Tos crónica pediátrica

How are pediatric chronic coughs diagnosed?

El proveedor de atención médica de su hijo escuchará el tipo de tos y le hará preguntas al respecto para descartar posibles causas.

The provider will want to know:

• Cómo suena
• Cuánto tiempo ha durado
• Qué la desencadena o qué la mejora
• Cuándo ocurre
• Si ya se trató con algún medicamento
• Si alguien en la casa fuma

What are the causes of a pediatric chronic cough?

• Viral infections, including colds, are the most common cause of a cough. Bacterial infections, such as bacterial bronchitis and sinusitis, can also cause a chronic cough. Sometimes a cough lasting more than a month is simply due to back-to-back viral infections, especially during the fall and winter seasons.
• Whooping cough (pertussis) is another infection that can cause a chronic cough. Pertussis is characterized by coughing spells ending with a deep breath that makes a “whooping” sound. Babies and young children may not produce the whooping sound and may have only the coughing fits, or rarely, have pauses in breathing or turning blue.
• Asthma - Cough occurs in response to airway irritants or inflammation. Cough due to asthma is most commonly triggered by exercise, cold air, weather changes or exposure to airway irritants, such as secondhand smoke or other strong smells (perfumes, cleaning supplies).
• Allergies - Cough occurs due to postnasal drip (mucous from the nose draining down the back of the throat) or from irritated or swollen airways. Allergies tend to flare in spring and fall, depending on what a child is allergic to, but can occur year-around due to allergens like dust mites, cat and dog dander.
• Gastroesophageal reflux disease (GERD) - Also called heartburn or acid reflux - When stomach acid comes back up from the stomach, it irritates the throat and can cause a cough. Reflux is typically worst at night or right after a meal.
• Irritants - Exposure to secondhand smoke or other household chemicals can lead to coughing even in otherwise healthy children.
• Pneumonia - Pneumonia can be bacterial or viral, and is usually diagnosed on a chest X-ray.
• Foreign body - the presence of a foreign object in the airway, most commonly a small toy or particle of food that a child chokes on and accidentally inhales into his airways. The child then coughs to try to clear the object from his lung.
• Habit cough - a cough without any infectious cause or other explanation, which typically starts when a child is sick but then persists after the illness resolves. The cough occurs when the child is thinking about or focusing on the cough, but goes away when he is distracted or asleep. This diagnosis is fairly common but can only be made by ruling out other causes of cough.
• Other illnesses - In some cases, a cough can indicate a more serious illness, such as cystic fibrosis (CF) or other genetic conditions that affect the respiratory system. However as of 2009, CF is on the newborn screen in all 50 states, so if your child was born after that and had a normal newborn screen, CF is much less likely.
• Age - The age of the child also plays a role in the diagnosis and cause.
  • Los niños más pequeños son más propensos a la aspiración de cuerpos extraños y a anomalías en las vías respiratorias.
  • Para los niños mayores, es más probable que la tos se deba a asma, goteo posnasal o ERGE. No obstante, las infecciones virales son la causa más frecuente de la tos en todas las edades.

How is a pediatric chronic cough treated?

El tratamiento depende de la causa de la tos. Si la tos se debe a un irritante, el mejor tratamiento es eliminar o controlar mejor el irritante en el hogar. 

• Medications may include antihistamines, antibiotics or acid blockers, depending on the diagnosis. Además, los medicamentos para el asma, como los esteroides inhalados, pueden controlar la inflamación de las vías respiratorias, mientras que los broncodilatadores ayudan a relajar las vías respiratorias para mejorar el flujo de aire.
• Bronchoscopy - Foreign bodies require a bronchoscopy, a quick procedure done under anesthesia with a scope to remove the foreign object from the airway.
• Other - Our pulmonary specialists rarely recommend cough suppressants since they only suppress the symptom of the cough. In young children, studies have shown that cough suppressants are rarely effective and tend to cause more side effects than benefits.

For children over age 1, honey can be used to help soothe the throat and reduce cough.