Now that we are well into cold and flu season, the chorus of coughs, sure to be found anywhere that more than a few children a

Nelson Branco, MD, FAAPPartner, Tamalpais Pediatrics, Greenbrae, CAMedical Staff, Marin General Hospital and Novato Community Hospital In cold and flu season, a chorus of cough can be heard wherever more than a few children gather. Cough can be caused by many different illnesses. We’ll review the most common and also what you can do to make a coughing child more comfortable, as well as the signs that indicate your child should be seen by a physician.
Cough is a protective reflex that keeps the lungs clear of mucous, irritants and infection. Cough can be voluntary, but it’s difficult to suppress a cough when your brain says it’s necessary. Cough can interrupt sleep, be disruptive at school or irritating to your child, and cough is a very efficient way to pass infections to others (Cover That Cough!).
Colds or viral upper respiratory infections are the most common cause for cough. Throat irritation from the virus itself, dry air from mouth breathing because of nasal congestion and mucous from post nasal drip can all lead to coughing. It can be day or night, dry or productive, and usually coincides with the nose or throat symptoms. If the cough doesn’t interrupt sleep and isn’t associated with chest congestion or wheezing, it can be treated with fluids, rest and something to soothe the throat. Herbal tea with lemon and honey, cough drops for older kids, soups and cool beverages can help. For the congestion, and to thin the mucous so that it’s easier to cough up, vaporizers/humidifiers, steamy bathrooms, and saline nose drops can help. I recommend over the counter cough suppressants only for children over one year of age who aren’t sleeping or are distressed by the cough. The right medication to use is a “Cough” or “DM” formula of your favorite brand. DM is Dextromethorpham, a cough suppressant. There are prescription cough suppressants, usually containing Codeine, a narcotic. This is less frequently used in children, since the side effects (mainly sedation, and respiratory depression with overdose) can be more common in children, who metabolize Codeine differently than adults.
Your child should be seen by their physician if the cough is worsening instead of getting better, is accompanied by a high fever, is wheezing, or having difficult and/or rapid breathing. If your child is distressed, look at their chest to watch for retractions. If you can see the spaces in between the ribs being pulled in with each breath, your child should be seen by a physician right away. Cough from a cold can last for several weeks. As long as there are no concerning signs, it’s fine to care for your child at home and wait for the slow, gradual improvement.
Croup is a viral illness that causes cough. A croupy cough is a distinctive barky cough - like a seal barking. Croup is treated with cool, moist air from a vaporizer/humidifier or a steamy bathroom. If your child makes a whistling or wheezy sound when they breathe in, this is called stridor. Stridor is common after and during a coughing fit or crying, and is a sign that your child should be evaluated by a physician. If they have stridor when calm and not crying, they should be seen right away. Croup is worse at night, and is a common reason for midnight visits to the ER. Croup with stridor or difficulty breathing may require steroids to help relieve swelling in the upper airway. Antibiotics are not necessary because it is a viral illness. Children with asthma or “reactive airway disease” can have frequent cough. These children use inhaled medications (most commonly Albuterol) to relax the muscles in their airways and open them. They may also use oral or inhaled steroids or other preventative medications to treat inflammation and allergy. If your child has asthma or recurrent wheezing, you should have a written asthma plan prepared by their physician. If you don’t, make an appointment to review your plan for illnesses that may arise this winter. You should make sure that they get a flu shot and that you have medication for cough and wheezing that may come with colds, which are a frequent trigger for kids with asthma. Another virus that can cause significant illness, especially in infants, is Respiratory Synctitial Virus (RSV). RSV and other viruses cause bronchiolitis. The viruses cause inflammation in the small airways of the lungs. This leads to fever, cough, wheezing, chest congestion, trouble feeding, or difficulty breathing. If your infant has any of these symptoms, they should be seen immediately by a physician. Bronchiolitis is not always serious, but can lead to hospitalization.
Pneumonia and bronchitis are a frequent concern of parents who bring their coughing children to the doctor. These are usually bacterial infections and often require antibiotics. Common signs are fever, productive cough, chest or abdominal pain and rapid or difficult breathing. Sometimes a chest x-ray is needed, but often a physician can diagnose these by listening carefully to the chest. If there is difficulty breathing or low oxygen level, hospitalization may be necessary.
There are other conditions and illnesses that cause cough – allergies, sinusitis, acid reflux, heart problems, tuberculosis, choking or aspiration, etc. If you suspect any of these, consult your child’s physician for help. I hope that this review of the common reasons and treatment for cough is helpful this winter season. Remember - the best treatment is prevention. Teach your kids to wash their hands frequently,get a flu shot and, as much as possible, avoid people who are obviously sick.


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