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I have a child who is couging…for the past 3 weeks.

Posted Jun 30 2009 5:54pm

Recently, a mother of nine came to the office with her 6 y.o. daughter who has been coughing on and off for the past 4 weeks.  Mom has been using albuterol inhalers (an aunt, grandmother and sibling have a history of asthma) , essentials oils on the chest and nebulized in the air, and over the counter cough and cold medicine but no change in the symptoms.


  • coughing spells (the child feels normal until she has coughing spells which seem to choke her)
  • vomiting after cough (not just mucus but food contents) especially in the night.
  • mild sore throat

Two other children (a 10 year old and a one year old) in the home have the same symptoms.  On one occasion, a sibling reported that the baby brother (1 y.o.)  turned purple after coughing but then was fine.

The older boy had a mild fever and a case of tonsillitis a week ago and has been taking a cephalosporin antibiotic.

All the children are up to date on their immunizations.

The physical exam is unremarkable:

  • lungs are clear
  • heart is beating regularly and rhythmically
  • child is playful and talkative
  • ears, nose, and throat appear normal

Possible diagnosis:

  • tuberculosis
  • asthma
  • viral illness (chest cold)
  • allergies
  • pneumonia
  • pertussis (aka whooping cough)
  • pyschogenic or habit cough


  1. Certainly allergies can elicit cough from post nasal drip and trigger cough however usually does not cause vomiting and the children had no other allergy symptoms (no runny nose of sneezing).
  2. Habitual cough is a diagnosis of exclusion
  3. Since several family members having a history of asthma, treating with albuterol makes sense.  Inhaled or systemic steroids may be appropriate.
  4. With all three children demonstrating the same type of symptoms to varying degrees then we also consider an infectious cause:
  • With the lungs sounding clear and no fever, pneumonia is less likely.
  • Regarding tuberculosis, the children have not been exposed to high risk individuals (HIV, IV drug users, inmates or the homeless) nor had they traveled outside the country.
  • most chest colds are self limiting and resolve within 7-10 days.

Pertussis is characterized by:

  • paroxysmal cough
  • vomiting after cough
  • high pitched whoop between coughs

In this case, pertussis or whooping cough was diagnosed in the clinic.  The patient was placed on azithromycin.  Before antibiotic was started, a nasopharyngeal swab was taken to confirm diagnosis.  Diagnosis was confirmed in the one year old.

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