Habit cough in apparently anxious 4th grader
Our daughter has a loud, abrupt, dry cough that started after a cold last winter. She coughs when she's engaged in reading or other activities but not when she's asleep. We waited for it to go away, then saw doctors, who ruled out serious stuff with a chest x-ray and bacterial cultures (all normal/negative). It appears to be a habit cough (and so say the doctors), so we've been patient and have tried to ignore it. It nearly went away during the summer, but it's back with a vengeance now that school is in session. I think she's a mildly anxious child and I remember having physical manifestations of nerves when I was a few years older than her. We're starting to look into mental health resources, but I thought I'd reach out to the community to see if anything or anyone (a particular therapist?) was helpful in a similar situation. The cough is very loud and very frequent and it's driving us up the wall.
Parent Replies
Hi! I know as much about habit coughs as any lay person. My son developed one at age 4, and my daughter just went through a period of having one at age 7. For my son it turned out to be his first tic and he was subsequently diagnosed with Tourette [formerly known as Tourette syndrome] at age 6. For my daughter, we'll see. Tourette is less common in girls than boys but if you don't freak out about the label, there's a lot of applicable approaches as a parent. #1 is DO NOT ASK HER TO STOP DOING IT. I know the sound is absolutely aggravating/nails on a chalkboard, but with any tic, the more you draw attention to it, the more it happens. It is an involuntary neurological response. #2 is if it's bothering HER (like hurting her throat), you can offer lozenges/water/mints/honey in warm water, or perhaps another mouthing stimulus (like a chewy necklace). #3 is let her teacher know it's a habit cough, she can't help it, and not to draw attention to it in class. Get permission to send her with gum (as a crutch - guaranteed she's not doing it as much in class as at home. Tics tend to get suppressed at school and tumble out at home.)
Tics/Tourette has a very strong genetic factor. If you had them (as you allude to) it's extremely likely your child will, but obviously it's not the end of the world. The good news is all tics wane eventually. The less good news is sometimes they are replaced by one that is even more difficult to live with, for you or her. If the habit cough is replaced by more or more intense tics that really start to impact the quality of her life, there are pretty mild medications that can take the edge off them. You may want to keep your eye out for additional repetitive behaviors. You can find out lots more at the Tourette Association website, www.tourette.org. Again, I'm not saying she has Tourette, but the Tourette community knows a lot about tics.
Anxiety may be an underlying cause; you can pursue some group therapy through Kaiser (my son did a couple sessions of "Confidence Club") as a first step if you have Kaiser. I would actually suggest group therapy first for a 4th grader due to the increasing influence of peers at that age. Child anxiety is overall a more complicated issue that I'm not as comfortable making recommendations about because what has worked for my son (who was dx with anxiety) may not be as applicable to another child.
Hi! It might be a tic. My son developed something very similar to what you are describing when he was about 4 years old. It lasted for quite a few years, but he finally outgrew it. His pediatrician ruled out other health issues and recommended that he see a neurologist.
My son also had a habit cough that started after having a cold around age 7 or 8. It was the first of many little tics and he was diagnosed with Tourette (which is just a word for a tic disorder). His tics have taken multiple forms, but none have been too impactful on his quality of life. He started taking a medication for ADHD in 5th grade, and it happens to be something that helps with tics as well. I can't say for sure that it is helping with the tics.... at first they were there just as frequently. But he's now in 6th grade and usually the beginning of the school year brings on more tics (more anxiety=increased tics for my son), but this year it hasn't.
I'd just keep an eye on it and not draw much attention to it. If you notice other tic-like behaviors discuss with your doctor. My son's tics wouldn't have sent us to a psychologist (other ADHD-like behaviors did), but it was something that was discussed when he went through assessments.
Our doctor diagnosed my daughter with a habit cough, and it went on for about two years, on and off as you described, until we finally figured out that she had viral-induced asthma. She was given a low dose daily steroid inhaler and a rescue inhaler, and it went away. Now we only start the steroid inhaler if she mentions that she has a hoarse voice, sore throat, stiff joints, runny nose, or any other cold symptom, and this has helped keep colds (and the cough) away. When she was going through it though, we gave her a lot of water to drink (can't hurt,) and cough drops. Good luck!
Try having her checked for allergies and asthma. My daughter was very anxious and prone to doing repetitive things to self-comfort. Then she started coughing occasionally in the 3rd grade. It wasn't all the time and she didn't appear sick, so I didn't even bother mentioning it to her pediatrician. I thought it was one of her self-soothing mechanisms. When the cough continued for a while, I talked to her doctor, who referred her out. It turns out that she had allergies and a slight case of asthma. She was prescribed an inhaler and Zyrtec, and the cough went away with those two medications.
Did the doctors try treating her for mild asthma? When I was in my 20s I developed a similar cough after a bad cold -- it wouldn't go away. It was the worst when I was breathing cold air (crisp Bay Area mornings -- especially in the winter) and wasn't bad during warmer weather. I went to the doctor several times over many months & they ruled out "everything" said it was in my head. I tried seeing a therapist -- the cough didn't improve. Finally one physician thought that maybe it was asthma so I started on the standard asthma treatment. The inhalers / steroids completely eliminated the cough. They also eliminated some wheezing during exercise that I had attributed to being out of shape but was actually due to poor lung function. I only needed the steroids for a few months. Then I needed the rescue inhaler on and off for about 5 years -- every time I got a cold the cough would come back & wouldn't go away without an inhaler. Over the past 5-10 years I haven't needed anything at all. Whatever was irritating my lungs seems to not be anymore.
I know that's not a therapist recommendation, but your description sounds exactly like what happened to me (including the improvement during warmer weather / summer), so I wanted to respond in case that's what's going on with your daughter. Good luck.
I am guessing the doctors have also ruled out other medical conditions right? Allergies, gastric reflux, or mild asthma? They can all have a symptom of dry cough. Just a thought.
My daughter had a throat clearing tic at around age 6. Her pediatrician said it was a nervous thing so we started her in therapy to help her with her anxieties. Fast forward she is now 25 and although still on the anxious side is fully functioning and happy.
I'm replying because we had a similar experience but there were no allergies or Tourettes involved. It really was just a habit.
My daughter did a similar thing. It started with a cold, she would sniffle and snuffle, and we thought it would go away when she got better. Instead, she developed a habit. It was super annoying to everyone around her.
I don't know how your daughter feels about it, but mine was open to trying to stop. What worked for us was copying her. We set it up ahead of time, as in, "How about if I snuffle every time I hear you snuffle because I don't think you are aware of how often you are doing it." When I made the same sound, she found it incredibly annoying. I really tried to be as kind as possible while pointing out that her noises were that annoying to everyone around her.
She really wanted to stop at that point, so she kind of decided it was important and made the effort. She hasn't done it in years now.
My 4th grader has on and off tic for 3+years now. It is different anytime from rubbing his hands on surfaces, straining the neck, blinking, rubbing his fingers...always different.
I use magnesium oil on the bottom of his feet at bedtime when I notice the tic flaring up. I’ll do this for about two weeks until it subsides. If it’s serious, I’ll also roll in between the shoulder blades.
I hope this helps!