Chronic Cough

Q. I have a 22-month-old daughter that has had a chronic cough since January 2004. The cough occurs more during sleep than awake times and will sometimes last for up to 1 hour. For the most part she starts coughing 5 to 10 minutes after she has fallen asleep. Our pediatrician has had her on a few medications for cold/flu symptoms and has also had her on albuterol and pulmicort breathing treatments. The breathing treatment were done for 4 to 5 months long at 3 to 4 times a day for both. We saw minor results but still had a cough. We have been to an allergy specialists who has tested her for the "common" food and other allergies and she had no reaction to any of them. We have tried using non-dairy products to rule out the excess phlegm and have even used chewable lactaid tablets with semi-dairy meals.

As a mother my diagnosis is that she may have over productive saliva glands. She just seems to be choking on her saliva when it accumulates in her throat. Is this a crazy diagnosis or is it possible? Help. Vicki, Gilbert, Arizona

A. It is possible to have a swallowing disorder and to choke or aspirate things as you try to swallow them. I think that you would expect some feeding problems and a frequent daytime cough if that were the case though.

Children with a chronic cough can be difficult to treat, as you have found. Among the top things that doctors think about when a young child is coughing for several weeks or months are:

• infections, including sinus infections, bronchitis, pneumonia, and walking pneumonia, etc.
• allergies
• and asthma

When treatments for those common conditions haven't worked, it is time to look for other possible causes. Reflux might cause a chronic cough that is worse at night and that might be something to look into.

A pediatric pulmonologist might also be helpful for further management and treatment.

See our cough symptom checker for more information.

Has she had a chest x-ray? If not, it would likely be a good idea to ask for one.

Does anyone at home smoke? If so, even if they smoke outside, that could be a trigger for a chronic cough.