Different Types of Coughs in Children
Coughs are a common complaint of parents, particularly when the cough is keeping the parent up. Coughing can be caused by multiple things. Asthma, allergies, reflux, respiratory viruses, pneumonia, and sinusitis are the most common causes of coughs, with allergies and asthma the most common cause of chronic coughs (more than 4 weeks). Good observations can help identify the cause and help you give the proper remedy for the cough. Parents are sometimes looking for the quick fix to help the family sleep, however, the quick fix sometimes is not the correct one.
The initial question that should come up is regarding asthma and allergy history. Sometimes, your child has not been formally diagnosed with asthma, but “gets bronchitis a lot” or has had “pneumonia multiple times.” If this is your child, these problems need to be brought to the attention of the physician, so that perhaps asthma, allergies, or other chronic conditions are not being overlooked. Also, family medical history of having asthma or allergies raises the possibility of these two diagnoses being a cause of the cough, particularly if recurring or chronic.
If your child is an asthmatic, he should have an Asthma Action Plan and it should be initiated accordingly. If an Asthma Action Plan has not been done for your child, make an appointment to have this done for future use. Gauge where the child is (green, yellow, red) and the plan should be implemented accordingly. If the plan has been implemented without improvement over the last 3-5 days, discuss this with your physician. If your child is worse, please call your doctor for an appointment that day.
The time of the cough can also be very helpful in trying to figure out what the etiology could be. Coughs that occur primarily between midnight and 3 a.m. are many times due to increased inflammation in the airway. This would be further confirmed if cough with activity or laughing or history of recurrent “bronchitis,” pneumonia, or family history of asthma. Your child should get an appointment for evaluation, unless they have an asthma action plan that has not been activated and are in the upper yellow zone. Coughs primarily restricted to bedtime (prone or supine position) or upon arising in the morning are predominantly related to post-nasal drip due to URI’s, allergies, or sinusitis. If there is a history of allergies, or your child also has itchy eyes, nose, dark circles under eyes, family history of allergies, perhaps some non-sedating anti-histamine or restarting their previous allergy medications may resolve the symptoms.
Other symptoms which accompany the cough are also very important. Fever (actual degree of temperature, duration, responsive to antipyretics, etc), associated pains (chest, back, abdominal), associated respiratory symptoms (wheeze, retractions, fast, regular rate, difficulty, etc.), feeding capability in infants, and the child’s age will give valuable information as to how your child is doing and whether an immediate appointment is needed. If there is any question regarding the care of your child, feel free to contact your doctor to assist on the health care needs of your child. At that time, the nurses or physician can make the decision on whether you need an appointment immediately, later in the day, the next day, or wait until symptoms worsen or don’t get better. If your child has had cough for a few days and now begins with fever and some chest, abdominal, or back pains, he should be seen within 24 hours. Respiratory distress or chest retractions generally need to be seen immediately in the office or need to go to the emergency room so please contact your physician’s office. Just ask one of the physicians! Cough that has an accompanied fever (>101) for more than 3 days should be seen within the next 24 hours. Infants who have a significant cough and are refusing to take the bottle or nurse should be evaluated that day. The younger the child, the more appropriate an appointment is, however, if it really sounds like a simple cold i.e. feeding okay and sleeping okay and temperament is okay, treat it as a cold,. Coughs that are associated with vomiting (persistently) should be seen that day, unless asthma action plan has not been instituted, than start asthma treatment and follow up later that day.
REASSURING SIGNS PROBLEMATIC SIGNS
Simple cold / allergy symptoms Feeding difficulty / persistent vomiting
Early in illness and doing well Worsening cough
No feeding difficulties New onset fever after a few days cough
No chest pain or tightness Chest pains / tightness
Action Plan in upper yellow to green zone Unable to improve from “Yellow Zone”
Older children without significant problems Approaching or in the“Red Zone”
No significant history of “bronchitis” Cough greater than 2 weeks
No significant history of “pneumonias”
REMEMBER, THE ABOVE ARE SOME SIMPLE GUIDELINES, AND THERE IS NO PERFECT WAY TO KNOW ABOUT THE CAUSE WITHOUT SEEING A PHYSICIAN. HOWEVER, SOME SIMPLE OBSERVATIONS CAN ASSIST YOU IN CARING FOR YOUR CHILD AND AVOIDING SOME UNNECESSARY VISITS. AS ALWAYS, IF THERE IS A CONCERN OR QUESTION, PLEASE FEEL FREE TO CALL YOUR DOCTOR. IF WE FEEL YOUR CHILD NEEDS TO BE SEEN, WE WILL MAKE THE NECESSARY ARRANGEMENTS.