Cough in Children
Cough helps clear materials from the airways and prevent
them from going to the lungs. The materials may be particles that have been
inhaled or substances from the lungs and/or airways. Most commonly, material
coughed up from the lungs and airways is sputum (also called phlegm—a mixture
of mucus, debris, and cells ejected from the lungs). But sometimes a cough
brings up blood. A cough that brings up either is considered productive. Older
children (and adults) typically cough material out, but younger children
usually swallow it. Some coughs do not bring anything up. They are considered
dry or nonproductive.
Cough is one of the most common reasons parents bring their
children to a health care practitioner.
Causes of Cough in Children
Likely causes of cough depend on whether the cough has
lasted less than 4 weeks (acute) or 4 weeks or more (chronic).
Common causes
For acute cough, the most common cause is
An upper respiratory infection due to a virus
For chronic cough, the most common causes are
Asthma (the most common)
Gastroesophageal reflux
Postnasal drip (drainage of fluid from the nose down the
throat)
Less common causes
Acute cough may also result from a foreign body (such as a
piece of food or a piece of a toy) inhaled into the lungs (aspiration) or less
common respiratory infections such as pneumonia, pertussis (whooping cough), or
tuberculosis.
Whooping Cough icon
Chronic cough may also result from aspiration of a foreign
body, hereditary disorders such as cystic fibrosis or primary ciliary
dyskinesia, a birth defect of the airways or lungs, inflammatory disorders
involving the airways or lungs, or may be stress-related (also known as a habit
or psychogenic cough).
Evaluation of Cough in Children
Not every cough requires immediate evaluation by a doctor.
Knowing which symptoms may indicate a serious cause can help parents decide
whether contacting a doctor is needed.
Warning signs
The following symptoms are of particular concern:
A blue tint to the lips and/or skin ( cyanosis)
A loud squeaking noise ( stridor) when the child breathes in
Difficulty breathing
An ill appearance
Spasms of uncontrollable, repetitive coughing followed by a
high-pitched intake of air (sounds like a whoop)
When to see a doctor
Children who have warning signs should be taken to a doctor
right away, as should those whose parents think they may have inhaled a foreign
body. If children have no warning signs but have a frequent harsh or barking
cough, parents should call the doctor. Doctors typically want to see such
children within a day or so, depending on their age, other symptoms (such as
fever), and medical history (particularly a history of lung disorders, such as
asthma or cystic fibrosis). Otherwise healthy children who have a cough
occasionally and have typical cold symptoms (such as a runny nose) may not need
to be seen by a doctor.
Children with a chronic cough and no warning signs should be
seen by a doctor, but a delay of a few days to a week is generally not harmful.
What the doctor does
Doctors first ask questions about the child's symptoms and
medical history. Doctors then do a physical examination. What they find during
the history and physical examination often suggests a cause of the cough and
the tests that may need to be done ( see Table: Some Causes and Features of
Cough in Children).
Information about the cough helps a doctor determine its
cause. Therefore, a doctor may ask
What time of day does the cough occur?
What factors—such as cold air, body position, talking,
eating, drinking, or exercise—trigger or relieve the cough?
What does the cough sound like?
Did symptoms begin suddenly or gradually?
What are the child’s other symptoms?
Does the cough bring up sputum or blood?
A nighttime cough can be caused by asthma or postnasal drip.
Coughing at the beginning of sleep and in the morning when waking usually is
caused by inflammation of the sinuses ( sinusitis). Coughing in the middle of
the night is more consistent with asthma. A barky cough suggests croup or
sometimes a cough that is left over from a viral upper respiratory infection. A
cough that started suddenly in a child with no other symptoms suggests possible
inhalation of a foreign body. Contrary to what many people think, whether
sputum is yellow or green or thick or thin does not help distinguish bacterial
infection from other causes.
When children are 6 months to 4 years old, parents are asked
about the possibility of swallowing a foreign body (such as a small toy) or
small, smooth, firm foods (such as peanuts or grapes). Doctors also ask whether
the child has had any recent respiratory infections, frequent bouts of
pneumonia, allergies, or asthma or has been exposed to tuberculosis or other
infections, as may occur during travel to certain countries.
A physical examination is done. To check for breathing
problems, doctors observe the child's chest, listen to it with a stethoscope,
and tap (percuss) it. Doctors also check for cold symptoms, swollen lymph
nodes, and abdominal pain.
Testing
Tests may or may not be needed depending on symptoms and the
causes that doctors suspect. For children with warning signs, doctors typically
measure the oxygen concentration in blood using a clip-on sensor ( pulse
oximetry) and take a chest x-ray. These tests are also done if children have a
chronic cough or if a cough is worsening. Doctors may also do other tests
depending on what they find during the history and physical examination ( see
Table: Some Causes and Features of Cough in Children).
For children without warning signs, tests are rarely done if
the cough has lasted 4 weeks or less and cold symptoms are present. In such
cases, the cause is usually a viral infection.
Tests also may not be needed if symptoms strongly suggest a
cause. In such cases, doctors may simply start treatment for the presumed
cause. However, if symptoms persist despite treatment, tests are often done.
Treatment of Cough in Children
Treatment of cough focuses on treating the cause (for
example, antibiotics for bacterial pneumonia or antihistamines for allergic
postnasal drip).
To relieve cough symptoms, parents have often been advised
to use home remedies such as having the child inhale moist air (as from a
cool-mist vaporizer or in a hot shower) and drink extra fluids. Although these
remedies are harmless, there is little scientific evidence that they make any
difference in how children feel.
Cough suppressant drugs (such as dextromethorphan and
codeine) are rarely recommended for children. Cough is an important way for the
body to clear secretions from the airways. Also, these drugs may have side
effects, such as confusion and sedation, and there is very little evidence that
they help children feel better or recover more quickly. Expectorants, which are
supposed to thin and loosen mucus (making it easier to cough up), are also
usually discouraged in children.
Key Points about Cough in Children
Usually, the cause of cough can be identified based on
results of the doctor's examination.
In children aged 6 months to 4 years, a foreign body in the
airways must be considered.
Chest x-rays are taken if children have warning signs or a
cough that has lasted more than 4 weeks.
Usually, cough suppressants and expectorants are not
recommended.
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