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KIDS' COUGHS - THE COMMON CULPRITS

A nasty cough is a horrible thing to watch your child struggle with, but it’s also one of the most common symptoms children have. Coughs are seen in more than half of all doctors’ appointments.1 Nearly all respiratory problems, as well as a huge range of environmental factors, can trigger a cough.2,3

Working out what’s causing your child’s cough can therefore feel both complicated and stressful.

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Everyday triggers

Many childhood coughs may be triggered by environmental factors, with the number-one cause being environmental tobacco smoke (ETS).3  ETS can cause cough itself but may also increase the likelihood of respiratory infections and worsen existing problems.3 As a rule, any child with a persistent cough should not be exposed to second-hand smoke.

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Minor ailments

It is useful to distinguish between a non-specific cough and a specific cough.

A non-specific cough is a dry cough with no signs that your child is finding it harder to breathe.3 This type of cough may have a range of causes, but none are considered serious. A non-specific cough is likely to mean that your child is recovering from an infection rather than developing one.3

A specific cough is linked to a defined, treatable condition of which acute respiratory infections (ARIs) are the most common cause in childhood.3 Children are likely to pick up six to eight of these infections each year and some of the underlying conditions, such as the common cold, sinusitis or pharyngitis (sore throat), may be relatively minor.3,4 As some ARIs are viral, the treatment required may only include rest and taking fluids, leading to natural recovery within two or three weeks.5,6

Viral infections can sometimes make a child more prone to subsequent bacterial infections.7 As a viral infection progresses it can become easier for bacteria to infect mucous surfaces, entering and growing in tissues.8 This weakens the body’s defence mechanisms, causing damage and leading to disease.8 

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Cause for concern?

In some cases, infections may be more severe: either lasting longer than three weeks or causing more serious symptoms. You should ask about treatment if your child is at elevated risk of chronic lung disease or if you notice any of the following:5     

  • weight loss     
  • coughing up blood     
  • high fever     
  • crackling chest     
  • night sweats     
  • worsening of cough over time     
  • unusually rapid breathing     
  • sudden cough and/or after a choking episode

Vomiting and a cough together may also be an indicator of gastroesophageal reflux disease (GORD), a condition of the airways and digestive tract which affects up to one in five children.9 GORD and its related form, laryngopharyngeal reflux disease (LPRD), have been associated with other conditions such as asthma, rhinitis and narrowing of the throat.9  

Amongst the more serious infections seen in children, there are several which are particularly important to look out for.5 The first is whooping cough (or pertussis), named after the characteristic ‘whoop’ noise caused by a rapid intake of breath after a coughing fit. Younger children may also vomit after a particularly intense spell of coughing.5 Early cases of whooping cough (after one to two weeks of illness) can benefit from antibiotics so if you think this might be causing your child’s cough, speak to your doctor as soon as possible.10

Next up is croup, a viral condition which affects up to 15% of children.4 With this condition, the airways become inflamed and swollen, leading to a dry barking cough and stridor (a whistling sound as your child breathes in and out).4,5 Most children with croup have only minor breathing difficulties, but it is possible for these to worsen rapidly so it’s worth making your doctor aware.4

Finally, pneumonia, which is characterised by rapid breathing alongside possible breathing difficulties and fever.5 As pneumonia can, in general, be either viral or bacterial, suspected cases will usually be treated with antibiotics so you should make a doctor’s appointment to see if this is necessary.11

An unexplained cough can be stressful for both you and your child, but a little time, careful observation and the right support where needed can make all the difference. Understanding the different types of coughs can help you to make the right decisions about care.

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What can I do to ease a cough?

Various over-the-counter (OTC) medications may be used to help alleviate a cough.

References
  1.  Morice AH. Epidemiology of cough. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003; Chapter 2:11-16.
  2. Chung KF. The clinical and pathophysiological challenge of cough. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003; Chapter 1:3-10.
  3. Chang A. Causes, assessment and measurement of cough in children. In: Chung KF et al. Cough: Causes, mechanisms and therapy 2003;Chapter 7:57-73.
  4. Innes Asher M and Grant CC. Infections of the upper respiratory tract. In: Max Taussig L and Landau LI. Pediatric respiratory medicine 2012;Chapter 32:453-480.
  5. Kantar A et al. Cough. In: Eber E and Midulla F. ERS handbook of paediatric respiratory medicine 2013; 44-49.
  6. NHS choices. What can cause a cough? Available at: https://www.nhs.uk/conditions/cough/. Last accessed 2017.
  7. Peltola VT and McMullers JA. Respiratory viruses predisposing to bacterial infections: Role of neuraminidase. Pediatr Infect Dis J 2004; 23:S87-97.
  8. Smith H and Sweet C. Cooperation between viral and bacterial pathogens in causing human respiratory disease. In: Brogden KA and Guthmiller JM. Polymicrobial diseases 2002; Chapter 11:201-212.
  9. Venkatesan NN et al. Laryngopharyngeal reflux disease in children. Pediatr Clin North Am 2013; 60:865-878.
  10. Alsubaie H et al. Clinical practice guidelines: Approach to cough in children. Int J Ped Adol Med 2015; 2:38-43.
  11. Domachowske JB. Pneumonia. In: Perkin RM et al. Pediatric hospital medicine: Textbook of inpatient management 2008; Chapter 77:433-436.