Joseph R. Anticaglia MD
Medical Advisory Board
Whether it’s 2’o’clock in the afternoon or 2 in the morning, parents will worry, “Why is my child coughing?” Can I ignore the cough? Does he need medication? Is it necessary for my child to be examined by a doctor?
Two year old Billy had a cold, runny nose and a low grade fever for three days prior to waking his mother in the middle of the night with his noisy breathing and coughing.
His mother explains to the Pediatrician, “He has trouble breathing in. When he breathes in, he makes this funny, harsh sound. When he coughs, he barks like a sea lion.”
Croup Laryngotracheitis
Croup is an inflammation, a swelling of the larynx (voice box) and trachea (wind pipe). This swelling narrows the airway passages making it difficult to breathe in and to get air into the lungs. It’s particularly worrisome because a child’s airway is much narrower; and a small amount of swelling can cause a lot of problems.
Children with croup have a barking cough, difficulty breathing in (stridor) and hoarseness. This inflammation is usually due to a virus although allergies and temperature changes can also influence croup. Croup can be mild or a medical emergency. In the case noted above, Billy should be should be examined by a doctor as soon as possible.
A coughing child is the main reason parents take their children to the doctor. Cough is a protective reflex that clears foreign matter and mucus from the airways. It is a symptom, not a disease and the causes are many. It’s a common symptom that usually can be managed at home; on the other hand, as in Billy’s case, it can trumpet a medical emergency.
Cough has been classified in a variety of ways: By age, for example, croup usually occurs between zero and three years of age; by anatomic location, for example, asthma involves the small bronchial “tubes” of the lung and by cause, for example, post nasal drip can be due to allergy, rhinitis or sinusitis.
Below is a classification of cough into Acute and Chronic categories with emphasis on the frequent causes of cough. Here, acute means a cough that lasts three weeks or less, and chronic is one that lasts longer than three weeks. Other authors have used different time frames in classifying cough.
Acute cough
“URI.” is an upper respiratory infection, frequently due to a virus and a common cause of cough treated without antibiotics. As in the case of croup, things can go from bad to worse requiring medication and even hospitalization.
Less frequent causes of acute cough are pneumonia and foreign bodies. Peanuts, beads and pieces of a toy all act as foreign bodies when swallowed and get into the breathing passages and lungs. Whooping cough (Pertussis) has seen resurgence in frequency since some parents have opted not to have their children vaccinated against this bacterial infection.
Chronic Cough
Asthma is a common cause of cough in children. Typically, asthmatic children present with symptoms of shortness of breath and wheezing. In contrast to croup, these children have difficulty breathing out, getting air out of the lungs.
However, some asthmatic children may present with cough as the only reason to see their physician. Often the parent reports that the cough happens at night or upon exertion. Yet, is it asthma, or could it be reflux or a combination of both?
Reflux Gastroesophageal Reflux Disease (GERD)
If your child has been diagnosed and treated for asthma and is not getting better, consider reflux disease as another possible cause of chronic cough. In a previous article on chronic cough, I discussed silent reflux and GERD.
Reflux is the backflow of stomach acid upward through the esophagus (food tube that connects the throat to the stomach) into the breathing passages. It can initiate the sensitive cough reflex, and/or trickle into the lungs causing symptoms suggestive of asthma
But here’s a KEY question to distinguish asthma from other causes. “Does the child have more trouble breathing in or breathing out?” If the answer is breathing in, getting air into the lungs, it’s not asthma. If it’s a chronic cough, consider reflux as another possible cause of the problem.
Post-Nasal Drip (P.N.D.)
P.N.D. is drainage in the back of the nose and throat. Allergic, viral and bacterial rhinitis and sinusitis are examples that can cause P.N.D.
Above the larynx, there are sensitive cough receptors and the drainage in the back of the nose and throat can trigger coughing. The underlying condition may require allergy testing or antibiotic medication or both.
A hereditary disorder, cystic fibrosis (CF), is a less common cause of chronic cough.
Patients have thick and sticky secretions blocking bronchial tubes and airway passageways making it particularly harmful to the lungs. A sweat test is diagnostic.
Foreign bodies must also be put on the radar screen as possible causes of chronic cough in young children. A chest X-ray is helpful in these instances. Also, post-viral Infections can result in coughing for weeks after the infection has been properly managed.
Summary
There are a many causes of cough and the above highlights some common reasons parents bring their children to doctors. Most coughs are not serious and do not require a doctor’s visit,
However, if your child is having a problem with coughing and you think it might be serious, contact your physician or take the child to an urgent care center or the emergency room.
References
Simpson, C. M.D. Amin, M. M.D.; Chronic Cough; Otolaryngology — HNS, 2006
What is Cough, NHLBL; NIH.
Hotaling, A. MD; Moynihan, G. MD; Pediatric Otolaryngology, Volume 2. 2003.
This article is intended solely as a learning experience. Please consult your physician concerning diagnosis and treatment options.