Managing Acute Cough in Children – Causes, Diagnosis & Treatment by Dr. Pothireddy Surendranath Reddy 

Managing Acute Cough in Children – Causes, Diagnosis & Treatment by Dr. Pothireddy Surendranath Reddy

By Dr. Pothireddy Surendranath Reddy

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Introduction

Cough is one of the most frequent symptoms in pediatric practice. Parents often become anxious when their child develops a persistent or severe cough, especially when associated with fever, vomiting, sleep disturbance, or breathing difficulty. While most acute coughs in children are harmless and self-limited, identifying the warning signs that suggest a more serious illness is crucial.

An acute cough is typically defined as a cough lasting less than 3 weeks in children. The majority of these episodes are caused by viral respiratory infections. However, several differential diagnoses exist—including bacterial infections, allergies, asthma, foreign-body aspiration, and environmental irritants—that require specific interventions.

This article provides a comprehensive overview of the causes, evaluation, management, and preventive strategies for acute cough in children, incorporating evidence-based guidelines from global pediatric organizations.

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1. Understanding Acute Cough in Children

1.1 Definition

An acute cough in children lasts up to 3 weeks.
A subacute cough lasts 3–8 weeks.
A chronic cough persists beyond 8 weeks.

1.2 Physiology

Cough is a protective reflex that clears mucus, pathogens, and irritants from the airway. Sensory receptors in the nose, throat, and lungs detect irritation and trigger a coordinated reflex via the brainstem, leading to a forceful expulsion of air.

Children, especially infants, have immature respiratory and immune systems, which makes them more susceptible to frequent cough episodes.

2. Common Causes of Acute Cough in Children

2.1 Viral Upper Respiratory Tract Infection (URTI)

The most common cause of acute cough in children. Viruses include:

§ Rhinovirus

§ Adenovirus

§ Influenza

§ Parainfluenza

§ Respiratory syncytial virus (RSV) (especially in infants)

Most URTIs resolve in 7–10 days without antibiotics.

Reference:
American Academy of Pediatrics (AAP) – https://www.healthychildren.org

2.2 Acute Bronchitis

Bronchial inflammation following a viral infection causes persistent cough. Usually lasts 2–3 weeks.

Symptoms:

§ Dry or wet cough

§ Mild fever

§ Chest congestion

Antibiotics are rarely helpful because bronchitis is usually viral.

Reference:
CDC – https://www.cdc.gov/antibiotic-use

2.3 Pneumonia

Can be viral or bacterial.
Symptoms:

§ Fast breathing

§ Fever

§ Chest indrawing

§ Lethargy

§ Poor feeding

Bacterial pneumonia (e.g., Streptococcus pneumoniae) requires antibiotics.

Reference:
WHO – https://www.who.int/news-room/fact-sheets/detail/pneumonia

 2.4 Post-nasal Drip / Allergic Rhinitis

Mucus trickles from the nose into the throat, triggering cough.

Symptoms:

§ Sneezing

§ Nasal itching

§ Clear nasal discharge

§ Cough worse at night

Triggers:

§ Dust

§ Pollen

§ Pets

Reference:
Mayo Clinic – https://www.mayoclinic.org

2.5 Asthma

Cough may be the only symptom in some children (cough-variant asthma).

Triggers:

§ Cold air

§ Exercise

§ Dust

§ Viral infections

Symptoms:

§ Nocturnal cough

§ Wheezing

§ Chest tightness

§ Recurrent episodes

Reference:
Global Initiative for Asthma (GINA) – https://ginasthma.org

2.6 Foreign Body Aspiration

A medical emergency.

Common in children under 5.
Clues:

§ Sudden onset cough

§ Choking episode

§ Persistent unilateral wheeze

§ Recurrent pneumonia

Reference:
Johns Hopkins Medicine – https://www.hopkinsmedicine.org

2.7 GERD (Gastroesophageal Reflux Disease)

Stomach acid reflux irritates the throat.

Symptoms:

§ Chronic cough

§ Regurgitation

§ Sour breath

§ Irritability after feeds

Seen commonly in infants.

 2.8 Environmental Irritants

§ Secondhand smoke

§ Air pollution

§ Aerosols

§ Strong perfumes

§ Household chemicals

They cause airway irritation leading to acute or recurrent cough.

3. Symptoms and Patterns That Help Diagnosis

Different cough characteristics often help identify the underlying cause:

Type of cough

Possible cause

Barking cough

Croup

Whooping sound

Pertussis

Wet, productive cough

Bacterial infection, bronchitis

Dry cough

Viral infection, asthma, allergies

Night-time cough

Asthma, postnasal drip

Cough while feeding

GERD, aspiration

Reference:
Royal Children’s Hospital Guidelines – https://www.rch.org.au

4. Red Flags – When Acute Cough Needs Immediate Medical Care

Parents must be alerted to danger signs such as:

4.1 Breathing difficulty

§ Fast breathing

§ Chest retractions

§ Nasal flaring

§ Grunting

4.2 Cyanosis

Bluish discoloration of lips or face.

4.3 Persistent fever

Especially if more than 3 days.

4.4 Lethargy or drowsiness

4.5 Poor feeding or dehydration

Dry lips, reduced urination.

4.6 Suspected foreign body aspiration

4.7 Cough with blood

4.8 Chronic diseases

If the child has asthma, congenital heart disease, immunodeficiency, etc., even mild cough may require early evaluation.

 5. Diagnosis and Evaluation

Evaluation depends on history, examination, and the presence of red flags.

