Cough

Introduction

Cough is an essential way in which the lungs expel unwanted material. It is a protection for the more fragile areas of the lungs. Unfortunately sometimes the cough is ineffective and annoying. There is little role for cough medicines in children. Though they are marketed very well. The most common cause of cough is a simple viral bronchitis. The word bronchits means inflammation of the large airways. There is generallly little role for antibiotics in the management of bronchitis. A cough itself is rarely serious with the exception of whooping cough. Coughs are generally described as moist, ‘chesty’, dry, barking, or wheezy. The severity, nature and intensity of a cough will often concern parents and is one of the most common reasons for going to the doctor with your child.

When is a cough serious ?

Doctors are generally not concerned too much about the nature or frequency of a cough if the infant or child looks well. In assessing a cough, the concern is whether it comes from the upper airways, such as the throat and windpipe, or the lower airways, which include the small air passages in the lungs. This can generally be determined by history and examination. A cough may indicate a serious problem if

The infant or child appears unwell
There is trouble breathing
The cough maybe caused by pertussis (whooping cough)
The cough has been productive and moist for 4 weeks or more.

Many parents are concerned about pneumonia or ‘chest infection’. They feel that a moist phlegmy cough is a sign of this. If a child has pneumonia the lungs will be involved and the child will be unwell, with high fevers, lethargy, and trouble breathing. Most phlegmy coughs are part and parcel of upper respiratory tract infections which do not require intervention such as antibiotics. Unfortunately antibiotics are often over prescribed for coughs and colds.

What do the types of cough mean ?

A moist or chesty cough will indicate the airways are trying to expel moist phlegm. Usually this will come from the upper airways. This is the most common cough and will occur particularly during the night when a child or infant is lieing down. Sometimes these coughing episodes result in vomiting.

A wheezy cough will be seen with viral illnesses that cause wheezing, or in those children who have asthma

A barking or seal like cough is seen in croup

A cough that is persistent and there are prolonged fits with 10 to 20 repeated coughs, without any breaths between is called ‘paroxysmal’ and sometimes can indicate whooping cough.

Treatment of coughs

This depends on the cause. Most coughs are due to viruses and there is no real evidence that cough mixtures or remedies have any affect. At night simply sitting the child upright and drinking something will ‘reorganise’ the upper airways and may enable some relief. For wheezy coughs in infants see the section on bronchiolitis. For toddlers see the section on wheeze. A barking cough will be due to croup. Parents will find cough very frustrating, as do doctors who feel helpless at times when clearly the only cure is time. Some parents use vaporisers, though there is no evidence these help.

Should you have any further questions please contact us

-Dr Scott Parsons