“Coughing, when should I worry?”

Paediatrics certainly presents some very difficult moments but on the upside I am dealing with children. They never fail to provide me with something to smile about each and every day.

One such moment happened during a very busy winter spell. My rooms were bursting at the seams with patients, some emergencies, others that had been referred by their GP’s and it all just seemed to be chaotic. I called my next patient through and another little three year old piped up “oh thank goodness! I can’t take listening to that coughing anymore!” Needless to say the adults were all very amused by the honesty of the little one but at that moment it also struck me how concerning coughs can be.

The truth is that there are many different coughs, many different causes and a variety of treatments depending on the cause. Coughs can impact on a child’s activity levels and affect their ability to have a good night’s sleep. In some cases children with severe coughs avoid playing and may need to be kept off school. Such coughs are a cause for concern for parents which brings them to the question “when should I worry?”

Why do children cough?

Coughing is an effective way for the body to protect itself and keep the airways clear. A cough may clear the throat of phlegm, be a response to a post nasal drip or may actually be a response to something, like a piece of food, being stuck the throat.

Studies have shown that on average children can cough up to 11 times a day but this increases when the child is ill or choking. Knowing whether the cough is serious and warrants medical attention now becomes a consideration.

Coughs are generally grouped in the literature into categories- wet coughs which include pneumonia, bronchiolitis or asthma. Secondly, dry coughs dry which would include croup and under unusual circumstances whooping cough (pertussis). I say that whooping cough is unusual because we do vaccinate against this illness. There are a number of sites where you can actually listen to a child coughing and this will help you to tell the difference.

Wet coughs

This type of cough occurs when your child has a lot of mucus. Generally their noses are congested and the chest sounds heavy. These types of coughs may be a simple response to the mucus and the body’s way of getting rid of the mucus. Under such circumstances, if the child is happy, is breathing well between coughing spells and does not have a high fever then there is no cause for concern. On the other hand your child could have one of the following illnesses if the cough is associated with other symptoms-

1. Pneumonia-

A child with pneumonia is generally very unwell, has a wet productive cough (wet and phlegmy and usually has discoloured green/ yellow mucus) and fevers. The child will also feel often tired. Pneumonia can be due to a viral or bacterial chest infection and this will determine the correct treatment.

This type of cough should be assessed by your doctor to ensure that the appropriate treatment is given.

2. Bronchiolitis or Asthma-

This may all begin with a common cold. What will result is a wheezing sound. A wheeze is a high pitch, whistling sound coming from the chest. The sound comes from a restriction in the airways. The child finds it difficult to breathe and may breathe a lot faster than usual.

If a baby is under a year old then there is the possibility of your child having bronchiolitis. There are a few common viral causes, RSV (Respiratory Syncytial virus), Rhinovirus, hMPV (Human Metapneumovirus) and influenza.

Bronchiolitis is common in autumn and winter when children are more likely to suffer from colds.

Asthma on the other hand may be suspected in cases where children have a strong family history of allergy, suffer from eczema or have recurrent wheezing episodes.

In all cases where your child seems to be wheezing you should consult a medical practitioner.

Dry coughs

1. Croup

Croup has a very classic sound. Your baby will make a barking sound and will find it difficult to breathe. Croup is a viral infection which makes the airways swell affecting breathing. Croup is most common in children under the age of five years. Very often croup is at its worst in the early hours of the morning when the body’s natural cortisone levels are lower. Cortisone usually improves inflammation but when the levels are low in the body inflammation can increase. This in turn may lead to croup in an unwell child.

Should your baby wake up with this barking sound, you could take baby into the bathroom. Run hot water in the shower and close the door. The steam from the shower may help to settle the inflammation down and relieve the cough.  If it does not help you should seek medical attention as the airways may continue to swell making it more and more difficult for baby to breathe.

2. Whooping cough (Pertussis)

Whooping cough is not something we see often at all anymore. This is really thanks to the vaccine. Babies are given three doses of the vaccine in the first year of life. This is followed up with boosters. The vaccine generally contains tetanus, diphtheria and pertussis. Whooping cough (pertussis) is a terrible condition which causes the baby to have severe coughing spasms. Babies with whooping cough may require hospitalisation for oxygen during the severe spasms. All members of the household will need anti-biotic treatment in the event of a whooping cough diagnosis. It is an illness that will take months to recover from.

The cough sounds like a fast whoop, whoop sound. Because the baby will struggle to breathe during these spasms they will often get bulging eyes, their faces will change colour and they may stick out their tongues.

Immediate medical care is required.

 Foreign objects

Children have a knack for finding little objects like buttons or bits of toys and putting them in their mouths. This along with pieces of food such as carrot or hot dogs may cause your child to choke. If your child suddenly starts coughing or gasping for air check the mouth immediately. Very often the cough will clear the object or your baby may vomit clearing the airway.

If your baby has an ongoing cough without any other signs of a cold then you should consider that they may have something caught in the windpipe or lungs. Children with foreign objects in the lungs are likely to develop pneumonia. Peanuts are often the culprits in these situations.

If your baby suddenly seems to be in distress, turns slightly blue or isn’t making a sound then it is possible that he or she is choking. Turn your baby upside down and give four or five firm smacks between the shoulder blades. This should release the object. If not call for emergency help.

If you suspect that your child has a partially lodged object try to get them to cough it out. If your child is not able to cough it out and a good pat on the back doesn’t help then you will probably need medical care. In most cases an x-ray will be taken to see exactly where the object is caught and if necessary a procedure known as a bronchoscopy may be necessary to remove the object.

Conclusion

A cough in itself is not a major cause for concern. As I said in my introduction coughing is very natural and usually serves to protect the body. There are times however that a cough indicates something more serious and then warrants medical attention. Under the following circumstances I would recommend you get help:

• If your baby is younger than four months old.
• If your baby is having difficulty breathing between coughs.
• If the cough is accompanied by a high fever.
• If your child is wheezing.
• If your child is making grunting noises.
• If your child is agitated it can be a sign that your child is struggling to breathe.
• If your child is turning blue.
• If the coughing affects your child’s quality of life. In other words if the child coughs when playing, doing sport or is unable to sleep.

As frustrating as coughs are there are times when you have to let them run their course. Coughs may take as long as seven to ten days to settle even when you are giving your child good treatment. As long as the symptoms above are not present then patience is the name of the game. As the old saying goes “this too shall pass”.