Dr. Victor Miranda

Paediatrician

The child with a cough

HPA Magazine 17

Coughing is an important and useful physiological reflex mechanism for clearing the airways and it also serves to protect them from accidental inhalations. In many situations, it is a symptom of a disease, which is why it is a frequent reason for parents' concern and for a Paediatric Consultation.
We can classify cough into dry cough when it does not have associated mucus, or productive when it has mucus. The intensity and daily pattern are also variable.
There are several possible causes for coughing in children.
It could be viral (the most frequent, such as nasopharyngitis and acute bronchiolitis) or a bacterial infection, foreign object inhalation, recurrent wheezing, asthma and other respiratory illnesses.

There are some of the signs that parents should be aware of, that require medical attention: 
• Persistent cough in very young children (under 6 months)
• Cough that induces vomiting or significantly interferes with sleep
• Signs of difficulty breathing (chest retraction, wheezing, quicker breathing) or very noisy breathing
• Cough with blood or yellowish/greenish sputum
• Persistent cough after a choking episode
• Difficulty in ingesting solid or liquid food
• Persistent fever or other associated symptoms that are a cause for concern
• Cough with 2 weeks or more of evolution and without improvement after treatment. 
Determining the cause of a cough is fundamental, for the correct treatment to be instituted. This is obtained mainly by obtaining a detailed clinical history, examining the child and with complementary diagnostic tests, when necessary.
Among the general measures to try improve a cough is reinforcing the child's hydration and creating a humid atmosphere in the bathroom or with a nebulizer device with saline solution.
One of the most frequent causes of a cough in children is nasopharyngitis ("colds", of viral origin). This type of cough, has a pattern that worsens at night due to posterior nasal secretions (which, when lying down, flows into the region of the throat) stimulating the cough. In this particular case, proper nasal hygiene is essential for improvement.
Laryngeal cough is a raspy, rough and dry cough associated with inflammation of the larynx. Sometimes associated with fever and hoarseness. Breathing cooler air, making the atmosphere humid and anti-inflammatory drugs can help improve the situation. 
 

Bronchiolitis are infections of the bronchioles (the smallest and most distal part of the bronchial tree), which causes these pathways to narrow and mucus to be produced. The main infectious agent is the Respiratory Syncytial Virus. This results in breathing difficulty with rapid breathing, wheezing (“wheezing”), chest retraction (retractions under the rib cage/between the ribs/above the breastbone) and coughing. Depending on age, various therapeutic options can be used, with the most serious cases justifying hospital admission to provide oxygen supplementation and reduce respiratory effort.
Asthma is a frequent cause of coughing during school going age and adolescence. It is an inflammatory disease of the airways that can have several triggering factors (allergens, exercise, tobacco smoke, etc.).  Its symptoms are difficulty breathing, faster/superficial breathing and wheezing. Treatment can be divided into crisis medication and control/prevention medication.
As previously discussed, the effective treatment will always depend on the child's age and the cause of the cough, which may include simple measures such as the aforementioned nasal hygiene, to anti-inflammatory drugs, bronchodilators, antihistamines, antibiotics, decongestants, among others.
Continued use of expectorant cough mixture or cough suppressants is not recommended, only with medical advice. The expectorants make the secretions more fluid and this can even end up increasing the cough initially, and cough suppressants eliminate the cough reflex without treating its cause.
In certain cases, respiratory physiotherapy (“kinesiotherapy”) may be necessary to help clear accumulated secretions.
As cough is a symptom common to several conditions and diseases, a well-documented clinical history and examination of the child are necessary in order to obtain a correct approach and treatment.