Decode Your Child's Cough

Sandra Gordon

It's always distressing to hear your little one cough, especially in the middle of the night. Though common, this wintertime symptom often sounds worse than it really is. "Coughing is the body's way of clearing and protecting the airways from irritating mucus and other secretions," says Charles Shubin, MD, director of the Children's Health Center at Mercy FamilyCare in Baltimore. Coughs also provide valuable clues about your child's illness. Follow our guide to figure out which coughs to wory about - and help your child feel better fast.

Cough Clues: A distinctive, shrill, dry, seal-like bark, which frequently starts in the middle of the night. "The sound is unlike any cough you've ever heard before," says pediatrician Mark Widome, MD, author of Ask Dr. Mark: Answers for Parents.

Other Symptoms: Your child's illness follows a circadian rhythm: better during the day, worse at night. She may have a slight fever. In severe cases, your child may develop stridor, a harsh, high-pitched sound every time she inhales - similar to the noise kids make after a long crying jag.

Likely Culprit: CROUP, a contagious wintertime viral infection that causes the throat and windpipe to swell and narrow. It typically affects kids between six months and three years. (Adults and older children have wider windpipes, so swelling is less likely to affect breathing).

What to Do: Sit with your child in a steamy bathroom for five minutes; the humidity will help move mucus from her lungs and calm her cough. At night, bundle her up in warm pajamas, open her bedroom window, and run a humidifier in the room; the cold, moist air may reduce airway swelling. Call your doctor right away if her cough worsens or she's having trouble breathing. She may need medicine to reduce inflammation. Otherwise, croup often runs its course in three to four days.

Cough Clues: A wet cough without wheezing, or fast breathing occurring day or night.

Other Symptoms: Sneezing, a runny nose, watery eyes, and a mild fever (usually less than 101.5°F).

Likely Culprit: COMMON COLD, a viral infection of the nose, sinuses, throat, and large airways of the lungs. Coughing usually lasts the entire length of the cold (about seven to ten days) but can linger twice as long, with mild improvement each day.

What to Do: Keep nasal passages as clear as possible; congestion and postnasal drip worsen his cough. For babies and toddlers who can't blow their nose yet, use nasal saline drops and a bulb aspirator to suction a runny nose. An over-the-counter nasal decongestant may help kids over two; ask your pediatrician for her recommendation. (For the lowdown on cough remedies for children, see "Facts Dr. Mom Should Know" on page 3). If your child's cough and stuffy nose persist for more than ten days without improving, see your doctor. Your little one could have sinusitis (a bacterial infection that's often brought on by a cold) or another problem such as asthma, allergies or even enlarged adenoids, which inhibit breathing.

Facts Dr. Mom Should Know

Cough suppressants: If your child's cough is keeping him up at night, a suppressant may help him sleep. Ask your pediatrician for a recommendation. However, you should know that inhibiting a cough, especially one that is mucousy and lower-respiratory, can actually exacerbate or prolong the illness, says pediatrician Charles Shubin, M.D.
Expectorants: They're meant to loosen mucous, but studies show they're not very helpful. "Water is a good expectorant," Dr. Shubin says.

Multi-symptom cold relievers: Because these formulas contain more than one drug, be sure to read labels carefully. Your child may suffer side effects such as sleeplessness (common with antihistamines) or irritability (typical of decongestants), says Meredith Messinger, M.D., an attending physician at Long Island College Hospital, in Brooklyn.

Throat lozenges: Cough drops increase saliva production, which can soothe your child's throat and loosen his cough. But don't give them to children under age four, Dr. Shubin says. Like any hard candies, lozenges pose a choking hazard.

Cough Clues: Dry, hacking coughing fits - as many as 25 coughs in a single breath. When your child inhales sharply to catch her breath, she makes a high-pitched whooping sound.

Other Symptoms: Before the cough starts, your child has a week of cold-like symptoms but no fever. In infants, the illness can be severe and cause mucus to bubble from the nostrils. It can also lead to convulsions and make a baby stop breathing if she gets tired.

