By Howard J. Bennett, MD
When children get a cold, they typically develop a runny nose and a cough with or without a fever. In most cases, the cough resolves in 3 to 10 days.
In some cases, the child gets better, but the cough persists. The first thing I consider in this situation is something called cough-variant asthma. With this condition, the child doesn’t have difficulty breathing, but I hear a mild wheeze when I listen to his lungs. The cough usually responds to asthma medication in a few days. Other respiratory problems that can lead to a persistent cough include a viral bronchitis, a sinus infection and pertussis (whooping cough).
Although colds and cough are very common, I occasionally see kids who present with a persistent or recurrent cough that is notably different from what I see on a daily basis.
An under-recognized cause of persistent coughing is something called a habit cough. The characteristics of a habit cough include the following:
- the child appears well, does not have other symptoms of a cold and has a normal examination
- the child typically does not cough with exercise
- the cough stops during sleep
- the cough is brief, loud and has a staccato or throaty quality
A habit cough can go on for months and does not respond to nonprescription cough medication, antibiotics or asthma treatment, including oral steroids.
A habit cough often bothers family members, teachers and classmates, though the child himself is usually not concerned. It can occur ten times a day or several times a minute.
If I suspect that a child has a habit cough, I don’t do any lab work or a chest x-ray. Instead, I teach him a technique I learned from Sally Galleena, a speech therapist who practices in Columbia, MD.
The key to Sally’s technique is to get the child to relax his throat before each cough. Since all coughs begin with a short inhalation, this is the time to intervene. As soon as the child inhales prior to the cough, he does one of the following three things:
- takes a sip of water
- hums for a five seconds
- makes a shushing sound for five seconds
When the child carries out these actions, it relaxes his throat and aborts the cough. However, children do not usually learn the technique right away. I practice with them in the office prompting them when to hum, etc. When the child goes home, I emphasize that his mom or dad will be his breathing couch until he becomes an expert at stopping the cough. Most kids lick the problem by the next day. If the cough persists, I refer them to a speech therapist that has experience in this area.
Exaggerated Sigh Breathing
Every few months, I see a child with difficulty breathing who does not have asthma or another respiratory disorder. They are healthy kids who suddenly develop an odd breathing pattern. The child may or may not have had a cold before the symptom began. (I first learned about this condition from Sam Rosenberg, a pediatric pulmonologist in Rockville, MD.)
On further questioning, the child usually says something like, “I have trouble taking a deep breath” or “I can’t breath normally.”
While I’m talking to the child, I carefully watch how he breathes. Every minute or so, I get to witness what he’s talking about. In between normal breaths, the child suddenly takes a fast and deep breath as though someone was blowing into his lungs. There is no associated cough or wheeze and the chest exam is normal.
When I ask the child if it happens when he’s running around, he usually says no. When I ask parents if they ever see this when the child is sleeping, the answer is always no. What’s going on?
Exaggerated sigh breathing is also called sighing dyspnea or psychogenic dyspnea. (Dyspnea is the medical word for shortness of breath.) It’s a mild breathing disorder that usually resolves over a few days or weeks. It also recurs in some children. The problem is not serious and does not usually require any tests or referral to a specialist.
Because kids may be anxious about the problem, I reassure them that their lungs are normal, but the signals that tell them to breathe are acting a bit weird like when someone taps your knee and your leg jumps on its own. I add that the examination is normal and the problem will go away in a few days. If reassurance doesn’t work, I refer the child to a pulmonologist or a speech therapist who has experience treating kids with the condition.
Repetitive Throat Clearing
Repetitive throat clearing is more common than the conditions I just described. In many cases, it’s due to postnasal drip and, as such, only lasts for a week or two after a cold. If the problem is recurrent, it may be due to allergies or stomach reflux in which case a trial of medication will relieve the symptoms. I treat the possibility of allergies with 2-week course of an oral antihistamine and a nasal steroid spray. For reflux, I recommend a 4-week trial of Zantac or a medication like Prevacid.
If the throat clearing persists, it’s either a habit or a tic. (Some children with Tourette’s Syndrome clear their throats rather than making other vocalizations.)
Once I’ve eliminated medical causes for repetitive throat clearing, I reassure parents and children that they’re okay and refrain from doing any additional testing. Most importantly, I encourage parents to ignore the symptom or it may paradoxically increase in frequency.
Bennett is a pediatrician/author who practices in Washington, DC. His website is www.howardjbennett.com.