Since everyone is back to school this week, it’s worth reviewing how it usually goes, illness-wise. Everyone’s healthy for a few weeks after the start of school — long enough to get through, say, NFL Week Three. Then it starts: a hack here, a cough there, and before you know it, we have a symphony, one we’d rather not have unfinished. The lucky ones do seem to come to conclusion after a few days. However, a not insignificant minority of kids (as well as some otherwise healthy adults) seem to linger with a cough for weeks, if not months. 

What’s up with that?

That last question is one of the most commonly asked ones I’ve heard in my years of practice. And it gives me great pleasure to finally commit my oft-recited “prolonged cough speech” to written prose.

The great majority of those kid coughs are, of course, due to colds. Most of these can normally last up to two weeks. Given that infants and young children characteristically get up to 10 colds a year, a lot of times that cough is just one cold after another. One clue that this is what’s going on is that you might get a day or two that’s cough-free in between bouts.

If a child has never, ever, ever had a day without cough for a few weeks or more, most of us will start looking for other things. Even here, though, the list of common conditions is pretty short, and since there are three that overlap, I’ll mention them all at once: asthma, allergic rhinitis (what most people call “allergies”), and something in the environment. All three are generally due to the body’s overreaction to one or more stimuli. In asthma, the small airways (tubes in the lungs that carry air) get narrow. Allergic rhinitis can cause a chronic runny or stuffy nose and sometime post-nasal drip that stimulates a cough. Stuff in the environment can cause either or both of these problems.

There are sometimes, but not always, clues to these conditions on an examination. And although there are tests that can be done, they often take a little while to arrange. For this reason, if a provider suspects that asthma or allergic rhinitis might be going on, she might choose to try some treatment — either to decrease inflammation in the lungs or nose, or to open up the airways by relaxing their muscles.

Most other causes of chronic cough are less common, and most have other symptoms associated with them. (Some not-so-rare exceptions: whooping cough and a foreign object in the lung.) Bacterial causes of cough such as pneumonia often come with a fever. We’ll occasionally try an antibiotic for a persistent cough, particularly if a sinus infection might be present, but it doesn’t help that often. Also, most cough medicines in kids are now largely a no-no due to side effects, particularly if they are infants or toddlers.

Do talk with your provider about how he wants to handle that cough, especially if it’s your child’s first long-haul bout. Coughing children who otherwise look and feel well do have a little time to get it all figured out, and usually, with a little trial and error, that NFL Week Three cough will be improved by Goombay weekend!

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