Likely Culprit: WHOOPING COUGH (also known as pertussis), a highly contagious bacterial infection of the throat, windpipe, and lungs. Children who haven't received their immunizations are most vulnerable. (Babies routinely get their shots at two, four, and six months, an additional booster between 12 and 18 months and again between four and six years. Immunity wanes as we get older. Therefore, adults may carry pertussis but get only a mild cough).

What to Do: Call your doctor if your child's cough worsens instead of improves after a week. Babies usually need to be hospitalized to control the cough and have mucus suctioned from their throat. The illness is treated with antibiotics, though the cough can last for many weeks or even months.

Cough Clues: A wheezy, crackly, persistent cough after your child eats. Coughing episodes typically worsen when she's lying down.

Other Symptoms: She may feel a burning sensation or may vomit or belch when swallowing. A baby might be fussy or have been labeled as colicky. Toddlers may develop wheezing and picky eating habits.

Likely Culprit: GERD (gastroesophageal reflux disease), caused by a weak or immature band of muscle between the esophagus and stomach that allows acid flow to back up. Sometimes the irritating juices can enter the lungs, causing a chronic cough.

What to Do: See your pediatrician if your child's wheezy cough lasts longer than two weeks. He may recommend keeping your baby upright for at least 30 minutes after feedings and elevating the head of her mattress while she sleeps. Prescription medicine can also control GERD symptoms.

Cough Clues: A persistent cough that's often whistling or wheezy, lasts longer than ten days, and worsens at night or after your child exercises or is exposed to pollen, cold air, animal dander, dust mites, or smoke.

Other symptoms: Your child wheezes or has labored, rapid breathing.

Likely Culprit: ASTHMA, a chronic condition in which small airways in the lungs swell, narrow, become clogged with mucous and spasm, making breathing difficult. Common asthma triggers include environmental irritants, viral infections, and exercise. "Children with asthma, in essence, have sensitive lungs," says Dr. Widome.

What to Do: In mild asthma cases, a chronic cough may be the only symptom, Dr. Widome says. See your doctor for an accurate diagnosis. Mention any family history of allergy, asthma, or eczema, which can increase your child's likelihood of the disease.

Cough Clues: A mildly hoarse, throaty cough that comes in frequent spells that's either wet or dry.

Other Symptoms: Your child feels listless and complains that his throat is scratchy and sore, his head hurts, and the muscles in his back and legs ache. He may also have a runny nose, fever, and nausea.

Likely Culprit: FLU, a viral respiratory illness that's most common from November through April.

What to Do: Call your doctor if your child has a fever above 101.5°F, is throwing up, has diarrhea, or is uninterested in eating or drinking (your doctor will recommend steps to prevent dehydration). Give your child plenty of fluids, and use a humidifier to alleviate congestion in his airways. Also, to ward off future bouts of the flu, ask your pediatrician about getting your child an annual flu shot; experts recommend the vaccine particularly for babies six to twenty-three months, who are most susceptible to complications associated with the flu.

Cough Clues: A phlegmy or wheezy cough that's often accompanied by fast, shallow, or difficult breathing.

Other Symptoms: Your child starts out with cold symptoms, such as sneezing or a stuffy nose, that last about a week, and may develop a fever up to 103°F. He's lethargic and makes a wheezing sound when he exhales.

Likely Culprit: BRONCHIOLITIS, an infection of the tiny lower airways in the lungs called bronchioles. It's usually caused by respiratory syncytial virus (RSV) and most often occurs from late fall to early spring. Not to be confused with bronchitis (a frequent upper-respiratory infection in older kids and adults), bronchiolitis is common among babies and toddlers. "Almost all kids will get a bout of it by age three," says Susanna McColley, MD, division head of pulmonary medicine at Children's Memorial Hospital, in Chicago.

What to Do: Call your pediatrician right away if your little one seems to be struggling to breathe or is too irritable to eat or drink. Infants with bronchiolitis sometimes need to be hospitalized to receive oxygen treatment. If your child's symptoms are mild (a wheezy cough without breathing trouble), put a cool-mist humidifier in his room to help loosen mucus in his lungs, and make sure he drinks plenty of fluids.

Sandra Gordon is the mother of two and the co-author of Consumer Reports Best Baby Products. She writes frequently on health and nutrition topics for Parents, Ladies' Home Journal and Family Circle.
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