Decoding those coughs

When should you be concerned about your child's cough? It all depends on the symptoms. Pediatricians
Parents face a daunting challenge trying to determine whether a child’s cough warrants a visit to a health-care provider. Posing in this photo illustration by Gazette photographer Peter R. Barber are Lisa Taft and her daughter, Allison.
Parents face a daunting challenge trying to determine whether a child’s cough warrants a visit to a health-care provider. Posing in this photo illustration by Gazette photographer Peter R. Barber are Lisa Taft and her daughter, Allison.

Ever notice that even as spring looms, your child can’t seem to shake the cough he acquired back in October? If so, you’re not alone.

Prolonged coughs are common among school-aged kids, and as frightening as they may sound at times, Carrin Schottler-Thal, a pediatrician at Albany Medical Center, said coughing is a natural defense mechanism that protects the body’s respiratory system by clearing it of irritants, mucous and secretions.

Most coughs last a few days to two weeks. Doctors generally don’t consider a cough chronic until it’s lasted more than three weeks, Schottler-Thal said.

Here is some advice for parents regarding various types of child coughs and when to be concerned.

Nighttime angst

It’s the fourth night in a row that your child has hacked for hours. He’s not bad during the day, but the minute he lies down, symptoms starts up again.

According to Joseph Gigante, a pediatrician with Monroe Carell Jr. Children’s Hospital in Nashville, Tenn., coughs are aggravated in the evening when a child lies flat in bed because congestion in his nose and sinuses drains down the throat causing irritation. It is not a signal of worsening symptoms — just a result of the angle.

Fortunately, he said, there are some things you can do to help your child feel more comfortable. Older children — usually over 4 years old — can suck on a cough drop. A teaspoon of honey may also decrease a cough’s frequency.

Over-the-counter cold and cough medicines are not recommended, as recent research indicates they are not only ineffective but may cause life-threatening side effects in younger children. In fact, the Food and Drug Administration and the American Academy of Pediatrics both issued statements in January strongly recommending that such cough and cold medications not be given to infants and children under 2 years old because of the risk of life-threatening side effects.

The bark

A barky cough is sometimes associated with a disease called croup, Schottler-Thal said. Croup is a viral infection of the vocal cords, voice box and windpipe. In addition to a barking cough, your child may also have a hoarse throat. This is a common illness in children between the ages of 3 months and 5 years.

You may hear a harsh, raspy, vibrating sound when your child breathes. This is known as stridor. Stridor is usually present only with crying or coughing. As the disease becomes worse, stridor also occurs when your child is sleeping or relaxed. With severe croup, breathing may be difficult.

Croup usually lasts five to seven days and generally worsens at night. It can change from mild to severe and back numerous times.

If the barky cough gets significantly worse or your child develops stridor, home treatment that can be effective is a foggy bathroom.

Run a hot shower with the bathroom door closed. Once the room is all fogged up, take your child in there for at least 10 minutes.

Cold air can also help relieve stridor. If it is cold outside, take your child outdoors. You can also hold your child in front of an open refrigerator. Call your doctor if your child experiences difficulty breathing or swallowing.

Allergies

If your child has a persistent tickle in her throat caused by excess mucus, a dry, shallow cough — especially in the morning — watery eyes and an itchy nose, she may have allergies. Seasonal allergies typically occur in the spring and fall, and symptoms are usually most pronounced in the morning when pollen counts are high. Talk to your pediatrician: A nonsedating antihistamine taken daily during allergy season may do the trick.

“There may be something in the bedroom that is causing this child’s allergies to act up, thus causing post-nasal drip with cough,” said Schottler-Thal. Examples could be dusty stuffed animals, pet hair, dust mites, molds.

Post-dinner rumblings

Coughing after eating can be a sign of gastroesophageal reflux and should be taken very seriously, said Marjorie Slankard, clinical professor of medicine at Columbia University College of Physicians & Surgeons.

“Not only can the reflux trigger asthma symptoms, but there can also be aspiration of acid and possibly food particles into the lungs. That can cause serious damage to the lungs themselves. If chronic and not treated, there could be permanent lung damage.”

Eating smaller, more frequent meals and elevating the child’s head higher than his stomach may help reduce symptoms. Nonprescription antacids after meals and at bedtime can also help. If those measures do not relieve the symptoms, a physician may prescribe medicine.

Wheeze

“Coughing or shortness of breath after physical activity may be caused by asthma. . . . If parents suspect their child may have a cough caused by asthma, they should have their child seen by a provider who will perform a history and physical examination,” said Gigante. “With the information they obtain, they can determine if the cough is caused by asthma, and they will treat your child accordingly.”

Asthma medications such as bronchodilators, which open the airways, and inhaled steroids, which prevent recurrences of the problem, may help. If your child seems to wheeze only in winter, she may need medication for just a few months.

Phlegm or fever

Your child’s rumbling cough started three weeks ago; it’s particularly bad at night and first thing in the morning. The key feature of this cough is that it brings up phlegm. A fever may be present.

In this instance, a lower respiratory tract infection such as pneumonia, may be to blame. Most coughs do get better within one to two weeks. A cough of three weeks’ duration, associated with fever and labored breathing may indicate pneumonia.

A pediatrician should examine your child, and on the basis of the physical examination, possibly administer a chest X-ray to determine whether your child has a lower respiratory tract infection, Gigante said.

Whooping cough

Caused by bacteria that irritate the airways and cause severe coughing spells, whooping cough is most serious in children under age 1. It gets its name because of the characteristic cough a patient makes. A child will cough and then make a high-pitched sound when drawing in the next breath. Kids may cough so hard that they vomit afterwards.

One of the routine childhood vaccines that children receive in infancy is the pertussis vaccine to protect against whooping cough. If a parent suspects a child has whooping cough, he should be seen by a pediatrician.

Slankard said pertussis can be diagnosed with a high nasal culture and treated with antibiotics. Just be warned: The coughing associated with whooping cough can last for weeks.

Phantom cough

Your child has had a dry, shallow, daytime-only cough for weeks. It doesn’t bother her too much, but it’s driving you crazy. And during a checkup, the doctor can’t find anything wrong.

“This sounds like a respiratory tic, which is seen in children as young as age 5, said Schottler-Thal. “It often follows an upper respiratory infection with associated cough, but the infection clears and the cough goes on. No other reason is found for the cough, and the cough stops during sleep. The cough is usually exaggerated during times of anxiety,” she said.

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