Chronic Cough and Fear of Medical Examination

QUESTION: My youngster, age 3, has a persistent and chronic cough that just
won't quit. I've tried all the over-the-counter remedies that you see on TV,
but nothing changes. I know I should take him to a doctor, but I dread the
possible things he may tell me. Can't you help?
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ANSWER: I often wonder how many times the fear of an unknown or unwanted
diagnosis keeps patients out of doctors' offices and delays the diagnosis and
treatment of important health problems. It is true that a chronic cough in a
youngster this age may be the symptom of serious disease, but the situation
can only continue to develop, growing ever more difficult to treat and
correct. Most of the common causes of coughing in children are infections,
ranging from the flu to pneumonia or even tuberculosis, but fortunately, there
are effective antibiotics for all of these conditions. It is possible that
the cough is a response to some irritant in the environment, such as tobacco
smoke or fumes from wood burning stoves. Allergy or asthma may be the base
for inflammation, resulting in chronic cough. Some congenital conditions,
involving either the heart or lungs or both, may result in the abnormalities
that provoke a continuing, chronic cough. Less common but still possible are
a long list of conditions caused by the failure of the immune system to
function, resulting in lung conditions like sarcoidosis. Even the presence of
an unidentified foreign body in the esophagus or bronchial tubes can be the
culprit, and can be speedily removed to eradicate that annoying cough. The
list goes on, far too long to include all the possibilities here. All these
problems can be discovered by a careful medical examination, and the
appropriate use of blood tests, pulmonary function tests, and bronchoscopy.
With the diagnosis comes the plan of action that can lead to removing the
causes. The best help I can offer you here is to assure you that the fear is
often greater than the reality and to offer you the very firm recommendation
to hasten and obtain the medical care your child really needs.