Cough alarm in children: How to recognize dangerous symptoms!

Cough alarm in children: How to recognize dangerous symptoms!

Mucous cough that lasts longer than four weeks is a serious concern, especially in young children. Dr. Anne Schlegentendal, senior physician at the Bochum University Children's Hospital, warns of protracted bacterial bronchitis (PBB), a common cause of this condition. The issue was addressed in a study published April 21, 2025 in the journal Pediatric Pulmonology. Without adequate treatment, which usually includes taking antibiotics for at least two weeks, there is a risk of irreversible long-term damage such as chronic lung damage news.rub.de.

Persistent coughs are also the most common reason for visits to the doctor in outpatient practice, especially in children. A period of more than four weeks can place a significant burden on the children affected and their families. Current evidence shows that many children with chronic cough are initially misdiagnosed as having asthma, even though other underlying pathologies are often present. The National Institutes of Health highlights that up to two thirds of children with chronic cough have previously received asthma treatment, but this was often ineffective.

Protracted bacterial bronchitis

PBB is the most common form of chronic cough in healthy children under six years of age. The definition includes a wet cough lasting more than four weeks, accompanied by evidence of at least 10⁴colony forming units (CFU/ml) from bronchoalveolar lavage or sputum. Significant improvement after two weeks of antibiotic therapy is also an important diagnostic criterion. There is also a high prevalence of purulent lung diseases in children, which also include empyema, lung abscesses and bronchiectasis. This information comes from current research, which, among other things, points to the need for consistent therapy and long-term pediatric pneumological support.

Lack of correct diagnosis can lead to chronic lung pathologies, such as foreign body aspiration. In resource-poor countries, PBB can progress undetected into serious purulent lung diseases. Various respiratory pathogens, includingH. influenzae,Streptococcus pneumoniaeandStaphylococcus aureus, are common causes of PBB. It is also noteworthy that viruses, mainly human adenovirus, can contribute to the development of PBB, as shown by the research results paediatrieschweiz.ch emerges.

Treatment approaches and challenges

The diagnostic challenges of chronic cough are significant. Delayed diagnosis can lead to serious health problems. Severe cough episodes represent not only a medical but also an emotional burden on families. Children cough on average between 1-34 times per day, with around six to ten cold-related cough episodes per year in the preschool years. A worrying aspect remains that around 10% of children suffer from a cough that lasts longer than four weeks, making early and thorough investigation necessary.
The treatment recommendations usually include a 2- to 4-week course of oral antibiotics for a wet cough without warning signs that require urgent treatment. If therapy fails, the differential diagnoses should be reviewed immediately. While prophylactic antibiotics are not considered useful, the role of the exact duration of treatment in relation to the risk of recurrence remains unclear.

Continuous research in this area could in the future identify genetic or epigenetic markers that make it possible to distinguish between benign and serious courses. In the past, the approach was to view the lower respiratory tract as sterile; today a physiological microbiome is assumed. These shifts in how we view respiratory disease could help significantly improve treatment approaches for children with chronic cough.