Doctor in the House: Is your child coughing a lot? Here’s what you need to know


Cough as a symptom is seen frequently in most illnesses in children. While cough may sound scary, it is usually not a sign of any serious illness. Coughing, in fact, is an attempt by the body to clear the airway.

There many different types of cough, and if you can try and understand the type, it will prevent you from rushing to the doctor because your child has been up all night coughing (though certain types of cough do require a visit to the doctor). Some prominent types of coughs are:

— whooping cough

— barking or dog-like cough or croupy cough

— Daytime cough

— Night-time cough

— productive cough with wheezing

fever with cough

Cough associated with vomiting

— persistent cough

— psychogenic cough

Whooping Cough

Whooping cough is a nasty infection produced by a bacteria called Bordetella pertussis. Children who develop this will have a spell of coughing followed by a loud whoop where they take a deep breath. Other symptoms are runny nose and a low-grade fever. This is a severe infection when it presents in children younger than one year. It forms part of the DPT or DTap vaccine, which is given at six, 10 and 14 weeks with boosters at 18 months, 5 years and 10 years. Whooping cough is diagnosed from blood test and is treated with antibiotics. The whooping cough may take many weeks to settle and no one treatment works.

Barking or croupy cough

Croup or laryngotracheobronchitis is a viral illness that presents with swelling of the voice box or larynx and the trachea. In children under 6 months, when there is swelling of the airway, it can lead to difficulty in breathing. This usually starts in the middle of the night with a strange cough and sometimes, difficulty in breathing. You can hear a sound called ‘STRIDOR’ which happens when the child inhales through a narrowed airway. Most older children with croup settle if you take the child to a steamed-up bathroom or room and stay there for 10 to 15 minutes with your child. This helps to reduce the swelling of the airway and help the baby breathe easily. Sometimes, taking the child outside to a slightly cooler air also works. In the hospital, to reduce the swelling steroids may be prescribed. Antibiotics are not needed in croup.

Daytime Cough

Daytime cough is usually an irritant cough because of cold air or air pollution or even activity. Try to keep your house dust-free and free of pungent smells like agarbatti or air fresheners and even cigarette smoke. You should not give cough syrups to children below four years of age as most cough syrups available are combination medicines and some of the ingredients can be harmful to children.

Night-time Cough

Some children cough mainly at night. This is usually because of post nasal drip, as the mucous from the nose and sinuses drip to the back of the throat while sleeping. Asthma can also trigger a night-time cough as the airway tends to be more sensitive and irritable at night.

Cough with wheezing

If your child is making a whistling of wheezing sound at the end of the breath, it may be because the lower airways of the lung are narrow because of swelling. This is usually seen in asthma and also certain viral illnesses like bronchiolitis. Sometimes, you hear it when a child has inhaled a foreign body like a peanut. If you baby suddenly starts to cough with wheezing while eating or, you doubt he may have choked on a small toy, then you need to consult a doctor urgently. Children with asthma need their asthma medication and this will be prescribed by your doctor.

Cough with fever

Children can develop upper respiratory infections where cough is associated with fever and runny nose. But if your baby has high fever above 102 and looks unwell with fast breathing then he may have a pneumonia and will need to see a doctor. Sometimes, children with pneumonia need intravenous antibiotics and may need to go into hospital.

Cough with vomiting

Sometimes, when children cough a lot, their gag reflex is triggered and they may vomit. When there is a lot of phlegm associated with an exacerbation of asthma, children can get nauseous and vomit. They don’t need any anti-vomiting medicine for this.

Persistent Cough

Cough can be a nuisance following a common cold and can take many weeks to settle, sometimes, children get back-to-back colds and it may seem that they are constantly coughing. Asthma, allergies and chronic sinusitis can also lead to persistent cough. Persistent cough with night sweat, loss of weight and low grade fever needs investigation for Tuberculosis.

Psychogenic Cough

Psychogenic cough or habit cough is sometimes see in children. The cough usually begins after an upper respiratory infection, but the cough persists long after other symptoms have resolved. Typically, it’s harsh, barking and non-productive.

It disappears during sleep, or if the child is distracted. Treatment involves making suggestions that it can be stopped, desensitisation techniques, use of self-hypnosis in older children.

Most of the time, just listening to the cough and examining the baby is enough for doctors to come to a diagnosis and usually elaborate tests are not needed. If your doctor suspects a pneumonia, he may ask for an x-ray.

When to call your doctor

Call your doctor when your child has cough along with any of the symptoms mentioned below:

  • Has trouble breathing and is working hard to breathe
  • Breathing fast
  • Is turning dusky, has blue lips
  • Has high fever
  • Has fever and less than 3 months
  • Has feeding difficulty
  • you can hear a ‘whooping ‘sound
  • Is wheezing or has stridor

Treatment

Most coughs in childhood are a result of viral illnesses and don’t need treatment, sometimes it can take two to three weeks to settle. Most of these coughs don’t need antibiotics as they only work in bacterial illnesses.

Cough syrups are usually not recommended for children under 5 years of age and cough syrup which contain two or more medicines are not given as some of them can cause serious side effects.

Non-drug treatments for cough include giving more warm drinks to soothe the throat. You can use saline nasal drops to clear the mucous.

The bottom line is that cough is a protective reflux and most coughs don’t need any treatment and settle on their own.

Dr Saroja Balan is consultant neonatologist and paediatrician at Indraprastha Apollo Hospital. Her column appears every fortnight

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