Childhood Coughs and When to Worry!

Wet or dry?? And no, I am not talking about vacuum cleaners!
This is usually the first question I ask when I see a little one presenting with a cough.
Coughing is one of the most common reasons for a consultation, and I have to emphasize that a cough is not necessarily a bad thing. It is a built-in and automatic way to fight infection and to protect our airways. It can alert us that a child is sick, but could also be an indication when they are getting better.

Dry coughs are usually an indication of upper airway infection or inflammation; the sinuses, vocal cords and throat. Irritation of the airway below the vocal cords can also cause a dry cough, but usually inflammation and infections of the lungs are associated with mucousy secretions, leading to a wet cough. Much to everyone’s dismay, all coughs seem to get worse at night and this is usually due to phlegm and mucous resettling in the airways when the child lies down.
Lets look at the different kinds of coughs.

•   A DRY BARKING COUGH

This type is usually due to croup and can be accompanied by a hoarse voice and a high tone whistling sound on the intake of air. This is caused by swelling of the vocal cords and the culprits are mostly viral infections.
When to act?
If it looks like your little one is not getting in enough air, please go to the emergency room immediately. If the child is comfortable and breathing is not difficult, I would still advise to make a same day or urgent care visit to see your Paediatrician. We usually treat it with oral steroids, but I do not advise parents using this without the supervision of their doctor.

•    A WHEEZY DRY COUGH

The term “wheezing” is often used by parents to describe any noisy breathing, but a dry ,wheezy cough is most commonly associated with Asthma.
The wheezy whistle is usually heard when air is blown out, but in severe cases it can be heard both on the intake and blowing out of air. The Asthma cough typically gets worse when the child is physically active, or in the early hours between midnight and 2/3 am. It can lead to periods of cough that is persistent, sometimes for hours on end.
When to act?
If your child has an Asthma diagnosis, you might already have an acute action plan. If their is no response, please see your doctor urgently. If newly diagnosed, please make sure to ask your physician for such a plan. With or without a diagnosis- If they seem to be working very hard, and struggling to breathe, it is a medical emergency and you should seek medical assistance immediately.

•   A DRY COUGH AFTER A CHOKING EPISODE

Little ones love exploring and with that comes putting everything they can find in their mouths; Small, bright Lego pieces and coins seem to be particularly tasty for some reason or another :-)Having a foreign object lodged in the airways may lead to a sudden onset dry cough, and that cough tends to be present for a long time.
When to worry?
Please tell your doctor if the cough started shortly after such a choking episode, is persistent and if the cough is not accompanied by any other flu like or illness symptoms. Special x-rays may be needed to detect such an object and it may have to be removed by a specialised surgeon under anaesthetic.

WET COUGHS

We generally refer to a cough as wet when there is mucous or phlegm involved. It usually comes from the chest and the mucous can be white, yellow or green. It almost always involves an infection of the lower respiratory airways and there are a few possible reasons for this.

COLDS AND FLU ( INFLUENZA)

A mucousy wet cough, together with a clear runny nose, mild sore throat and poor appetite, might be an indication of the common cold or flu. Your littlies might present with fever (sometimes very high in the case of Influenza), but are generally happy and playful whilst the temperature is controlled. Children can get up to 12 or more common colds per year, all caused by viral infections.
Both cold and flu viruses spread via droplets from the nose and throat, more so in daycare settings. The cough following the common cold can be cumbersome and interruptive leading to disturbed sleep, especially in the early evening just after they are put down for the night. Coughing after a cold or flu may last up to 14 days.
Remember that Influenza and its complications can be prevented by the yearly Flu vaccine and I recommend the flu vaccine for everyone over 6 months of age.
When to worry?
If your little suddenly has spiking fevers, is very miserable, have difficulty in breathing and is refusing food and drinks, please contact your doctor. Colds and flu should not be treated with antibiotics unless a secondary bacterial infection has set in. Simple Saline sprays in the nose may help clear the nasal passages. keep them well hydrated and comfortable. Fever can be controlled by Paracetamol ( Panasonic and Calpol), and Ibuprofen syrup. A cool-mist humidifier or giving your child a nice bath may also help to decongest their noses.

PNEUMONIA

Pneumonia is an infection of the lung and can be due to viral or bacterial causes. It can follow on cold and flu-like symptoms and the child is usually acutely ill and presents with fever, cough, vomiting, lethargy and signs of difficulty in breathing. The breathing is often , shallow fast and laboured. Appetite can also be severely affected and children can become dehydrated quickly.
When to worry?
If your child has an ongoing wet cough, a spiking fever and signs of laboured breathing, please seek help immediately. Pneumonia usually requires an x-ray for diagnosis and antibiotics for treatment. Some cases of Pneumonia may be managed at home whilst the very sick kiddies may have to be admitted into the hospital for intravenous fluids, antibiotics and possibly oxygen.

BRONCHIOLITIS

This condition is very common in babies under 12 months of age and It is caused mostly by viral infections. RSV ( Respiratory Syncytial Virus) deserves a special mention. RSV bronchiolitis is probably the reason for most of the admissions to our children’s wards from late February to August each year.
This condition starts the same way as the common flu with sniffles, blocked nose and a mild cough. Within a day or two, the cough worsens, becomes very wet, with copious thick, white secretions and is typically wheezy. The younger babies may have fever, difficulty feeding and laboured breathing. They are often lethargic or sleepy. Admission is mostly for oxygen and supportive treatment, with either intravenous fluids or a feeding tube. Bronchiolitis doesn’t respond to antibiotics. Babies are sickest on day 3-5, but the cough may last up to 4 weeks after. Your doctor will often prescribe nebulised medications, but it has been proven not to make much of a difference in the outcome and duration of this disease.
When to worry?
If your baby is lethargic, refuses to feed or has signs of raspy, laboured breathing, please make a plan to see your Paediatrician soon.

WHOOPING COUGH

This condition is caused by a bacteria, Bordetella Pertussis, and because it can last up to 3 months is also called the 100-day cough- a very very long time to cough!
It typically starts with mild symptoms that may mimic the common cold. Within a week the cough starts to become worse and child or adult can present with coughing episodes and spells, often leading to vomiting. The typical “whoop’ at the end of these coughing episodes is usually what gives away the diagnosis. A baby younger than 6 month is particularly vulnerable to complications such as apnoea, seizures and brain inflammation or encephalitis.
If recognised, this disease does respond to certain antibiotics, but only if started within the first week after the start of symptoms. This also limits the extent of contagiousness (is that even a word?) of this disease.
Whooping cough is a vaccine-preventable illness. It is widely recommended that everyone receive the Pertussis vaccine, or a booster vaccine as an adult. The vaccine can be given during pregnancy and it is important that all close household contacts be vaccinated, preferably before a new baby is born.

OTHER REASONS FOR A COUGH

Gastro-oesophageal reflux, chronic hay fever, structural abnormalities of the lungs and airways and immune deficiencies are but a few reasons for chronic cough. If your child’s cough is ongoing or seems to come back often you should see your Pediatrician to help you get to the bottom of the reasons for this chronic problem.

GENERAL ADVICE
Over the counter medications, and particularly cough suppressants are not recommended for use in children. It hasn’t been proven to relieve the symptoms or to shorten the duration of coughing due to viral and bacterial infections. Some medication can have serious side effects, especially if the dosage recommendations are not followed. Always consult your doctor before using any of these medications.

Xoxo, Dr Christa