Hi all! I hope you are doing well, ’cause there are lots of sick kiddos out there.  I have been so busy in the office, I haven’t had time for a post, so this one is going to be full of info for you.

So many kids are coughing!  I’m sure you are nodding your head in agreement right now.  What I’m noticing is a common goal: Most parents just want the cough to go away!  Well, of course they do, so I…. it’s the same in my house.  Drew Elizabeth has been coughing on and off for months; but, that’s life in Kindergarten.   Joshua coughs and sneezes and clears his throat every morning, which has got to be disturbing to him, it is to the rest of us.

With all of this coughing going on the real question is WHY IS MY CHILD COUGHING?? 

A cough is the body’s way to protect itself.  The real goal for parents and pediatric providers is to determine what is causing the cough? Is it post nasal drip, congestion from a cold, asthma, croup, pneumonia??   Figuring out what is causing the cough is the first step in figuring out how to treat the cough.  Treating a cough with a cough suppressant is not a good idea, the cough is there for a reason.

If your child has a cold (upper respiratory infection or URI), the congestion may be causing the cough.  URI symptoms are cough, congestion, runny nose (clear or yellowish), low-grade fevers (<102F), decreased appetite, disturbed sleep and overall they feel kind of miserable. The congestion from a cold usually runs down the throat, causing the body to cough.  Coughing is the body’s defense mechanism to keep the congestion from travelling down to the lungs.  Colds are caused by viruses, rhinovirus, adenovirus, etc.

Some viruses cause Croup.  Croup is caused by inflammation of the airway and vocal cords during a URI.  This causes a “barky” sound that is SCARY the first time you hear it. I freaked out the first time Josh had croup, at 2am my first thought was asthma attack because he looked like he couldn’t breath and his eyes were as big as eggs! He looked terrified, which terrified me!  If this happens to you in the middle of the night, do the tried and true steamy shower trick. As soon as you can, take a trip to the doctor for a dose of steroids and that cough won’t sound so scary.

Antibiotics will not get rid of a virus, antibiotics kill bacteria, not viruses.  Viruses typically last 7-10 days, with symptoms worsening over the first 3-5 days.   The best way to treat the cough is by trying to dry up the congestion.  I usually recommend an antihistamine or decongestant to help.  Check with your medical provider to see if this is proper treatment advice for your child.

Specific treatment options should be discussed with your primary care provider (PCP).  Children that do not start improving within a week should be evaluated for ear infections, pneumonia or other complications.  Children with symptoms that get bad quickly should be evaluated sooner.   Infants with lots of congestion and runny nose should also be evaluated sooner.  Babies are at higher risk for complications from viruses that older children and adults can easily fight off.

Pneumonia, a lower respiratory infection, can be a serious complication from ongoing cough and congestion. Children that have pneumonia will often present with symptoms other than cough, but not always.   These children will typically have little energy, and tire more easily when playing. Children with pneumonia will often have difficulty taking a deep breath, or doing so may be painful and will cause lots of coughing. These children are often compensating by doing lots of shallow breathing, and their breathing may be faster than usual.  Keep in mind fevers can also cause fast breathing and rapid heart rate. Children with pneumonia will often run a fever, but not always.  Another red flag with pneumonia is a cough that went away, or you thought it went away… The cough that is wet, thick and sounds bad, and then just disappears, may be a sign that there is fluid in the lungs that is inhibiting the child’s cough.  These children often look sick and have little energy, but again, not always.  If your child has a cough for more than a week that doesn’t get any better, but continues to linger, please have your child evaluated.  Children of all ages get pneumonia. I’ve treated just as many teens with pneumonia as younger children this winter.

Vaccinate against Pneumonia: You can help protect your children under the age of 5 years old with a vaccine.  Please check with your doctor to be sure that your child has had all of their pneumonia vaccines; this vaccine protects against 13 different organisms that cause pneumonia.  Children over the age of 2 years old with asthma or other chronic health conditions should consult with their doctor to see if they should have an additional pneumonia vaccine that is for people of all ages; this vaccine protects against 23 different causes.

Coughing can be a symptom of asthma.    Children with asthma will cough because of inflammation and secretions in the airway.  Children with asthma may not look like they are having difficulties breathing because they will breath more shallow to compensate.    Frequently, parents and children do not even realize this is happening.  I treated a little girl (8 yrs old) yesterday for asthma that was flaring because she has a cold.  The child’s symptoms were cough and congestion.  When I evaluated her, I discovered she was moving very little air in her lungs, but didn’t look bad at all.  Mom had not realize she needed her asthma treatments because her symptoms were so mild.  After giving her a nebulizer treatment in the office, she was able to move air in and out of her lungs more easily.   URI’s frequently cause children with asthma to have increased breathing problems.  Even if the child has not needed daily treatment in the past, they may while they have a URI.  Without a proper physical assessment, it is not possible to determine if a child is coughing because of asthma.  Please consult your provider to create an Asthma Care Plan for your child.  This plan should include treatment for mild, moderate, and severe asthma symptoms.  Asthma symptoms are often exacerbated by allergies, this should be addressed by your provider. Children cannot be diagnosed with asthma with one visit or one incidence of breathing difficulties.  Asthma is a diagnosis of chronic/ongoing incidence. 

If a child has allergies, they usually have a nighttime cough, but this cough goes away during the day.  These children will often cough, sneeze, and clear their throat for a while in the mornings.  Yes, this does sound like Joshua.  Zyrtec is often helpful for him, but at almost 10 years old, I let him chose if he is going to take it.  Recently, he has chosen no; so, the morning sneezing continues.  As April approaches  his allergy symptoms will get worse, and I will strongly encourage 😉 him to take his Zyrtec every night.  Joshua’s allergies are tricky to say the least, but that’s for another day.  If you think your child has allergies, check with your doctor to see if your child displays other silent allergy symptoms.  Allergy medication can be helpful, but you should always consult with your pediatric provider before starting a chronic medication.  I’ll talk about allergies in a future post, the season is not too far off.

I enjoy sharing my advice, and encourage you to consult with your pediatric care provider about all of your child’s healthcare needs and concerns.  Think of your Doc, PA, or NP as your partner in parenting and caring for your child. That is what I hope I am for all the families that I work with.  The journey is a challenging one, the more we stick together, the better parents we can be!

I hope you enjoy the journey, even with the coughs and runny noses! 😉