Habitual cough (psychogenic cough)

What is habitual cough?

A cough that lasts over a couple of days and sounds like the child tries to clears his throat. There is no fever or other systemic symptoms. The cough is annoying; just listen to the following audio file as an example.

Who has habitual cough?

Most cases are of children, more in boys than girls. They are typically 6 years old and older, somewhere until they are in their mid- adolescence. On the other hand, I have seen some adults with this specific diagnosis.

What causes habitual cough?

A lot of times I see a child who had a mild viral infection, with a little cold and a bit of a cough. But then, the cough changes its character and continues. In some cases, this is a child who wakes up in the morning and out of the blue starts coughing this typical cough.

What are the characteristics of a habitual cough?

A few important details:
First of all – this cough is annoying. Yes, you read correctly. What do I mean? That usually, when a person coughs it makes you feel sorry about him. Poor guy. But when a child with habitual cough coughs, it makes you annoyed and aggravates the entire surrounding, mostly the parents. Listen to the attached audio file. Imagine hearing that all day long.
Sometimes, a second before the cough, the child will breath in and makes an effort to release the cough, you can even hear that in the attached example, and see that when he is in front of you.
The child will not cough at night, during sleep. This means that he coughs less during the night time.
Sometimes the cough will get stronger when people are around, but sometimes he will cough even if he is alone in the room.
The cough has the quality of half a cough – half trying to clear the throat. This is a cough that origin in the upper part of the airways; it is not a “wet” cough.

What’s important to do during physical examination of a child with habitual cough?

This is a child that coughs like a shooting machine, from the moment he enters the clinic. So I approach him and ask to examine his lungs, and ask him to try not to cough until I’m done. I elongate the physical examination of the lungs on purpose, and ask the child to take a few deep breaths. With any other cough, when the child takes a deep breath, the cough strengthens. With a little encouragement during the examination, the child will not cough at all. At the end of the examination, I say to him that he can start coughing again, and then – he will start all over again. There is no need to mention – the physical examination of the lungs will be totally fine.

What can’t you miss in a case of habitual cough?

Of course, you cannot miss a real, organic condition.
A lot of children are receiving treatment with inhalations or inhalers like they have asthma, yet their lung auscultation is normal without any wheezing or rales or any other finding suggestive of airway obstruction.
A lot of children received treatment with antibiotics as if they have pneumonia, yet they don’t.
A lot of children received treatment with cough syrup, or antihistamines or many other treatments.
A lot of children got an X-ray, which will be concluded as normal.
An of course, if you want to not miss it, ask the parents if there is any chance the child inhaled a foreign object, though the experienced physician will differentiate the nature of the cough in these two cases.
An experienced physician will not forget there are other diagnoses that can lead to a prolonged cough in children – but the nature of this situation is so distinct, that diagnosis is easy.

So what is in fact a habitual cough? Can the child stop it?

A habitual cough is in fact some kind of tic.
The child doesn’t control the cough. Being mad at him or making comments will not help. On the contrary – it will cause even more distress.
Once I was in the restroom of a clinic I worked at, and from the waiting room I heard a child (in that case a little girl), with a habitual cough. When the mother entered the room I asked around the subject and she told me that she and the girls’ father are getting a divorce. So there is not always such a clear story about emotional distress, but stress is definitely a factor.

How do you treat a habitual cough?

The truth is – it’s not that simple, and every case has its own answers.
What do I mean? There are families where I say and explain to the parents (not to the child), about the nature of the cough, and there are families where you cannot say loud and clear that this is a habitual cough, you have to build a “little story” about an illness.
I mostly want the parents to know the correct diagnosis for the child, since we need them to relieve stress and not comment on the cough.
For the child himself, I explain this was a very minor viral infection, and sometimes the cough remains a bit longer, that is not a cause for concern and that this happens a lot.
I suggest in these cases to not perform additional tests and not to go and see specialists, since any additional attention will only commemorate the situation.
Sometimes I will prescribe cough syrup, mostly in homeopathic dosage, with detailed instructions on how to decrease the dosage gradually, and I often declare that the cough will be gone on Tuesday on 15:00.
The process is long, but with a correct management of the parents and the pediatrician, and by lowering the stress level in the house, it will be ok.

So in this post I did not refer to the textbook at all, pure clinical experience. I hope it helps.