Coughing is one of the most common symptoms that presents to general practitioners. Although coughing is a normal reflex to maintain lung health, coughing is often disturbing to the child and the parents and should never just be dismissed as nothing serious. While an occasional cough is normal, a cough that persists may be a sign of a medical problem.
Types of coughs: Wet versus dry cough
- Wet cough: A cough that produces phlegm is known as a wet cough or productive cough. Coughing up mucus from the airway makes the cough sound “wet,” as mucus shifts in the airway.
- Dry or unproductive cough: Also known as a hacking cough, this cough has a consistent tone because it is free from the sound of mucus. It is caused by irritation and inflammation of the airway.
Acute and chronic causes of coughing
A cough is considered “acute” if it lasts less than two weeks. It is considered “chronic” if it lasts longer than four weeks in children.
Acute
- Croup is a viral illness that causes inflammation in the larynx (voice box) and the trachea (windpipe), may cause a barking cough and a noisy, harsh breathing, often described as a coarse, musical sound (stridor) when a child inhale. After a few days, the cough becomes wet. Croup can be mild or severe and it is important to seek the help of your nearest healthcare facility.
- Whooping cough or pertussis is a very contagious infection of the respiratory system. One of the childhood vaccines that kids receive in infancy is the pertussis vaccine which protects against whooping cough. Kids with pertussis have spells of back-to-back coughs with or without vomiting and these spells can last for months. At the end of the coughing, they’ll take a deep breath in that makes a “whooping” sound.
- A foreign object in the respiratory passages does not only lead to acute symptoms but can also lead to severe airway damage. Children may have coughing episodes with other respiratory noises such as wheezing. This may occur after an episode of choking, but sometimes the choking episode might not be noticed. If you suspect your child has inhaled a foreign object, seek immediate medical care.
Chronic
- Gastro-oesophagal reflux disease (GERD), or reflux is common in infants, obese children, and children with neurological disease. These children’s cough varies from a dry to wet cough and could be associated with wheezing that is not responding to bronchodilators. It is thought that more than 25% of chronic coughs are caused by GERD.
- Congenital airway disorders are airway disorders that occur during the development process in the foetus e.g., “Floppy airways” or Tracheomalacia, which presents with a cough that is dry and barking in nature.
- Coughing in asthmatics can be worse during respiratory tract infections, during exercise and when the asthma is not well controlled.
- Chronic non-specific coughing in childhood is common and is usually dry, intermittent and worse at night. This cough causes a lot of distress in families and leads to night-time waking. This cough usually last for about two weeks after a viral chest infection but it can last up to eight weeks.
- Suppurative lung disease is characterised by a chronic wet cough and should be managed by a paediatric respiratory specialist.
When should I seek the help of a doctor?
A cough by itself is not very worrisome, but if it is accompanied by other symptoms of illness, it can help you identify when it’s time to call your doctor. Seek help if your child has…
- an acute cough that influences the child’s breathing (e.g. fast breathing), feeding (e.g. vomiting or just poor feeding) and sleeping pattern (e.g. lack of sleeping, sleepy)
- a deep cough from the chest, bringing up thicker yellow or green mucus. This is a sign of a possible bacterial infection like pneumonia
- any cough that is associated with respiratory noises like wheezing, stridor or a heavy snoring sound, sometimes due to obstruction of the larynx or upper airways (stertor).
- a chronic cough lasting more than two weeks
- any chronic lung or heart disease that is worsened by a cough
- a cough associated with other physical signs such as fever, weight loss, failure to grow or develop, persistent vomiting or recurrent chest infections.