5.1 Clinical History

Important questions:

§ Duration of cough

§ Onset (sudden vs gradual)

§ Exposure to sick contacts

§ Vaccination status

§ Allergy history

§ Choking episodes

§ Feeding problems

§ Environmental exposures

5.2 Physical Examination

Includes:

§ Temperature

§ Respiratory rate (age-specific norms)

§ Oxygen saturation

§ Lung auscultation

§ ENT examination

§ Hydration status

5.3 Investigations

Not all children require investigations.

Only when indicated:

Chest X-ray

§ Pneumonia

§ Foreign body

§ Persistent cough >3 weeks

CBC, CRP

§ Suspected bacterial infections

Throat swabs / viral panels

§ Influenza, RSV (in infants)

Spirometry

§ In suspected asthma; usually done in children >6 years.

CT scan / bronchoscopy

§ For suspected foreign body

§ Recurrent localized pneumonia

6. Management of Acute Cough in Children

Management depends on the cause.

6.1 General Supportive Measures

Hydration

Warm fluids help loosen mucus.

Humidity

Cool-mist humidifier improves comfort.

Nasal saline drops

Useful for infants with congestion.

Honey (age >1 year)

Proven to reduce cough frequency and improve sleep.
(Do not give honey to infants <1 year—risk of botulism)

Rest and Adequate Sleep

Avoid Irritants

No smoking near children.

Reference:
AAP HealthyChildren.org – https://www.healthychildren.org

6.2 Medications

Antibiotics

NOT routinely needed.
Use only for:

§ Bacterial pneumonia

§ Suspected pertussis

§ Bacterial sinusitis

Unnecessary antibiotics cause:

§ Diarrhea

§ Allergic reactions

§ Resistance

Cough syrups

Most OTC cough syrups are not recommended in children under 6 due to:

§ Lack of benefit

§ Potential side effects

Bronchodilators

Only useful if wheezing or asthma is diagnosed.

Antihistamines

Useful in allergic rhinitis.

Steroids

Used cautiously in:

§ Moderate to severe croup

§ Severe asthma exacerbation

§ Certain allergic conditions

7. Condition-Specific Management

7.1 Viral URTI

§ No antibiotics

§ Fluids

§ Honey (>1 yr)

§ Saline nasal irrigation

§ Steam inhalation (supervised)

 7.2 Croup

Barking cough + stridor.

Treatment:

§ Single dose oral dexamethasone

§ Humidified oxygen in severe cases

7.3 Asthma-Related Cough

§ Short-acting bronchodilator (salbutamol)

§ Inhaled corticosteroid if recurrent

7.4 Pneumonia

§ Antibiotics (amoxicillin first line)

§ Hospitalization if:

§ Breathing difficulty

§ Oxygen saturation <92%

§ Poor feeding

§ Infant <2 months

7.5 Pertussis (Whooping Cough)

§ Macrolide antibiotics

§ Isolation to prevent spread

§ Emphasis on vaccination (DTaP / Tdap)

 7.6 Foreign Body Aspiration

§ Immediate hospital referral

§ Removal via bronchoscopy

8. Prevention Strategies

8.1 Vaccination

§ Influenza vaccine

§ Pneumococcal vaccine

§ DTaP (diphtheria–tetanus–pertussis)

§ COVID-19 vaccine (age-appropriate)

8.2 Breastfeeding

Boosts immunity.

8.3 Nutrition

A balanced diet strengthens immune defenses.

8.4 Hygiene

Handwashing prevents viral spread.

8.5 Avoid environmental pollutants

Clean indoor air reduces recurrent cough.

9. Special Considerations in Infants and Toddlers

Infants have:

§ Narrow airways

§ Limited immune response

§ Higher risk of dehydration

§ Higher risk of respiratory distress

Always seek early medical care for infants under 3 months with any cough.

10. Prognosis

Most acute coughs resolve within 1–2 weeks.
Some post-viral coughs may last up to 3–4 weeks.

Long-term outcomes are excellent when serious causes are excluded.

Relevant Website Links

Here are authoritative websites for parents and clinicians:

1. American Academy of Pediatrics (HealthyChildren.org)

https://www.healthychildren.org

2. CDC – Cough & Respiratory Infection Information

https://www.cdc.gov/antibiotic-use

3. Mayo Clinic – Pediatric Cough

https://www.mayoclinic.org/diseases-conditions/cough

4. WHO – Pneumonia in Children

https://www.who.int/news-room/fact-sheets/detail/pneumonia

5. Royal Children’s Hospital Clinical Guidelines

https://www.rch.org.au

6. GINA Pediatric Asthma Guidelines

Global Initiative for Asthma

7. Johns Hopkins Medicine – Foreign Body Aspiration

https://www.hopkinsmedicine.org

References

1. AAP. “Coughs and Colds: Medicine or Home Remedies?”

2. CDC. “Antibiotic Use in Children.”

3. WHO. “Pneumonia in Children: Key Facts.”

4. Mayo Clinic Staff. “Chronic and Acute Cough Causes.”

5. Royal Children’s Hospital (RCH) Clinical Practice Guidelines.

6. GINA (Global Initiative for Asthma) Pediatric Guidelines.

7. Johns Hopkins Medicine. “Airway Foreign Bodies in Children.”

8. BMJ Best Practice – Cough in Children.

9. Lancet Respiratory Medicine – Viral respiratory infections in children.

10.  NEJM – Management of Community-Acquired Pneumonia in Children.

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