It may be tough to watch and hear your kids cough, but it's actually a healthy and important reflex that helps clear the airways in the throat and chest. Although many childhood coughs are caused by pesky everyday viruses, persistent coughing may be a sign of something more. And a new study shows that three common conditions, in particular, are probably behind lingering coughs in kids.

Researchers from West Jefferson Medical Center in Louisiana ran extensive tests (including X-rays and lung function tests) on 40 kids with chronic coughs that had lasted for more than 8 weeks.

They found that 90% of the cases were most likely caused by:

• Allergies. An allergy is an overreaction of the immune system to a substance that's harmless to most people. Symptoms can range from minor or major seasonal annoyances (for example, from pollen or certain molds) to year-round problems (from allergens like dust mites or food).
• Asthma. A chronic lung disease that causes airways to become inflamed, asthma affects more than 20 million people in the United States and is the No. 1 reason why kids chronically miss school.
• Gastroesophageal reflux disease (GERD). Reflux, when acid from the stomach refluxes into the esophagus, is very common in infants and sometimes occurs in older children. Doctors diagnose GERD when a child's reflux is causing complications, like irritation of the esophagus, poor weight gain, or breathing problems. In some kids, persistent cough can be a symptom of reflux.

The Scoop on Kids' Coughs

Occasional coughs are often just a common part of childhood and usually aren't a symptom of a serious condition. Common respiratory viruses are often behind many kids' occasional coughs, which means they don't respond to treatment with medications, including antibiotics (unless the doctor suspects a bacterial infection). So, many coughing-related illnesses just need to run their course.

But sometimes a cough that's severe or just won't go away warrants a closer look. Give your doctor a call if your child has:

• a severe cough, especially with:
  - blood or lots of mucus
  - a "whooping" sound when breathing after coughing (found with pertussis, or whooping cough)
  - wheezing when exhaling (a common symptom of asthma)
  - stridor when inhaling (a noisy, coarse, almost-musical sound)
• cough or cold symptoms that:
  - get worse instead of better after 3 days
  - last for more than a week
  - last for more than a few hours in infants under 3 months old
  - appear at the same time every year
  - seem to be triggered by something (e.g., pollen, dust, animals, certain types of food, etc.)
• difficulty breathing (working hard to breathe or breathing faster than usual)
• a blue or dusky color in the lips, face, or tongue
• a fever of 103° F (39.3° C) or higher; 101° F (38° C) or higher lasting longer than a day; or any fever in a baby 3 months or younger

If your child has a persistent cough, try to give your doctor as many details as possible — what it sounds like, if there are other symptoms, and when it usually happens (at night, during the day, while exercising, after eating certain things, etc.). Be sure to mention if anyone in your family has a history of asthma or allergies.

What This Means to You

As your child copes with a cough of any kind, you may be tempted to give your little one over-the-counter (OTC) medicine to help relieve it. But it's wise to avoid these medications altogether in young children. In fact, health officials say OTC cough and cold remedies should never be used for kids under 2, unless a doctor says otherwise.

In October, the U.S. Food and Drug Administration (FDA) yanked 14 popular infant cough and cold medicines after three infants died and more than 1,500 babies and toddlers visited emergency rooms in 2004 and 2005. Also in October 2007 an advisory panel for the FDA recommended that these medications not be used in kids under 6, saying they don't work in young kids and haven't been deemed safe for them. However, the FDA hasn't made an official decision to ban them in this age group yet.

Although OTC cough meds aren't the way to go for young kids, these simple steps can help make your coughing child more comfortable:

• Use saltwater (or saline) drops in the nostrils to relieve nasal congestion.
• Use a cool-mist humidifier to increase air moisture.
• Put petroleum jelly on the skin under the nose to soothe rawness.
• If your child wakes up with a "barky" or "croupy" cough in the middle of the night, sit in a steamy bathroom for approximately 20 minutes (after letting the shower run on hot for several minutes).
• Offer plenty of fluids — breast milk or formula for infants; and juice, water, or other cool, soothing, noncaffeinated beverages for kids older than 12 months. But avoid carbonated or citrus drinks that can be painful on raw areas.

And, again, if the cough is severe or persistent, don't hesitate to call the doctor.

Reviewed by: Steven Dowshen, MD
Date reviewed: December 2007