Prevalence and management of persistent cough in children post-viral infection

Abstract

Persistent cough in children following viral respiratory infections is a common presentation in clinical practice, often causing concern among caregivers and prompting repeated healthcare visits. While acute viral illnesses typically resolve within two to three weeks, a subset of children experience prolonged cough that persists beyond this period, sometimes lasting up to eight weeks. The pathophysiology involves a combination of heightened cough reflex sensitivity, lingering airway inflammation, and potential involvement of coexisting conditions such as asthma or protracted bacterial bronchitis. Identifying the underlying cause can be challenging due to overlapping symptoms, variability in caregiver reporting, and the limited availability of pediatric-specific diagnostic tools. Prevalence rates vary significantly across regions, with higher incidences observed in low-resource settings where environmental exposures, overcrowding, and delayed access to care are more common. Differences in viral pathogens also influence outcomes, with viruses such as respiratory syncytial virus, rhinovirus, and adenovirus more likely to be associated with prolonged symptoms. Diagnosis relies heavily on clinical judgment, as cough characteristics and duration alone are often insufficient to distinguish between post-viral cough and more chronic respiratory conditions. Management strategies are inconsistent, with frequent reliance on medications lacking strong evidence of efficacy in pediatric populations. Antitussives, inhaled corticosteroids, and antibiotics are often prescribed without clear indications, contributing to unnecessary treatment and potential harm. Non-pharmacologic approaches, including caregiver reassurance and environmental modifications, are commonly recommended but remain under-researched. Overall, the variability in clinical practice highlights the need for more robust pediatric-focused studies and clearer guidelines to support appropriate diagnosis and treatment. Addressing these gaps is essential to improve patient outcomes, reduce unnecessary interventions, and alleviate the burden on families and healthcare systems.