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Why is My Child Coughing So Much?

My daughter, age nine, had croup more than two weeks ago but is still coughing. Her attacks of dry cough are exhausting and last for more than two hours. Doctors say she is healthy and that this is a tic cough. They offer no treatment. Almost every day her school calls, asking us to pick her up because of her condition (despite a note from a doctor about her not being contagious).

Answer (Published 8/31/2010)

Tic coughs are a real phenomenon. Like other tics (eye blinking, shoulder shrugging, facial grimacing, neck twisting, throat clearing, sniffing) they are rapid involuntary movements and occur in about 20 percent of school age children. Tics can appear suddenly after physical or social stress and tend to worsen when a child is tired, tense or idle. They become less frequent when kids are able to relax and never occur during sleep.

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I discussed your question with Sandy Newmark, M.D., a California-based pediatrician who is on the faculty of the Arizona Center for Integrative Medicine. He thinks it may be too soon to conclude that your daughter's cough is a tic or habit cough and said that there are a number of more common reasons for an extended cough in children, including undiagnosed asthma. Dr. Newmark asked if the diagnosis of tic cough came from a pediatric pulmonologist. (If not, scheduling an appointment with one of these specialists should be your next step.)

If it really is a tic cough, Dr. Newmark said that effective treatments are available. He noted that mind-body methods can be quite helpful, especially self-hypnosis training. In addition, he said that speech therapists can treat tic coughs using voice therapy techniques, but he stressed the importance of making sure this is the correct diagnosis before proceeding. I agree.

Because tics are common in young children whose brains are still developing, they may be a transient aspect of normal neural maturation, according to the American Academy of Pediatrics (AAP). And because tics seem to run in families, they may have a genetic component. Although it's apparent that stress influences them, we really don't know what triggers them.

If your daughter does have a tic cough, it should disappear without any treatment within several months, and it's good to plant the seed in her mind that it will go away on its own. Making her feel self-conscious about her cough and pressuring her to control it may prolong it.

Andrew Weil, M.D.

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