Why Your Child's Cough Won’t Go Away: What Parents Need to Know
Introduction
A cough that just keeps hanging around can wear on a parent’s nerves—especially when your child seems otherwise okay. It’s common to wonder: “Is this still part of the cold, or is something else going on?”
While most lingering coughs are part of normal healing, others may point to a deeper issue. As pediatric pulmonologists, we’re here to help you understand when to wait, when to worry, and what to expect if your child needs an evaluation.
Quick Takeaways for Busy Parents
Coughs lasting more than 3–4 weeks may need a closer look
Common culprits: post-viral irritation, asthma, allergies, or reflux
Less common causes like protracted bacterial bronchitis (PBB) and chronic aspiration can be missed
Watch for wet coughs, nighttime symptoms, or trouble breathing
When in doubt—especially if the cough is affecting sleep or school—we’re here to help
What Counts as a “Persistent” Cough?
Coughing is part of healing—but how long is too long? We define coughs this way in pediatric care:
| Type of Cough | Duration | Common Causes | Action Needed |
|---|---|---|---|
| Acute | < 3 weeks | Cold, flu, mild bronchitis | Usually resolves on its own |
| Persistent / Prolonged | 3–4 weeks | Post-viral irritation, sinusitis | May need pediatric evaluation |
| Chronic | > 4 weeks | Asthma, PBB, allergies, aspiration, pertussis | Specialist assessment recommended |
If your child’s cough is still going strong after a month, or seems to be getting worse, it’s a good time to check in.
How Long Should a Cough Last After a Cold?
Most viral coughs: 10–14 days
90% are gone by 3 weeks
Bronchiolitis in infants may last longer
Pertussis (whooping cough): 6–8+ weeks
Persistent bacterial bronchitis or aspiration may keep a cough going much longer
The Most Common Reasons Kids Keep Coughing
Post-Viral Cough (Airway Irritation)
Even after a cold is over, airways may stay sensitive. This is one of the most common reasons a cough lingers—especially at night or after running around. It usually fades with time, no antibiotics needed.
2. Sinus Infections (Bacterial)
Thick mucus
Cough worse at night
Stuffy nose that just won’t go away
Fever that returns or won’t quit
Sinus infections can drip mucus into the throat (postnasal drip), triggering coughing fits.
3. Asthma and Allergies
Asthma can show up as:
Cough during play or at night
Wheezing
Shortness of breath
In some kids, cough is the only asthma symptom. Allergies (to dust, pollen, pets) can also cause postnasal drip and cough.
Less Common — But Important — Causes of Persistent Cough
Protracted Bacterial Bronchitis (PBB)
This is a chronic wet cough caused by lingering bacteria in the lower airways. It doesn’t improve with typical cold care and often comes back.
Cough >4 weeks, especially if it’s wet or rattly
No wheezing or asthma signs
Improves with a longer course of antibiotics
2. Chronic Silent Aspiration
Some kids silently inhale small amounts of food or saliva into their lungs, which irritates the airways over time. This is called aspiration, and it doesn’t always come with choking or obvious symptoms.
Cough during or after eating
Recurrent pneumonia or “bronchitis”
Feeding difficulties in infants
Wet-sounding breathing
Slower growth
3. Gastroesophageal Reflux Disease (GERD)
Cough worse when lying down
Throat clearing
Sour taste in mouth
Fussiness after meals in babies
This cough isn’t from infection—it’s from acid irritating the throat and upper airway.
When to Worry: Red Flags to Watch For
Cough >4 weeks
Wet or worsening cough
Nighttime or exercise-triggered cough
Wheezing
Fever >102°F lasting more than 24 hours
Vomiting after coughing
Blue lips or nails
Coughing during feeds or choking episodes
Chest pain or breathing that looks hard
When to See a Pediatric Pulmonologist
Cough over 4 weeks
Multiple prolonged cough episodes in a year
Wet, disruptive, or activity-triggered cough
Suspected PBB, asthma, GERD, or aspiration
History of choking or inhaled object
Need for clear diagnosis and care plan
What to Expect at Our Visit
Full History & Examination
Cough duration and type
Triggers and relief patterns
Feeding history
Growth trends
Past treatments and environmental exposures
2. Targeted Testing
Lung function (age 3+). Also Know as “Pulmonary Function test” or “PFT”
Chest imaging (X-Ray, CT-Scan etc)
Swallow study or pH probe
Allergy testing
Bronchoscopy (rare cases)
3. Personalized Plan
Inhalers, antibiotics, or reflux treatment
Airway clearance techniques
Habit cough coaching (Habit cough will be covered in a separate article)
Written action plan and follow-up schedule
What Can You Do at Home?
Supportive Care That Helps
Hydration – thins mucus
Warm fluids or honey – for kids over 1
Humidifier – soothes irritated airways
Nasal saline spray – clears postnasal drip
Elevated sleeping – for reflux
Avoid smoke and strong scents exposure
2. Avoid Over-the-Counter (OTC) Cough Medications
OTC cough medications don’t help young children and may cause side effects. For kids under 6, avoid them unless your pediatrician specifically recommends otherwise.
3. Preventing Persistent Cough in the First Place
Stay current on vaccines (pertussis, flu, COVID)
Reduce exposure to allergens
Avoid secondhand smoke
Encourage handwashing and hygiene
Support immune health with sleep, nutrition, and physical activity
Bottom Line: You Know Your Child Best
If your child’s cough just doesn’t feel right—trust your instincts. You don’t have to wait it out alone. We’re here to help you sort through the possibilities and get your child back to feeling like themselves.