Coughing in Children
Every parent experiences coughing in children — it can last for just a short time or persist for weeks. As parents, how worried should we be when our child starts coughing?
As a reflex that helps clear the airway of secretions and protect it from foreign bodies, coughing is a physical reaction used by the body to maintain unobstructed breathing. In this sense we can see this as a benefit, such as when a small child gets a peanut lodged in an airway and uses this protective reflex to expel it. On the other hand, coughing can also be symptomatic of a viral or bacterial respiratory infection.
Coughing is one of the most common complaints for which parents bring their children to a healthcare practitioner. It could be because of an upper or lower respiratory infection, or it could be due to exposure to irritants. The causes differ widely, with symptoms being acute (less than four weeks) or chronic (for a longer period). For an acute cough, the most common cause is a viral upper respiratory tract infection, whereas conditions such as asthma or gastro-esophageal reflux disorder (GERD) most commonly cause chronic coughing.
Common Causes – Coughing in Children
In most common cases of coughing in children, a post respiratory tract infection is a type of viral infection that causes a cough. The child gets a viral infection, with cold symptoms and a cough, or even a low grade fever—but because it’s viral, antibiotics won’t help. While the other symptoms may fade after five–seven days, the virus can induce a respiratory tract infection making the cough last up to three or four weeks.
After having a viral respiratory infection, otherwise healthy children can have a cough lasting for weeks. This is called post-viral cough, and again, antibiotics are usually no help.
Bronchiolitis, another common viral infection in children, is initially similar to an upper respiratory tract infection with cough and a runny or blocked nose. The difference is that after a few days the child will experience wheezing and difficulty breathing. Fever is often present, and the baby or child may not eat properly and become lethargic. Feeding less than 50% of their normal amount is a sign that treatment by a pediatrician is required. Again antibiotics should not be used in this case, as the infection is viral, unless there is evidence of bacterial co-infection.
Croup, another viral infection, is characterized by a harsh, barking cough usually seen in children less than five years of age. Unlike bronchiolitis or asthma, croup affects the upper airway, not the lower airway. Croup begins with symptoms of a cough and causes swelling or partial blockage of the voice box (the larynx), resulting in a hoarse voice or noise when the child breathes in—a symptom called stridor. Stridor is usually worse at night, and croup usually lasts anywhere from three days to a week, while the cough can persist for several weeks.
Pneumonia often causes coughing in children of all ages, and this infection of the lungs can be due to viral, bacterial or (rarely) fungal infections. This illness presents with fever and coughing with phlegm, as well as breathing that is fast and labored such as nasal flaring and chest retraction. Chest retraction results from the effort to increase intrathoracic pressure to compensate for decreased compliance. This is a sign that parents should take the child to a hospital immediately. A chest X-ray will be used to diagnose pneumonia, and here treatment would include antibiotics if bacteria is likely the origin of the infection. Most children can be managed at home with an oral antibiotic and will improve within two or three days, taking up to 10 days to recover.
Whooping cough is an acute bacterial infection that affects children of all ages. It usually starts with cold-like symptoms, but after a week the cough can be paroxysmal or comes in spells, and is often followed by vomiting. Whooping cough is a serious disease, especially in young babies. In infants less than six months the cough can cause them to go very red and then blue in the face, and even stop breathing. If a woman becomes pregnant she should consider receiving the vaccination for whooping cough—because the baby cannot receive the first vaccination for whooping cough until six weeks of age, and before that time is most vulnerable and at risk of developing severe complications including meningitis, pneumonia or brain inflammation resulting in hospitalization.
Causes of chronic coughing in children include tuberculosis, a serious bacterial infection that requires immediate treatment. Allergic rhinitis, or hay fever, as well as cystic fibrosis also cause chronic coughing, as can foreign bodies stuck in the lower airway. These embedded foreign bodies are sometimes the reason for repeated pneumonia in children. If they go through an antibiotic treatment and after recovery see a recurrence, a CT scan or X-ray may show that there is a foreign body in them. It’s generally not something swallowed, however—it’s usually breathed in.
Asthma is a pervasive source of chronic coughing. Asthmatic symptoms are similar to bronchiolitis, however asthma is more typically diagnosed in children who are two years old or older. Asthma normally appears with wheezing and tightness of the chest. As asthma becomes worse, it causes rapid breathing—and the child may work harder to breathe with sucking in noticeable at the neck and the base of the ribs. Asthma can be triggered by many things, among them exposure to allergens or physical activity. The typical treatment for asthma is Ventolin, a medicine used to open up the airways. If the child has asthma symptoms between attacks they will need a preventer inhaler.
