Author: Dr. Miles Weinberger, MD
A 9-year-old girl had had a chronic cough interspersed with periods of relief for more than 2 years. She had no fever or history of other medical problems. The cough was loud and was described as sounding like a barking dog. The girl would sometimes cough for 18 hours straight. Because of the cough, she had frequently missed school, had had more than 20 visits to 3 different hospital emergency departments, and had seen 2 pediatricians, 3 otolaryngologists, 2 speech therapists, and 1 pediatric pulmonary specialist. Multiple diagnostic tests had identified no cause for her chronic cough.
She had been treated with bronchodilators and several antibiotics and had gained excessive weight from having been prescribed corticosteroids. These treatments had had no effect on her cough. She had been hospitalized once to sedate her in an unsuccessful attempt to stop the coughing. The pulmonologist had recommended psychiatric help, which had been of no benefit.
At presentation, the girl’s cough was present from when she wakes up until she falls asleep. Once asleep, she does not cough. She had headaches and chest soreness from the forceful nature of the coughing. She loves school, does well there, has friends, and her only source of anxiety was the cough.
Based on the clinical presentation, the girl received a diagnosis of habit cough.
Discussion: There are many causes of chronic cough in childhood. An algorithmic approach begins with a diagnosis that can be made just on the clinical presentation and proceeds to specific noninvasive tests. More invasive tests, such as bronchoscopy, are necessary when causes of the cough are not identified from those initial measures.1
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