Cough in children

Why cough?

It might be the most common problem bothering your child. Sometimes even the sound of it makes you uneasy or even anxious. If you don’t worry about the sleepless nights ahead you might be sweating over what might be going on in your child’s body.

What is it?

Cough is what your body does to keep your throat and airways clear of foreign material like mucus, irritants, gems, and particles. Although it can be annoying it is helping your airways protect and heal itself. It is normal to cough once in a while. If a child begins to cough more than usual then you should try to find out if there’s a reason for it. Your doctor will help you in this process.

What is causing cough in my child?

The likely cause of cough may differ depending on how long it has been; how it sounds; when it occurs; whether it is accompanied by other symptoms like rapid breathing, noisy breathing, pain, fever among many others. Your doctor will ask you some questions to help pinpoint the cause of your child’s cough. Here are some of the common causes of cough :

Viral upper respiratory tract infections. These cause the majority of coughs in children. Children in regular contact with their peers at day care centres or school or any play environment tend to get these infections frequently and is a common reason why they get repeated coughs.

A cough that starts suddenly especially when the child appears to be choking could be due to a foreign body in the airway. Toys and food can be inhaled accidentally. It is prudent for caregivers at home, or in the school or play environment ,to learn simple techniques of helping a chocking child.

If a child has problems of reflux, where stomach fluids flows backwards towards the thoat, they may cough for long. Sometimes their voices get hoarse. Some might have choking episodes. Your doctor can check and even do tests to confirm if this is your child’s problem.

Sometimes after a child has had a viral respiratory infection the cough may linger for additional weeks. It is believed  the body’s response to such infections make the airways have that lingering sensitivity to irritants or germs that are in the air we breathe. It is called post-infection cough. It usually goes away on its own.

Children with asthma have recurring episodes of wheezing, coughing, chest tightness, and shortness of breath. Sometimes prolonged cough following a viral infection may be the only symptoms. If the coughs occurs mainly at night or early morning ask your doctor if asthma is the one causing your child’s problem.

Problems with the nose or sinuses, air filled spaces in the bony part around your nose may make mucus build up and drip down the  throat. One can have a scratchy feeling in the throat, attempt to clear the throat more frequently. It could be the reason your child has been coughing for a long time. Your doctor will check if this is your problem and recommend a remedy.

Infection in the lungs or air tubes, like pneumonia (No, it’s not caused by cold air, baridi)

Can cause cough. Usually there will be other symptoms like fever and fast breathing. The doctor may tell if he makes some physical findings during examination. But sometimes it may be diagnosed only after some tests. The doctor will inform you if a test will be necessary.

Some children and adolescents can  cough out of “habit” after overcoming a viral respiratory infection or irritation in the airways. It’s a small, harsh or honking kind of cough that persists for weeks or months. It is also called “habit cough” or “psychogenic cough”. This diagnosis can be considered after other organic causes of cough have been ruled out. Your doctor will take you through the options available for treatment if this is suspected.

Irritants in the air like cigarette smoke, fumes, pollen, pet fur can cause cough in people with asthma or allergies.

Protracted bacterial bronchitis is a common cause chronic wet cough in children. Alternative causes of the cough would have to be ruled out. Usually it resolves with antibiotic treatment.

Sometimes no cause can be found for a dry cough that lasts for weeks. The phrase “non-specific cough” is used to describe these kind of cough. Most of the time its not due to anything serious and can resolve on it’s own. An attitude of watchful observation for upto 8 weeks may be the reasonable approach under such circumstances. It will not be necessary to use Medications that are used for treating other coughs with specific causes because they are unlikely to provide benefit.

Will my child need tests?

The doctor will need to understand your symptoms and narrow down on the likely cause(s) of your child’s cough. He will ask you some questions. He will gather more information by examining the child physically. Sometimes the doctor will give you advise about your child’s symptom without doing tests. However, if there are things he wishes to get more information on or clarify he could send your child for tests. Here are some common tests that the doctor may want to do:

A chest radiograph or chest X-ray can be used to evaluate a number of problems affecting the heart, lung and airways . Your doctor will help you find out whether it is necessary to obtain one.

Bronchoscopy .In this procedure a special tube is inserted into the airways. It enables the doctor to look into the airways. It may be useful if the cough is suspected to be due to an inhaled foreign body. It is also helpful for obtaining fluid from the airways for testing in the laboratory.

Breathing tests in older children can help determine if asthma is the cause of their coughs or not.

Blood tests may be done to check your overall health or answer specific questions about your child’s cough.

Sputum samples may be obtained

Allergy testing may be done for those in who have frequent or severe allergic reactions.

How are coughs treated?

Whether your child receives treatment depends on what is determined to be the cause of the cough.

Most viral upper respiratory infections with resolve on their own within 2 weeks. No specific medicines are required for them. One does well to keep the child comfortable like encouraging taking plenty of fluids, salty water drops for the nose helps when a child has runny or stuffy nostrils. Paracetamol or ibuprofen can be given to if pain or fever makes the child uncomfortable or irritable. Antibiotics, cough syrups, antihistamines are not useful for treating coughs caused by viral infections in children . They are not recommended for this purpose because they could suffer risks associated with the medicines without obtaining any benefit. Bronchodilators are not effective and should be avoided in those whose cough is not caused by asthma; Children older than one year can get some relief when they are given honey. Do not give honey to those younger than 1 year. As you wait for time to heal observe for any signs of worsening illness.

Sometimes cough will outlast the viral infection and persist beyond 10 days. For some it maybe  post infection cough talked about above. They eventually will get better and usually don’t need to take medicine for it. For others it may be because of additional problems which will need to be checked by the doctor.

Bacterial infections affecting the lung will be treated using antibiotics. The type of antibiotic and whether it is given by mouth or injection, in hospital or to use at home ,will depend on the kind of infection, how severe the problems are that it’s causing, the general health condition of the child, whether the child can tolerate the medicine, and other considerations. The doctor will help you make the most appropriate decision.

Problems with asthma and allergy related cough will be handled as described in the allergy and asthma sections.

Foreign bodies are extracted from the airways using special tools. Usually a x-ray is done to confirm the presence of a foreign body and to visualize it’s location. Bronchoscopy can be done for the same reasons.

When habit cough is diagnosed behavioural interventions may be tried. This can include counseling and behaviour therapy.

When should I visit the doctor?

  • If your child’s cough has lasted more than 10 days;
  • If you observe shortness of breath; If the child appears to be using more effort to breath or breathing fast.
  • If the cough is severe or becomes worse with time.
  • If the cough is sudden and choking is suspected.
  • If the cough also comes along with noisy breathing, or swelling of the mouth, face or tongue.
  • If the child has a fever;
  • If the phlegm is thick, smelly, greenish-yellow or blood stained.
  • If your child’s cough worries you in any way.
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