A reflex that forces air from the lungs with a sudden noise. It is a symptom for a wide
group of diseases.
- The main concern is in watching for signs of difficult breathing:
difficulty breathing is noted when a child is breathing a little faster than usual,
but is able to eat and talk normally. Babies are able to take a bottle or nurse
comfortably and are able to smile and coo. The stomach muscles may be moving in and out
very slightly when the child breathes. This visible movement of extra muscles to breathe
is called retractions. Places to look for retractions include the muscles in the
neck, the muscles in between or below the ribs and the stomach muscles.
Moderate difficulty breathing is noted when a child is
breathing with more effort than normal, has retractions of the muscles of the stomach and
possibly between the ribs. He may appear pale, but not blue. He will interact and talk in
short phrases, but maybe not in complete sentences and may play for brief periods. A baby
taking the bottle or nursing may need to pause more frequently, but is able to feed.
Severe difficulty breathing is noted when a child is struggling
to take each breath. Retractions are seen of the stomach muscles, the muscles between the
ribs and those above the collarbone. Audible grunting may be noted. He may need to sit up
and lean forward just to breathe. The child will appear agitated or frantic. The child
will not make good eye contact, interact and there is obvious difficulty getting a word
out. A baby may appear listless and is unable to suck a bottle or nurse effectively.
The tongue, lips and possibly nailbeds will appear blue. This is a real
emergency and it must be decided if it is quicker to take the child immediately to the
emergency room or call 911.
- Coughs may be dry and hacking or wet and productive. This does not really help to tell
you the cause of the cough.
- Coughs help protect the lungs and do not necessarily need to be suppressed with
- Coughs are usually the last symptom to resolve during the course of a cold and may last
up to 2 weeks.
- Coughs may cause a child to vomit immediately after a coughing episode.
Causes of cough can include:
- Cold viruses often causes a postnasal drip and that causes a cough. This is the
most common cause for a cough.
- Croup is characterized by a barking,
"seal-like" cough caused by a virus.
- Pneumonia, which is an infection in the lungs. It may be caused by viruses or
bacteria. There is also an unusual organism called mycoplasma, which causes the
classic "walking pneumonia". Children with pneumonia can barely appear sick with
low-grade fever and a mild cough or be very ill with high fevers and labored breathing.
- Asthma may cause coughing and wheezing. This may be
triggered by viruses, exercise or an allergic trigger like dust, smoke, mold or pets.
- Foreign body aspiration should be suspected if there is a history of a coughing
or choking episode with eating, especially with small hard foods like nuts or popcorn.
- Sinusitis may cause a cough especially at night or in the mornings. (See colds for information on sinusitis).
- "Spitting up" or gastroesophageal reflux in babies under a year may
trigger coughing because of small amounts of aspiration of food into the lungs. Wheezing or recurrent pneumonia may be associated with reflux.
- Pertussis or whooping cough is an infection that is characterized by a severe
cough where the child has difficulty catching his breath with the coughing episodes and
may turn blue with coughing.
- Bronchitis is a debated issue in pediatrics. Some researchers feel that children
dont really develop true bronchitis. The very deep cough, "bronchitis type
cough" is sometimes from a postnasal drip or may be due to pneumonia.
- Signs of severe or moderate difficulty breathing
- Breathing is fast and/or labored in between coughing episodes
- Appears agitated, gasping for breath
- Lips or tongue or nailbeds turn blue or purple with the coughing episodes
- Blood tinged secretions being coughed up
- Chest pain that is continuous
- Listless, lethargic or difficult to arouse or acting sick
- Suspicion of aspiration of a foreign body, household chemicals or powders
- Fever more than 48 hours
- Cough more than 2 weeks
- Coughing episodes associated with chest pain
- Less than 2 months old
- Coughing episodes that cause lack of sleep
- Coughing associated with significant vomiting
Medications. Coughs may be a helpful mechanism for the body to protect the
lungs, they do not necessarily need to be suppressed. If the cough interferes with a
childs sleep or school or work, a cough suppressant may be helpful. They
should not be used under one year of age without discussing with your physician.
Dextromethorphan (DM) is an over-the-counter medicine available in many of the cold
remedies. Codeine cough suppressants are available only by prescription and should not be
used without the approval from a physician. Cough drops are not recommended in young
children because of a choking risk.
Humidifiers. These are helpful, especially if a dry cough is present. If a child
is having a coughing spasm that is difficult to stop, a session in a steamy bathroom with
the shower running may be helpful. Humidifiers must be kept clean and if possible,
distilled water is recommended. Cool mist humidifiers are safer than steam vaporizers
because of the risk of a curious toddler burning himself with the steam.
Diet. Milk does not need to be eliminated with a cough or cold, unless milk
allergy is suspected. Fluids do need to be encouraged, solid foods are not as important.
Make sure the child is staying well-hydrated (see dehydration).