PEDIATRICS Vol. 108 No. 3 September 2001, pp. 819-819

Psychogenic Cough

To the Editor.

Bye has described a patient with a chronic barking cough and has proposed a treatment for what he considers a condition related to stress or anxiety.¹ I would like to offer an alternative explanation for this chronic cough. Tics are involuntary actions that may be motor or phonic.² Phonic tics can be natural sounds done excessively or may include the utterance of partial or whole words. Children whose chronic cough has been considered a tic have previously been described.^3,4

In the case reported by Bye, the patient also had a facial twitch. Thus, this patient has both a motor and a phonic tic. The natural history of tics is to wax and wane in intensity and to disappear and then reappear in the same or in different forms. The typical age of onset for tics is between 5 and 10 years. As was the case here, phonic tics are often a continuation of what began as a normal phenomenon, eg, continued sniffing or coughing after an upper respiratory infection.

In summary, I believe that the patient described by Bye has a tic disorder and will need to be followed to see if other tics occur in the future.

Gerald Erenberg, MD
Cleveland Clinic Foundation
Section of Child Neurology
Cleveland, OH 44195

REFERENCES

1. Bye MR Use of a peak flow meter for positive feedback in psychogenic cough. Pediatrics. 2000; 106:852-853 [Abstract/Free Full Text]
2. Erenberg G The clinical neurology of Tourette syndrome. CNS Spectrums. 1999; 4:36-53
3. Cohlan SQ, Stone SM The cough and the bedsheet. Pediatrics. 1984; 74:11-15 [Abstract/Free Full Text]
4. Cohlan SQ, Stone SM, Zimmerman SS Coughing and bed sheet wrapping [letter]. Pediatrics. 1991; 88:1077-1078 [Abstract/Free Full Text]

In Reply.

I would like to thank Dr Erenberg for his insights. I believe we are on the same wavelength. The cough I described is frequently a manifestation of stress or anxiety, such as a tic might be. The nomenclature of this type of cough is imperfect, and there are descriptions of this cough as a "tic cough," as Dr Erenberg suggests.

This young lady continues to receive specialty care from us, and visits her primary care pediatrician regularly. Her asthma has been under good control. She has not had any other manifestations of tics or stress-related phenomena. At Dr Erenberg's suggestion, we will continue to monitor her for this.

Michael R. Bye, MD
College of Physicians & Surgeons of Columbia University
Babies & Children's Hospital of New York
Columbia-Presbyterian Medical Center
Department of Pediatrics
Pediatric Pulmonary Division
New York, NY 10032