Why Is My Child Coughing?
20
November

By Adem Lewis / in , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , /


Children cough, endlessly,
everywhere, that’s a fact. It’s one of the commonest
reasons for children to be brought to my
outpatient clinic or to the emergency
department for that matter. I’m going to talk to
you a bit about what’s normal in childhood
cough, what’s abnormal, and what are the key features
that should make you seek help. The things that I described
towards the end of this talk are incredibly rare. I’m not here to scare you. I’m here to reassure you
that what your child is doing is probably normal. What’s a normal cough? Healthy 10-year-olds
will have around 11 bouts of coughing in a normal 24
hour period, that’s healthy. Young children will have
up to 12 colds in a year. When children get
a cold, they will cough for two to three weeks. With that in mind,
you can imagine that it’s difficult to find
a point when they’re not coughing, and that’s normal. So how do you treat a
normal bog-standard cough? Well the first question
is, do you need to? Most children with a cold will
cough for one, two, maybe three weeks, and then they’ll be fine. And actually that
cough will be part of the way in which they clear
the chest of any secretions that are causing irritation. If your child is
coughing to the extent that they’re getting
no sleep, that they’re in pain or significant
discomfort, or they’re vomiting
all the time, you may want to do
something to relieve those coughing symptoms. And at that point, it’s
reasonable to give them an over-the-counter cough syrup. You need to recognise that these
aren’t going to make your child better any sooner, but they
may make them feel a bit more comfortable. The other thing
paracetamol, ibuprofen, again over-the-counter
can relieve some of the pain
associated with coughing. So that’s a normal cough. What’s abnormal? What should get your
spidey senses tingling? Well thankfully, the most common
causes of an abnormal cough are still not too worrying. Your child may have a bit
of gastroesophageal reflux. That’s when stomach
acid comes up from the stomach up
to the upper airways and irritates the airways
or the vocal cords and makes some
cough, particularly at night or on
exercise, and actually sounds a lot like asthma. Persistent bacterial
bronchitis is a name for a low level bacterial
infection, which causes your child to have a
wet cough that just doesn’t go away even between colds. There’s also a quite unusual
cause for a persistent cough. We call it habit or
psychogenic cough. And it occurs in a context where
children look very well and yet they cough and cough and cough. What is odd about this
cough is that it’s much more prominent
in the daytime, and they hardly
ever cough at night. They cough an awful lot more
in front of their parents, particularly if their parents
are worried or in front of a paediatrician,
but they won’t really cough when they’re having fun. Quite often they won’t
cough on the weekend. And they won’t cough
if a nurse is watching. The key thing is if a
habit or psychogenic cough has been identified,
don’t worry. The answer is calm
indifference, reassurance. Don’t talk about it, don’t
notice it, it will go away. So let’s talk about asthma. Asthma is a condition where
we have reversible narrowing of the airways. What that means for your child
is wheezing and coughing, quite often in response
to a virus or exercise. And the cough is particularly
prominent at night. Thankfully, most
children with asthma are readily controlled
on inhaled steroids or a blue inhaler, and you
have seen these before. And the key thing
is if it is asthma, it gets better with
these treatments. So we’ve talked
about abnormal cough. What then are the
key red flag features that should make you seek an
urgent paediatric opinion? We’ve talked about a wet
cough that doesn’t go away. If you add to that a child that
has also had severe breathing difficulty maybe at birth, has
had a runny nose since birth, and maybe gets recurrent
chest infections, these may be a sign
of immunodeficiency, so a weakness in the
immune system, or more rarely a condition called PCD
or primary ciliary dyskinesia, where the hair cells that line
the upper and lower respiratory tract don’t waft
mucus out effectively. I guess the final
red flag you’d like to look out for is a child
whose cough is worse with eating and drinking or perhaps
doesn’t like to eat and drink, maybe the child who vomits
a lot and has done severely since they were born, this child
may possibly have cough related to aspiration. That’s passage of food and
drink into the lungs, perhaps through an abnormal connection
between the breathing tubes and the feeding
tubes, something we call either a fistula
or a laryngeal cleft, or perhaps due to severe
gastroesophageal reflux. So at this point, I
think it’s probably helpful to go back
to where we started. Children cough, it’s what
they do, it’s normal, it’s even healthy. If you have doubts based
on anything that I’ve said, that’s why you have a GP, that’s
why we have paediatricians. Thank you for watching. I hope that that’s
been informative. Please do subscribe
to the YouTube channel for more content on this and
other childhood subjects. We’ll see you soon.


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