Girl’s barking cough eased only after doctors uncovered the anxiety behind it

After scans, allergy tests and medication failed to explain a nine-year-old’s persistent cough, doctors linked it to stress at school and home , highlighting why functional causes should be considered only after physical illness is ruled out.

A nine-year-old girl in India developed a barking cough that came in bursts every 30 seconds to a minute and persisted for two months, eventually sending doctors through a long series of tests before they considered the pressures in her life at school and at home. According to a case report in the Indian Journal of Psychological Medicine, clinicians at the Institute of Neurosciences in Kolkata concluded that the child had psychogenic cough linked to an anxiety disorder, a diagnosis that continues to be missed or delayed in some children with persistent cough. The report notes that her symptoms eased only while she was asleep, which is one of the features that often prompts doctors to look beyond an infection or allergy.

At first, she was treated as though she had allergic bronchitis. Antihistamines and steroids brought temporary relief, but the cough returned on the way home from hospital, leading to further investigation at a tertiary care centre. Doctors ordered sputum testing, a high-resolution CT scan of her lungs, an allergy profile and blood tests, yet none of those examinations explained the symptom. By the time she was referred for psychiatric assessment, the cough had become a series of dry, barking spells that caused soreness in her chest and abdomen but no obvious breathing difficulty.

The team’s interviews suggested that the cough was tied to mounting emotional strain. The child had changed schools about a year earlier and described hostile classmates, including an episode in which she was taken into a dark room said to be haunted. The report also described punitive parenting and tension with a younger brother, who had allergic bronchitis and appeared to draw more of the parents’ attention. A standard childhood anxiety questionnaire completed by her parents pointed to separation anxiety, and clinicians combined play therapy, drawing, breathing exercises and suggestion therapy, in which she practised delaying the urge to cough for longer intervals. Her doctors also introduced a very low dose of escitalopram because of her anxiety and slower-than-expected progress, and they reported significant improvement at follow-up one month later.

The broader medical literature supports that approach, but only after a thorough work-up. In 2015, an expert panel of the American College of Chest Physicians said the older labels “psychogenic cough” and “habit cough” should be replaced by “somatic cough syndrome” and “tic cough”, though it acknowledged that the evidence base was weak. The guidance says the diagnosis should come only after clinicians have ruled out tic disorders and unusual medical causes, and it favours non-drug options such as hypnosis, suggestion therapy, reassurance, counselling and referral to a psychologist or psychiatrist in children. A review published in 2014 found that suggestion therapy and hypnosis often helped, but the authors stressed that the studies were small and of poor quality. More recent reviews also note that medication is generally not recommended unless a child has clear anxiety or depressive symptoms. A 2025 case report from Turkey shows the diagnostic delay still occurs: a 13-year-old boy with a barking dry cough after brain surgery was seen by multiple specialists before psychiatry was involved, and his doctors also concluded that greater awareness could reduce unnecessary testing and treatment.

Parents should still treat a persistent cough as a medical problem first, not a psychological one. A barking cough can point to croup, a common viral illness in young children, and other causes such as asthma, infection or allergy are far more likely than somatic cough syndrome. But if a cough keeps returning despite treatment, and especially if it stops during sleep and is accompanied by signs of stress, clinicians may eventually consider a functional cause after other explanations have been excluded. As the Indian report and the Turkish case both suggest, listening for what is happening in a child’s life can be as important as listening to the cough itself.