COUGHS - It seems that at this time of year not many families escape the coughs and colds that rip through the community and particularly seem to bother the younger folk. Coughs are one of the most frequent symptoms of childhood illness, and although they can sound awful at times, they usually are not a symptom of anything dangerous. Actually, coughing is a healthy reflex that helps clear the airways in the throat and chest. Occasionally, though, coughs can be cause for a visit to your clinic. If you learn to recognize certain types of coughs, you will know how to handle them and when you should seek medical help.
Types of Coughs and What They Mean
- “Barking” Cough
These coughs are usually caused by croup, an inflammation of the larynx (voice box) and trachea (windpipe) brought on by allergies, change in temperature at night, or most commonly a viral upper respiratory infection. When a young child’s airway becomes inflamed, it may swell around the vocal cords, making it harder to breathe. Children younger than 3 years of age have croup most often because their windpipes are narrow - some children have it almost every time they have a respiratory illness. Croup can occur suddenly in the middle of the night, which can be frightening for both parents and child. Although most cases can be managed at home, if you suspect your child has croup, call your child’s doctor to determine whether your child needs to visit him or her.
- “Whooping” Cough
The “whooping” sound actually occurs after the cough, when the child tries to take in a deep breath after a round of several coughs in a row. If your child makes a “whooping” noise (which actually sounds like “hoop”) after severe bouts of rapid coughing, it is most likely a symptom of pertussis (whooping cough) - particularly if your child has not received her diphtheria/tetanus/pertussis (DTaP) vaccinations. In infants and very young children, pertussis can be deadly, so call your child’s doctor right away.
- Cough With Wheezing
When coughing is accompanied by a wheezing sound as your child exhales (breathes out), it is a sign that something may be partially blocking the lower airway. This might be caused by swelling from a respiratory infection (such as bronchiolitis or pneumonia), asthma, or an object stuck in the airway. Call your child’s doctor unless you are already versed in treating this at home (i.e. your child is already diagnosed asthmatic and you know how to medicate). If the cough and wheezing do not improve with medication, call your child’s doctor. Be aware that many local doctors will incorrectly term any “wheeze” as asthma. NOT ALL CHILDREN THAT HAVE AN OCCASIONAL WHEEZE ASSOCIATED WITH A RESPIRATORY INFECTION ARE ASTHMATICS.
- Stridor
Although wheezing usually during exhalation, stridor is noisy, harsh breathing that’s heard when a child inhales (breathes in). Most often, it’s caused by swelling of the upper airway, usually from viral croup. However, it’s sometimes caused by a more serious infection called epiglottitis or a foreign object stuck in the child’s airway. If your child has stridor, call your child’s doctor immediately.
- Sudden Cough
When a child suddenly starts coughing, it may mean they have swallowed some food or liquid “the wrong way” (into the airway) or something (a bit of food, vomit, or perhaps even a small toy or coin) is caught in the throat or airway. Coughing helps clear the airway and may even continue for a minute or so simply because the throat or airway is irritated. But if the coughing does not seem to improve or your child has trouble breathing, call your child’s doctor. Do not try to clear the throat with your finger because you might push the obstruction even farther down the windpipe.
- Night-time Cough
Lots of coughs get worse at night because the congestion in a child’s nose and sinuses drains down the throat and causes irritation while the child lies in bed. This is only a problem if your child is unable to sleep. Asthma can also trigger nighttime coughs because the airways tend to be more sensitive and become more irritable at night.
- Daytime Cough
Allergies, asthma, colds and other respiratory infections are the usual culprits. Cold air or activity can make these coughs worse, and they often subside at night or when the child is resting. You should make sure that nothing in your house, like air freshener, pets, mosquito coils, thatched (alang-alang) roofs or smoke, is making your child cough.
- Cough With a Cold
Because most colds are accompanied by a cough, it’s perfectly normal for your child to develop either a wet or dry cough when they have a cold. The cough usually lasts about a week; often after all other symptoms of the cold have disappeared.