In other circumstances where a cough is more prolonged and infection seems unlikely, other causes may be sought. For example, in infants a structural problem may be causing the cough. Toddlers may have swallowed an object. Older children may be suffering from allergies, or they may have a habitual cough, one that disappears when sleeping but continues while awake despite normal activity and alertness, without being accompanied by other symptoms. Habitual coughing occurs following coughing due to a respiratory infection—by which time the coughing should have subsided—becoming something of a tic.
How should we treat cough? In the case of the most common cause among children—an upper respiratory tract infection (e.g. colds)—children can be infected anywhere from six to 12 times annually. These can produce up to four weeks of coughing, meaning affected children will be coughing many times in a year, especially in the first year of school when the child is exposed to many contagions. Parents often worry that the child has an immune deficiency due to repeated infections or persistent coughing—but in fact, it’s quite normal.
Best Treatment – Coughing in Children
The best treatment is to provide adequate fluids, rest and paracetamol or ibuprofen. Outside of severe or extenuating circumstances, there’s no reason to see a doctor. Keep the child calm and rested, keep them hydrated and keep them in a sanitary environment, these are the best ways to treat a cough. Honey may be helpful, but only for children over 12 months of age because it can cause botulism. However, honey is just a symptomatic treatment used to soothe the coughing.
Coughs don’t require antibiotics, as most respiratory tract infections are viral and not bacterial—however this distresses many parents. If they bring their child to a pediatrician, the expectation is they will receive medication—and when they don’t, they may feel as though the doctor is ill-informed or inattentive and seek a new physician. Unfortunately this pressure is why some doctors prescribe antihistamines, because they reduce a runny nose in the short term, which reduces coughing a little bit and satisfies parents. Longer term use, however, can worsen the situation.
Over-the-counter cough medicines should not be used as they are of no proven benefit and may actually be harmful to children under six years of age. A prudent pediatrician after diagnosing a viral respiratory infection will recommend rest, fluids and Tylenol or ibuprofen if the child has a fever.
Obviously there are times where a thorough physical examination by a doctor is necessary, such as exhibiting symptoms like labored breathing or a prolonged high fever. If the cause of the cough is bacterial, after three to five days with no antibiotics, the condition may worsen—but 90% to 95% of the time it’s a viral infection that does not require medication. The child will be fine in two or three days even if the cough lasts a few weeks. Therefore parents should be counseled by their pediatrician about detecting the warning signs and under what circumstances they need to see a doctor. Do remember that the overwhelming majority of the time, fluids and rest are all that are required.
Dr. Nguyen Huu Linh
Dr. Linh’s pathway to medicine was sealed at the age of eight, when a talented pediatrician gave him expert care during a child illness—prompting him to tell his mother that he’d already decided what he wanted to be. By 1993, the gifted student had graduated from the prestigious Hue Medical University, undertaking postgraduate studies and his pediatric residency at the same institution. This led him to a position at Hue Central Hospital, one of the three largest hospitals in Vietnam, working there for 11 years before moving to Saigon. There, he took up a position at FV hospital, where he practiced until joining FMP in late 2018.
Dr. Linh also undertook professional training at an international level while studying general pediatric practice in France as well as courses in hemato-oncology in both South Carolina and Tennessee in the United States. The studies gave him a far broader depth of experience in treating a range of pediatric illnesses, as child oncology patients are immunocompromised and thus highly susceptible to multiple distinct pediatric conditions, which require complex and dedicated treatments. Dr. Linh’s experiences led him to an appreciation of medical coordination between multiple departments in the course of pediatric care, skills he has applied during his practice here in Vietnam. He is also a longstanding member of the Ho Chi Minh City Pediatric Association.
With his extensive medical background in pediatrics, Dr. Linh brings unique experience to the Family Medical Practice team and a comprehensive approach to the care of both foreign and domestic child patients. During his consultations, he takes particular care in cooperation, communication and education of parents to ensure a better treatment environment for children in medical need. Family Medical Practice’s active and challenging work environment has brought Dr. Linh to a satisfying new turn in his career at a time when his adult children are taking on their own university studies, giving him time to focus on his medical practice and his own personal passion—tennis.
For a complete guide to Family Medical Practice’s services throughout Vietnam see https://www.vietnammedicalpractice.com