Cough in Babies And Children

Winter in the pediatrician’s office means cough: wet cough, dry cough, constant cough, barky cough, nighttime cough, and cough-so-hard–she-vomits cough. It rings out in the night and shakes your son or daughter’s body violently. So why does this happen, and when should you call or go see your doctor?

What is Cough?

Cough is a voluntary or involuntary expulsion of air and mucous from the airway. It is a crucial part of the body’s defense system. The airway, which includes the nasal passages, mouth, trachea, bronchi, bronchioles, and alveoli, is lined by cells with small hair-like appendages on them, called cilia. These cilia beat rhythmically, carrying mucous up and out of the airway on a continual basis to keep the area clean and moist, and to keep foreign material out of the body. The cilia can be damaged during a respiratory illness, and the body then uses coughing to move this mucous up and out. Even after the infection is gone, the body may produce a cough, as the cough sensors remain hypersensitive.

What are the Causes of Cough?

The most common cause of cough in children is an upper respiratory tract infection, caused by a virus. Other common causes include post-nasal dripping from allergies, asthma, bronchitis, which is typically from a virus as well, sinus infections, bronchiolitis (lower lung respiratory virus), or pneumonia (which can be viral or bacterial).

Less common causes include tuberculosis, an inhaled foreign body, gastrointestinal esophageal reflux, inhaled irritants like smoke, or even a habit or tic. Recently in California there has been a major increase in Pertussis cases. Pertussis is Whooping cough, and in our office, we have had many, many cases since December of this year. These cases are happening in vaccinated children and their parents, and because of the vaccine, the cough can seem mild, but lasts for weeks. It is especially dangerous in infants less than 3 months of age or unvaccinated individuals, so quick diagnosis and treatment with antibiotics is crucial.

Symptoms of Cough

The sound a cough makes can be quite varied, and may provide a clue to the diagnosis. Croup, for example, is caused by a virus that affects the vocal cord area of the trachea, causing a classic seal-like barky cough that worsens in the night. A throat-clearing quick persistent cough is likely from post-nasal drip due to allergies. A deep, wet cough is likely from the bronchi or below, and can be from either viruses or bacteria, as in pneumonia. Spasms of coughing, followed by vomiting may indicate whooping cough, or bronchospasm, which produces wheezing in the lower lungs. Wheezing may be a result of asthma, bronchiolitis, or a foreign body.

Cough from a classic upper respiratory tract infection occurs with the onset of symptoms, or up to 3 days after the initial symptoms. It can last for 7-14 days, but should progress from daily and nightly coughing, to mostly night and early morning coughing. It should definitely start to improve after 5-7 days.

Treatment of Cough

Children get 6 to 10 colds a year on average, and surely, as parents, you want to alleviate the discomfort associated with these colds, especially when accompanied by a cough. Unfortunately, there just aren’t many options.

Popular over-the-counter cold and cough remedies for infants have been withdrawn from the market after the FDA warned in January 2008 against giving those types of medicines to children younger than 2 because of the possibility of serious harm or death. In addition, studies show that even in adults, cough and cold treatments do very little to help symptoms.

In October 2008, the FDA recommended that these nonprescription cold medicines should not be given to children ages 2 to 4. These medications include antihistamines for runny noses, decongestants for stuffy noses, cough suppressants, and expectorants for loosening mucus to relieve congestion. It is the AAP recommendation that no cough medications be given to children under 6 years of age.

So what can you do to help?

• Fluids

First of all, make sure your child stays hydrated. For babies, stick to breast milk or formula for those younger than 6 months. An oral electrolyte solution designed for infants, such as Pedialyte, also can be given. Don’t give straight water to babies younger than 6 months as their kidneys can’t process it correctly and an electrolyte imbalance may occur. For children older than 12 months, try water, diluted juice, and milk. Don’t be afraid of milk…it doesn’t increase mucous, as many believe. Babies should have at least 5 wet diapers in a 24-hour period, and older children should continue to urinate regularly.

• Analgesics

If your child or baby has a fever with his or her cough, acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) may help alleviate the discomfort. And as you know, sore throats and headaches often accompany colds, which can be treated with these medicines as well.

For babies under 3 months of age, call your doctor first before giving any medication. For those 3-6 months of age, acetaminophen may be given, but make sure you have the proper dosage. After 6 months, try acetaminophen or ibuprofen. Check with the doctor for the right dosage. Read bottles and packages carefully to make sure you’re giving the right dose. Infant drops and children’s liquid fever reducers come in different strengths. Make sure you’re giving the correct amount.

Aspirin should not be used because of the risk of developing Reye’s syndrome, a serious illness that can damage the brain and liver.

If you have questions about fever, please refer to my article entitled Babies with Fever – How Worried Should I Be?

• Saline Drops and Humidifier

Saline nasal drops can help relieve congestion, especially in an infant’s small nasal passages. Because babies breathe through their noses and not their mouths, breaking up nasal congestion can make it easier to breathe, allowing a baby to nurse or drink from a bottle more comfortably.

Place a few of the salt water drops in each nostril, wait a minute, then use a blue bulb syringe or Nasal Frida to gently remove discharge. For infants, try this before feeding. If the aspirator is too upsetting to your infant, skip it and just use the saline.

Saline drops or spray also can relieve stuffy noses in older children. Have children wait a minute after using the spray before gently blowing their noses.

A cool-mist humidifier in the bedroom helps to keep the nasal passageways moist. Be sure to clean the humidifier frequently.

• Honey

Honey has been shown to be as effective at suppressing cough as dextromethorphan, the ingredient in many over-the-counter medications. It has soothing and anti-bacterial properties.
For infants and children 1-2 years old, give ½ teaspoon of honey. For children 2-5 years old, give them 1 teaspoon, and for those over 6, 2 teaspoons should help. Remember never to give honey to an infant under 1 year of age, as they are at increased risk of developing botulism if the honey contains spores. I like Zarbee’s brand for their honey cough syrups that add Zinc and some add Elderberry, which has been proven to fight off influenza virus.

• Positioning

Cough worsens when we lie down, so babies and children may feel more comfortable at night if they are propped up. Prop the bassinet or crib up at a 30-45 degree angle for babies. Sleep positioners are not recommended, and can increase your baby’s risk for Sudden Infant Death Syndrome (SIDS).

• Bronchodilators or Inhaled Steroids

Asthmatics will be prescribed medications to help dilate the lower lung airways, or help reduce inflammation in the lungs. Children without asthma may also be prescribed these medications if they are wheezing, as many of the lower respiratory viruses can cause wheezing even in children without asthma. These medications may occasionally help those babies and children, and may not. Your doctor may try it in the office to determine if it will help. If you suspect your child is wheezing, please call your doctor immediately.

When Should Your Infant or Child Be Seen?

Call 911 or go to the Emergency Room if:

• Your infant or child appears blue
• Your infant or child stops breathing for more than 15 seconds
• Your infant is lethargic and won’t feed
• Your child is breathing so hard he/she can’t talk in full sentences

Call the doctor or make an appointment if:

• Your child’s cough that lasts more than 10-14 days
• Your child has a cough accompanied by a fever, particularly if the cough has been ongoing. This could be pneumonia
• Your child is breathing fast, having shortness of breath, or some difficulty feeding
• Your baby is under 6 months of age and has a cough

Here’s to a safe and healthy fall and winter season. I hope that the dreaded cough doesn’t bring too many sleepless nights to your home, but if it does, you can help alleviate it with some of my tips.