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Habit cough in children is a potentially perplexing problem. It is not uncommon in clinical practice to have to deal with a child with a persistent, often harsh cough that is very disruptive - at home as well as at school. By the time the family reaches the doctor's office, a spectrum of cough medicines up to and including narcotics have been tried without success.
Habit cough is to a great degree a "diagnosis of exclusion." To find out what a cough represents, we generally must find out what it is not (not unlike the solution proposed in The Cat in the Hat). The classic habit cough is "honking" or "barking" in character (simulating a croupy cough in the absence of croup). These coughs have been variously described as habit cough, psychogenic cough, or vocal tic. The hallmark of habit cough is that despite its terrible sound during the day, it disappears in sleep.
One problem with harsh coughing is that it tends to be self-perpetuating. One need only to cough voluntarily as harshly as possible for a few times in succession to notice that the throat can readily be irritated enough to lead the urge to clear the throat and even cough involuntarily. Treatment of habit cough begins with its identification, and reassuring the parents that a thorough investigation for other causes of cough has turned up nothing. Then some behavioral intervention is most helpful; a good speech therapist can really help these young patients.