What is that cough?

By Jennifer Shaer, MD

It seems like kids cough all winter long. When is it time to worry about the cough? When can you treat it at home and when should you go to the doctor?

There are many causes of cough in children. Most commonly, a cough is caused by a viral upper respiratory infection. However, coughs can also be caused by asthma, pneumonia, croup, bronchiolitis, whooping cough, sinusitis, allergies, reflux and even an inhaled foreign body. Here are some tips to help you figure out what your child’s cough is from, how to treat it and when to get help.

1. Viral upper respiratory infection:

This is the common cold. A cough from a cold will typically last two weeks. There is usually fever for the first few days of a cold. There is commonly some productive phlegm toward the end of a cold. Antibiotics do not help viral illnesses so it is best to let this type of cough run its course. Usually there is fever with a viral upper respiratory infection for the first few days. However, you should visit the doctor if the fever lasts more than a few days. You should also see the doctor if the cough lasts more than ten to fourteen days or the fever comes back after having stopped. These could be signs of sinusitis or pneumonia.

2. Sinusitis:

Sinusitis can develop in children after a cold goes on for more than two weeks. Children do not develop sinusitis after just a few days of a viral upper respiratory infection. Yellow or green discharge from the nose does not always mean you have a sinus infection. In general, it is a good idea to take care of a cold at home. However, if after two weeks the cold does not improve, the cough is worsening or fever develops then you should see the doctor.

3. Pneumonia:

Pneumonia in children is often viral and gets better by itself. However, there is a very specific time to think about a bacterial pneumonia. Viral infections can cause a fever during the first few days of the common cold. A cough from a cold can last for two weeks but the fever should not return. If your child’s fever returns later in the course of a cold, then you should visit the doctor to check for pneumonia. Bacterial pneumonia is treated with antibiotics.

4. Whooping cough (pertussis):

Recently there has been a resurgence of pertussis. Pertussis starts off just like the common cold. However, instead of getting better, the cough gets worse. Children with pertussis will cough many times in a row. They will often lose their breath and take a big “whoop” breath at the end of a series of coughs. The cough from pertussis can cause children to vomit or faint. Babies with pertussis will sometimes stop breathing and turn blue. The cough can last for months and while antibiotics will help stop the spread of disease to others, it does not improve the cough. Pertussis is extremely dangerous to babies and is preventable by vaccine. It is important to make sure that your baby gets all his pertussis vaccines. In addition, we now give teenagers and adults a pertussis vaccine. Adults and children should all be vaccinated for this disease.

5. Asthma:

The cough from asthma is usually not associated with a fever. Kids with asthma cough more with exercise and at night. Asthma is usually triggered by a cold so children who have a history of wheezing should always see the doctor when they are sick and coughing. The cough from asthma can be minimized by close medical attention.

6. Bronchiolitis:

Bronchiolitis occurs when a viral upper respiratory infection moves into your baby’s chest and causes wheezing. Signs that your baby’s cold might be bronchiolitis include trouble nursing or taking a bottle, heavy or fast breathing and a wet sounding cough. In general, babies with a cough should see the doctor.

7. Croup:

The cough from croup sounds like a barking seal. Croup is caused by a virus that attacks the larynx or vocal cords. In older children the only symptoms will be a harsh sounding cough and a horse voice or laryngitis. In babies, the virus can cause more severe swelling and difficulty breathing or stridor. Babies with croup should see the doctor. The treatment is supportive with mist and sometimes steroids.

8. Foreign bodies:

Toddlers are known for putting things in their mouths. Sometimes a toddler will inhale a foreign object or even a piece of food and it will get stuck in the airway. This can cause unexplained cough in a toddler. Sometimes wheezing or pneumonia can develop. Your doctor can help determine if this has occurred by a careful exam and sometimes a chest xray.

9. Allergies:

The cough related to allergies is usually associated with other allergy symptoms, itchiness, sneezing and congestion. There is no fever with an allergic cough. There are many good medicines available to treat an allergic cough. Some are over the counter and others are prescription. It’s a good idea to see your doctor to evaluate this.

10. Reflux:

Babies and children with reflux can have cough as the main symptom. In fact, reflux can even cause wheezing. Your doctor will help you determine if your child has reflux.

As you can see, children cough for many reasons. Keep in mind that children typically get six colds a year. This is why it seems like your child is always coughing. Cough medicines have not been proven safe or effective for children. It is important to determine the cause of the cough and treat the cause.

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