Cough in Children

Understanding the Differences between Benign Cough and One that needs Attention

Cough in children is not only a serious health hazard for the children affected, it often generates a lot of anxiety among the parents too. Most of it consists of benign episodes, which would go away on their own, but it is difficult to take that chance. Better awareness can help in understanding how to deal with it.

A coughing child is bound to make the parents anxious, and yet, it is not practically feasible to run to the paediatrician every time the child coughs. The inability to differentiate between a benign occasional bout of cough that is nothing more than an indication of ‘yet to mature’ reflexes of your darling child and the dangerous cough that signals a sickness, often causes as much anxiety as any disease itself; so it is always worthwhile to know a few things about a coughing child.

Cough that May not be a Result of Sickness

Cough can occur in normal children without any sickness. It may not always be possible to confirm a benign cough, but certain characteristics may suggest that it is not worth panicking.

(i) Single Bout of Cough – Sometimes a child can have a single bout of cough which does not recur again during the day. Such cough is usually due to swallowing, and is unlikely to be of any real significance, unless it is very severe or the bout is prolonged.

(ii) Cough Immediately After Feeding – Immediately after feeding, if the child has a mild bout or two of cough, it is likely to be due to regurgitation of milk from stomach. It will often be associated with vomiting of milk, and does not denote any sickness. However, it should be differentiated from severe recurrent cough which may also sometimes cause vomiting – it is usually because of some sickness and requires attention.

(iii) Honking Cough in Older Children – Sometimes older children develop a habitual cough that is more a behavior than a reflex. It may have a ‘honking’ quality, or can be just frequent clearing of throat. It usually disappears with time.

(iv) Post Infectious Dry Cough – After a prolonged viral illness like Influenza, sometimes a severe and dry cough persists for a few days or even a couple of weeks. Its cause is not fully understood, but it is often self-limited, though it can create severe anxiety in parents. Usually it is too perturbing not to seek a consultation.

Cough That Needs Attention

Most of the times, one should not take a chance and consult a physician or a paediatrician. In certain cases, seeking attention of an expert should be resorted to as matter of priority.

(i)  Productive Cough with Fever- In PNEUMONIA, the cough usually begins with dry coughing, but soon becomes productive. Usually there is fever, and the child appears sick and restless. This is a sure indication of urgent consultation. Any delay should be avoided.

(ii) Cough with Change of Voice or Pain in Swallowing -  Change in voice quality usually results from infection and inflammation of the wind-pipe or Larynx. Pain in swallowing usually results from Acute Pharyngitis or infection and inflammation of pharynx. Both of these conditions indicate infection of upper respiratory tract and require immediate treatment with antibiotics.

(iii) Productive Cough with Nose Block -  Productive cough with yellow or green colour expectoration with frequent nose blocks on lying down is a typical sign of SINUSITIS or infections of nasal sinuses. There may be mild fever and headache.

(iii) Whooping Cough - Severe cough associated with a 'whooping sound' is a characteristic feature of Pertussis or Whooping cough. It is a bacterial infection that can be treated with antibiotics.

(iv) Dry Cough with Running Nose - Running nose is usually a result of allergic or infectious rhinitis that cause secretions that run down the nose into throat and cause cough. It often irritates the child in night. Treatment of running nose is required.

(v)  Cough in Asthmatic Child – Cough in a child earlier diagnosed as Asthma indicates the need to immediately begin treatment.  Consulting with her physician should be urgently done and treatment started, to avoid worsening of asthma.

(vi) Persisting Cough in Children – Any cough persisting for more than three weeks should be investigated in detail. It could be due to undiagnosed asthma, allergies or infections like Tuberculosis. 

(vii) Worsening Cough – Any cough that starts worsening should always be referred to the physician.

Deciding About What to Do Next

For first time parents, it can often be difficult to take a decision whether to consult or not. Knowing about the types of cough where immediate attention is preferable helps, but there is no substitute for experience which comes with time. Till then, it is always better not to take a chance and go for expert advice. Sometimes, it may be a right decision for the sake of reassurance and peace of mind. At other times, it can help in expedient control of infections or other diseases.