Chronic cough in children — defined as a cough lasting at least 4 weeks in kids 14 and under — is frequently misdiagnosed, and a pediatric pulmonologist is calling on colleagues to reset their thinking. Speaking at the AAP 2026 National Conference, Ajay Kasi, MD, of Children's Healthcare of Atlanta and Emory University, highlighted several common misconceptions that can lead to poor outcomes and urged pediatricians to follow validated pediatric cough algorithms instead.

Among the biggest myths: that kids don't get bronchitis (they can develop protracted bacterial bronchitis, or PBB, often mistaken for asthma), that asthma is the go-to explanation for isolated chronic dry cough (it usually isn't), and that over-the-counter cough and cold medicines are safe and helpful (evidence suggests otherwise). Kasi also noted that reflux — a common adult culprit — is rarely the cause in children, and acid suppression shouldn't be used empirically.

Key Takeaways:

• Order chest X-rays and spirometry routinely for chronic cough; spirometry is feasible in children as young as 3–6 years
• Wet cough lasting ≥4 weeks with no other identified cause? Suspect PBB and treat with antibiotics
• If a 2–4 week trial of inhaled steroids and bronchodilators doesn't improve a dry cough, stop the meds — it's likely not asthma
• Habit cough (absent during sleep/engagement) may respond to suggestion therapy and mental health referral

Why it matters: Chronic cough significantly impacts quality of life for children and their families. A structured, evidence-based approach — rather than reflexive treatment — can help the vast majority of patients find relief.