a habit cough can result from being under stress, changes in family dynamics such as the birth of a new sibling or even from breaking up with a girlfriend or boyfriend. "A habit cough can also be a sign of avoidance of something, such as a child who might not want to go to school because they aren't prepared for a test, they may be being bullied or they're having other problems with their classmates," said Dr. Kaslovsky. And, not to be ruled out, is secondhand smoke. "You have to ask yourself if anyone is smoking at home, whether inside or outside the house, which can be a trigger for a chronic cough," said Dr. Kaslovsky.

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