My child coughs all the time and nothing seems to relieve it. Cough protects the body by removing mucus, irritating substances, and infections from the respiratory tract. Coughing helps to clear mucus and fluids from the airways. Cough is the most common respiratory symptom for which patients seek medical attention. Coughing does not always mean there is a problem with your child. Normal children can cough 1 to 34 times a day and have coughing episodes lasting up to a couple of weeks. However, coughing at night after going to sleep is almost always abnormal and needs medical attention. The cause and management of cough in children and adults have several similarities. There are also several differences. Cough in children is divided into acute cough (usually lasting one to two weeks) and chronic cough (lasting greater than four weeks).

The vast majority of children with brief periods of coughing are coughing because of viral upper respiratory tract infections. Many different viruses cause these infections in children. Healthy preschool children in day care can have up to six to eight viral respiratory infections with cough every year. This acute cough is usually due to postnasal drip and direct airway irritation by the virus. Postnasal drip is a condition in which mucus drips slowly from the nose and sinuses to the back of the throat. Medications may or may not be necessary or helpful. It is best to check with your doctor.

Chronic or persistent cough lasting longer than four weeks is very common in children. The most common causes include: Cough as a symptom of asthma For children with asthma, cough is a common symptom (along with wheezing and shortness of breath). In some children, cough is the only symptom noticed by the child or parent. Some experts believe that cough is the most common symptom of asthma in children. Coughing from asthma is typically made worse by viral infections, particularly at night, and by exercise and cold air. Cough due to asthma is treated with the same inhaled and oral medications used in all patients with asthma. Nasal and sinus disease causing cough Postnasal drip due to rhinitis (inflammation in the nasal passages) or sinusitis (inflammation in the sinus cavities) is another common cause of cough that can become chronic. Usually, other symptoms such as nasal congestion and runny nose are present, but sometimes the only symptom noticed is the cough. Allergic rhinitis (hay fever), either seasonal or year-round, is often the cause, and tests for allergies may be necessary. Sinus infections can persist for weeks to months causing cough, sometimes with minimal nasal symptoms. Occasionally, your doctor may advise you to do a sinus X-ray or limited CT scan of the sinuses. Stomach and esophageal causes of cough In some children, the cause of chronic cough is due to problems with the stomach and esophagus (food tube). Most commonly, this is due to gastro esophageal reflux disease (GERD). This is often associated with a feeling of heartburn. But young children often don't complain of heartburn because they may not know it is abnormal or may not be able to describe the feeling. In some children, heartburn does not seem to occur even with GERD. Other children may develop a hoarse voice and/or choking as a symptom of GERD. This may need to be investigated by your doctor which includes a trial of medicines for GERD. X-rays and other tests to look at the stomach and esophagus or measure stomach acid refluxing into the esophagus may also be needed. In young infants, reflux and swallowing problems are a common cause of persistent cough, particularly when it occurs after eating.

Post-viral cough Children without asthma, allergies or sinusitis can have a cough after viral respiratory infections lasting for weeks. There is no specific therapy for this cough and it does eventually resolve. It is often due to increased sensitivity at the cough trigger points and is suspected when the cough does not respond well to asthma medications. Cough suppressant medications can be tried but they are not always helpful. Inhaled foreign body Although small foreign bodies, such as a piece of a plastic toy or part of a peanut, hot dog or a hard candy can be accidentally inhaled at any age, it most commonly occurs in boys, ages two to four years. The foreign body may or may not appear on an x-ray. It can cause a cough to persist for many weeks to months until it is discovered. "Habit" cough This is a persistent cough that has no physical cause. It occurs most commonly in children, adolescents and young adults. It occasionally persists after a simple viral respiratory infection. The cough typically is dry and repetitive or is a "honking" cough that usually worries parents and teachers much more than the child. Habit cough is absent at night after the child goes to sleep. Irritant cough Exposure to environmental tobacco smoke and other pollutants (smoke and exhaust from wood burning, air pollution and exhaust from vehicles) is associated with increased cough in healthy children and may worsen the cough associated with asthma or rhinitis. These substances should be avoided, particularly in children with asthma or rhinitis.