- Cough With a Fever
If your child has a cough, mild fever, and runny nose, chances are she has a simple cold, but coughs with a fever of 39 C, (102 degrees Fahrenheit) or higher can mean pneumonia, particularly if your child is listless and breathing fast. In this case, call your child’s doctor immediately.
- Cough With Vomiting
Children often cough so much that it triggers their gag reflex, making them vomit. This is not usually a cause for alarm unless the vomiting persists.
- Persistent Cough
Coughs caused by colds can last weeks, even up to 3 weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or breathing passages might also be responsible for long-term coughs. Any person with a persistent cough should be assessed for TUBERCULOSIS (TB or TBC). Even those who have received the Tuberculosis vaccine are still susceptible to the disease (the vaccine is about 60 – 70 % effective). If your child’s cough lasts for more than a month, you should schedule a visit with your child’s doctor.
When to Call Your Child’s Doctor
Most childhood coughs are nothing to be concerned about. However, in some instances you should consult a doctor, just to be safe. Call your child’s doctor if your child:
- has trouble breathing or is working hard to breathe
- has a blue or dusky color to the lips, face, or tongue
- has a high fever (particularly in a young infant or in the absence of congestion or a runny nose; contact your child’s doctor for any fever in an infant younger than 3 months of age)
- if an infant (3 months old or younger) who has been coughing for more than a few hours
- makes a “whooping” sound when she breathes after coughing
- is coughing up blood.
- has stridor when inhaling
- has wheezing when exhaling (unless you already have home asthma management instructions from your child’s doctor)
- is listless or cranky
Professional Treatment
One of the best ways to diagnose a cough is listening. Your child’s doctor will determine how to treat your child based in part on what the cough sounds like.
Because the majority of respiratory illnesses are caused by viruses, doctors do not prescribe antibiotics for many coughs. If bacterial pneumonia or another bacterial infection is suspected, your child’s doctor will probably prescribe antibiotics.
Unless your child’s cough is keeping her from getting adequate sleep, cough medicines are usually unnecessary. These medicines, both prescription and over-the-counter (OTC), may have unpleasant side effects and can even be dangerous for infants and young children. It’s usually best to just let the illness run its course.
Pneumonia, pertussis,and serious cases of croup may require hospitalization. Usually this is just for close observation and to make sure your child gets enough fluids, but sometimes, if your child is having a hard time breathing, oxygen may be given.
Home Treatment
Home treatments should never take the place of consulting your child’s doctor for any of the conditions listed above, but there are several things you can do at home to make your child more comfortable when she has an annoying cough.
- If your child has asthma, make sure you have received asthma-management instructions from your child’s doctor. Monitor your child’s progress carefully during a flare-up and give asthma medicines according to the doctor’s instructions.
- If your child wakes up with a “barking” or “croupy” cough in the middle of the night, take her into the bathroom, close the door, and let the shower run on hot for several minutes. After the room steams up, sit on the bathroom floor with your child for about 20 minutes. The steam should help your child breathe more easily. Try reading a book together to keep your child occupied. Never leave your child unattended near hot water..
- Cool beverages like juice can be soothing; avoid carbonated or citrus drinks, however, because carbonation and citric acid can be painful on a raw throat.
- You should not give your child (especially a baby or toddler) OTC cough medicine without specific instructions to do so from your child’s doctor. Many of these medicines suppress coughs, but respiratory illnesses sometimes produce a lot of secretions and coughing helps clear them out of the airway. If the cough were suppressed with medicine, it could actually be harmful to your child.
Cough lollies, which are fine for older children, are a choking hazard for young children. It’s best to leave decisions about your child’s medicine to your child’s doctor.
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Kim Patra is a qualified Registered Nurse and Midwife that has been living and working in Bali for almost twenty years. She now runs her own private practice and medical referral service from her Kuta office. Kim is happy to discuss any health concerns with you and she may be contacted via e-mail at info@chcbali.com”.
