Update: The Chronic Cough in Children online course is now available. Learn more here.
Are you frustrated by your child’s chronic cough? Is it happening daytime, nighttime, or all the time?
Are you wondering why cough medications aren't working, or for that matter, why inhalers for “asthma,” including steroids, and another 10 days of antibiotics, and/or allergy medications are all not working? Are you tired of doctors telling you the cough is just from a “virus” even when your child doesn’t have other symptoms of a cold, because you can tell the difference and when they have a cold?
Have you dragged your child all over town to see yet another specialist to find out why they are not really “sick” but they just keep coughing?
If you answered yes to any of the above questions, please keep reading.
Coughing is an involuntary reflex, or protective mechanism the body has to get unwanted particles or irritants out of our airway. Dust in your child’s windpipe, a droplet of liquid in the airway from drinking and talking at the same time, or phlegm from a viral illness can all make your child cough.
However, some children experience a chronic cough that just doesn’t seem to go away.
Here are the top 3 reasons your child might have a chronic cough:
NUMBER 3: HABITUAL THROAT-CLEARING
Your child may have started out with a bad could and began coughing because he/she was sick. However, even after the fever and acute illness goes away, their throat and voice box stayed irritated or “hyper-reactive,” and they continue coughing.
At some point your child may not really be coughing anymore, rather throat-clearing (it’s not as hard as a cough, often less dramatic and happens in annoying short bursts every few minutes). If you no longer hear them “coughing” during sleep and only when they are awake, it’s has now turned into a harmless but disruptive habit.
These children often show no other signs of illness or discomfort. It’s a difficult diagnosis to make and usually only made after reasons #2 and #1 (below) are ruled out. It can also be a result of reason #1.
One strategy I often offer to families to help break this habit is having the parent(s) help their child suppress the urge to “cough” using a kitchen timer. I tell them to start with 30 seconds working their way up to 5-minute intervals. Do nothing else except focus on not coughing. Every time they want to cough or throat clear, have them say “sh..sh...sh” by pursing lips. This will force vocal cords to spread apart and not touch each other and trigger the throat clearing.
NUMBER 2: CHRONIC RHINOSINUSITIS (NOT A “SINUS INFECTION,” BUT INFLAMMATION)
Chronic rhinosinusitis means inflammation from the thickening of the lining inside the sinus cavities. It means the sinus “plumbing” is clogged up.
Chronic sinus inflammation is NOT a bacterial infection so antibiotics will not make it go away completely, even if it seems to decrease the cough temporarily. It usually occurs in children older than 4, especially if they have underlying test-proven allergies to common aero-allergens, like trees, pollen, grass, dust mites and other environmental allergens.
Sometimes it may develop after your child has experienced a terrible viral illness, such that the mucous membranes inside the nasal passages became so swollen that the natural drainage points that lead each sinus cavity into the nasal passage became blocked. This then leads to inflammation inside the sinus. Due to a reflex called the “sinopulmonary reflex,” children who have chronic sinus inflammation will continue to cough until the nasal passage and sinus mucous membranes are no longer inflamed and are healthy again.
The only way to truly know if your child has chronic rhinosinusitis is if your child gets a CT scan or special imaging of their sinus cavities, which can involve some radiation exposure. These children tend to complain of a stuffy nose all the time along with a cough, and can’t blow anything out of their nose even if they try.
This is a CAT scan image of a head staring back at you, bone is white, air is black and gray inside the sinus cavity represents thickened mucous membrane/tissue.
Maxillary (cheek) Sinuses Without Air
Healthy Sinus Cavities Full of Air
NUMBER 1: ACID REFLUX FROM THE “MILK AND COOKIE DISEASE" (MCD)
Your child may be coughing because day after day, night after night, their larynx (voice box) is bombarded with stomach content backwash (gastroesophageal reflux and laryngopharyngeal reflux) coming up to the voice box and irritating it. Coughing is designed to keep unwanted materials from entering our airway. If the body did not protect itself by coughing, then we would aspirate and possibly get pneumonia.
The “backwash” is a result of eating and drinking excessive dairy and/or sugar (hence “milk and cookie disease”) throughout the day, and especially in the evenings. Your child is most at risk if he/she has a habit of eating and/or drinking (other than water) just before going to bed, the infamous “bedtime snack”. By minimizing the intake of dairy and sugar (“milk and cookies” are synonyms” in the evenings, your child’s voice box can rest and will not be in “fight” mode all the time.
I have met thousands of children who have chronic cough, not because they are sick, but because they were eating an unhealthy diet and drinking too much non-water beverages containing processed dairy and/or sugar, and at the wrong times. It’s not just the beverages, but often snacks full of high fructose syrup, added sugars, or just highly processed junk food. Yogurt products marketed for kids are the most common culprit I have observed over the past 15 years. Cutting out multiple pouches, drinkable yogurt, and yogurt in a tube often quickly reduces the cough. All of these items increase the likelihood of reflux or backwash and assault on the larynx, all the while being marketed as “good” for your child with “organic” and “just for kids” with animated cartoon character labels.
Learn more about the “Milk and Cookie Disease” here.