Often, simple daytime cough after viral respiratory infections requires no specific treatment, particularly if it resolves in one or two weeks. The primary treatment for chronic cough should be aimed at the underlying cause-asthma, GERD, rhinitis or sinusitis. Treating cough symptoms with mucus thinning agents such as guiafenesin has limited benefit in most patients. Cough suppressing medications such as over-the-counter medications that contain dextromethorphan are also of limited value, but can be tried. Stronger cough suppressing agents such as codeine-containing medications are more effective, but have more side effects and should only be used for short periods of time.

Patients should contact a doctor if a cough changes in character, trial therapy shows no signs of reducing the cough, you begin to cough up blood and/or the cough interferes with the activities of daily living or sleep.

The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they: Have a cough that lasts 3-8 weeks or more. Have a cough that coexists with asthma. Have coexisting chronic cough and nasal symptoms. Have a chronic cough and tobacco use or exposure. Created by the Public Education Committee of the American Academy of Allergy, Asthma and Immunology.

My child hates her nebulizer treatment and refuses to let us do it. Sometimes, parents and childcare providers will aim the mist at the baby’s face while he/she is sleeping thinking that this is a good way to sneak a breathing treatment past him. This practice is called a blow-by treatment, which is an appropriate name for an ineffective practice. The medication blows right by the baby’s face and does not reach the airways. In fact, it is more likely that the parent will inhale more medicine than the baby. Your Daily Routine Treating your child's breathing problems can really be tough, especially if it involves a nebulizer. Most parents of kids with breathing problems have had to force a nebulizer mask over the face of their kicking, screaming child at least a few times. You know you're only trying to help your child, but it doesn't make you feel much like a candidate for "Parent of the Year," does it? More like "Parent Meanie." Some kids are just too busy playing to want to stop and sit still for their treatments. Others hate having the mask placed over their faces or the elastic strap wrapped around their heads. No matter what the reason for their fighting back, you're left with the challenge of finding a way to get the treatment done. "I hate making my child use her nebulizer, but even if I had to hold her down, I'd make sure she got the treatments, because they work. I'd rather be 'mean' for a few minutes a day than watch her gasp for breath." It's important that your child's breathing treatments become a natural part of his or her daily routine. This can be a challenge, and sometimes it may seem as though it would be easier just to skip a treatment, especially if your child isn't having any symptoms. But making sure your child gets his or her asthma medication on a regular basis is a key step in helping to manage his or her condition. Facing up to this challenge is something every parent or caregiver of a child with breathing problems must do sooner or later. When you and your child figure out a way to master this challenge, you just may find that you've forged a stronger mother-child bond. You may also find that it is helpful to get advice from other parents dealing with the same issues as you

Do the treatment(s) at the same time each day, so that your child comes to expect it as a regular part of the daily routine Offer a treat afterward as a reward. Treats can be healthy foods, such as fruit or pretzels. Or, make the reward an activity, such as reading a favorite book or watching TV Distract your child during the treatment with videos, music tapes, or toys. Coloring books and puzzles work well too. Young children can sit on your lap during the treatment, while you play hand games such as patty cake or peek-a-boo Buy a special "fun" mask in the shape of a fish face or something similar Pretend the child is a firefighter, astronaut, or "Buzz Lightyear" when wearing the mask. Playing with the mask during nontreatment times can also help Let older toddlers help be "in charge" of their treatment. Allow them to turn the machine on or off and to put the mask on and take it off Put the mask on a favorite stuffed toy or doll first. Show how much fun the toy is having or how brave it is. Then transfer the mask to your child Invite someone else to help you. Your spouse or another relative or friend can distract your child while you slip the mask on and start the treatment. You can even enlist an older child to read a story or play a game to turn nebulizer-time into an experience that the family can share If your child is still a baby, try giving the treatment while he or she is asleep. You can also look into getting a mask that has a pacifier attachment. We have another suggestion. Visit Pulmi's Zone, a valuable resource for you and your child with breathing problems. If you haven't joined Everydaykidz™ yet, "Pulmi's Zone" is a great reason to do so. You can use the activities in "Pulmi's Zone" to help your child understand why treatment is important. You can also offer a visit to this special place as a reward for cooperating with treatment.