There are many causes of coughing, not only involving the respiratory system, but also some related to diseases of the ear, nose and throat, digestive system, etc. We usually refer to a cough that lasts for a long time, with cough as the main manifestation and no obvious lesions on chest X-ray as a chronic cough. (The duration of chronic cough has not been defined in pediatrics.) Because children with chronic cough have few other accompanying symptoms and no abnormalities on X-ray, the rate of misdiagnosis and mistreatment is quite high. Many children are misdiagnosed as having “interstitial pneumonia” or “bronchitis”.
Here are some relatively common diseases that cause chronic cough that parents should know about.
Postnasal drip syndrome
This is a cough caused by a nasal disease that causes secretions to flow backwards into the postnasal or pharyngeal area, or backwards into the vocal cords and trachea. In pediatrics, the common diseases are allergic rhinitis, sinusitis and adenoiditis.
In addition to coughing and sputum, such children usually complain of flu dripping from the throat, or nasal itching, nasal congestion, runny nose, sneezing, etc.
Gastroesophageal reflux syndrome
Gastroesophageal reflux cough mostly occurs at night or shortly after sleep with paroxysmal cough. Some children have reflux symptoms such as acid reflux, vomiting, eructation, heartburn, and indigestion. However, children, especially infants and young children, have atypical presentations and often have more prominent respiratory symptoms.
Cough variant asthma
This is a special type of bronchial asthma with mainly cough without typical symptoms and signs, which can be easily misdiagnosed because there are no obvious symptoms such as wheezing and shortness of breath. Children mainly have an irritating dry cough and coughing at night is common. Cold, cold air, fumes, pollen season, etc. can easily trigger a cough. Children who had eczema as children and have allergic families (e.g., allergic rhinitis, asthma, hives) should be on high alert.
Mycoplasma pneumoniae pneumonia
Mycoplasma pneumoniae infection causes a cough in all children, most of them have a violent and persistent cough, some of them have a spasmodic cough like whooping cough, and about half of them may have a cough so severe that they vomit, have facial swelling, and have nasal, chest, and abdominal pain. The cough is usually dry at first and may be followed by purulent sputum. Coughing for not less than 3 weeks accounts for 90% of cases. The disease is characterized by a heavy respiratory tract and obscure pulmonary signs, as well as significant chest radiograph shadows. The rate of Mycoplasma pneumoniae positivity in children with chronic cough has been reported to be significantly higher than that in children with acute cough, suggesting that Mycoplasma pneumoniae is an important cause of chronic cough in children.
Eosinophilic pneumonia
Eosinophilic pneumonia is relatively uncommon. It has been suggested that eosinophilic pneumonia is an allergic syndrome characterized by pulmonary infiltrates with increased eosinophils in the peripheral blood. Most children have a low-grade fever, mild cough, malaise, and chest discomfort.
Cerebral palsy
Cerebral palsy (or cerebral dysplasia) is the most common but most underdiagnosed condition in children with chronic cough. Because the brain is damaged, the swallowing and coughing reflexes are abnormally regulated, so these children are most likely to repeatedly choke and aspirate, leading to repeated respiratory infections and coughing. However, in our country, not many children with cerebral palsy are diagnosed at an early stage, unless parents carry their children to the doctor when they should sit or even walk but cannot, and in normal times, they would not even know that recurrent coughing is caused by brain damage.
Tuberculosis infection
Coughing is one of the basic symptoms of tuberculosis in children. Tuberculosis has the highest mortality rate of any infectious disease in the world, and the incidence of tuberculosis in children has been on the rise in recent years, and tuberculosis control is far from ideal worldwide.
The control of tuberculosis is far from ideal worldwide. Therefore, the diagnosis of tuberculosis should not be overlooked in all children with chronic cough, especially in some high-risk groups, even in the absence of abnormal signs and symptoms of tuberculosis toxicity.
Psychogenic cough
Psychogenic cough is caused by psychological problems or intentional throat clearing and is usually seen in school-age children and adolescents, with a higher incidence in girls than in boys. A variety of psychosocial stressors can trigger or exacerbate the cough, including school phobia, cognitive stress about grades, and dependence on loved ones,
It disappears when attention is diverted or during sleep.
Whooping cough
Pertussis is an acute respiratory infection caused by the bacterium Bordetella pertussis, which has been reported in disseminated cases, mostly in children who have not received the pertussis vaccine. It is characterized by a progressively worsening cough with typical paroxysmal spasmodic cough and a deep, long, chicken-like inspiratory roar at the end of the paroxysmal cough, and lasts for 2 to 3 months.
Bronchial foreign body
It is not uncommon for bronchial foreign bodies to cause prolonged coughing, especially in children under the age of 3. Some parents are negligent in their care and do not notice the obvious choking process in their child, and when the child coughs, it is always treated as a cold.
In addition, many diseases such as drug-induced cough, congenital malformations of lung development (including primary cilia dysfunction), bronchial tumors, and cardiac insufficiency can also cause chronic cough.
In short, when a child has a chronic cough that cannot be easily controlled, parents should not take it lightly and take their child to the hospital for some comprehensive and necessary tests.