Nurture Article | The Portland Hospital Parenting Magazine
Autumn Issue 2012 | Sophie Goodchild
There are many different types of coughs – tickly coughs, chesty coughs, wheezy coughs, dry coughs, wet coughs and persistent coughs.
But when is your child’s cough just the symptom of a mild virus and when is it something that needs specialist treatment?
Decoding the difference can be difficult, especially if you are a first-time parent.
The reassuring fact is that all young children develop coughs and colds (normally between eight and 12 a year in the first two years of life) and the majority don’t have a serious underlying cause.
Dr Ranjan Suri, a Respiratory Specialist at the Portland Hospital, says the vast majority of children with acute coughs have a respiratory tract infection, and in most cases this is caused by a virus and needs no treatment.
“However, a bacterial infection may require a course of antibiotics,” he adds.
“Coughing in children can be distressing and can have a major impact on a child’s sleep, school performance and ability to play.”
Paracetamol can help if your child has a temperature or other cold-related symptoms.
However, it should only be given if your child has a persistent fever, says Dr Murtuza Khan, Consultant in Paediatric Respiratory Medicine also at the Portland Hospital.
“In the majority of instances, I would not recommend giving paracetamol in the first couple of days of a cough – or at least only at night-time,” he explains.
“A fever is the body’s way of fighting off an infection. Giving analgesic can also falsely reassure parents that a child no longer has a fever when in fact they need medical attention.
“A cough which lasts a week or two, which is associated with an upper respiratory tract infection and maybe vomiting once as a day as a result of the cough, is quite normal.”
Some health advice talks about different sounding coughs, such as ‘barky’ or ‘wheezy’ coughs.
However, trying to decode different cough sounds can be confusing for parents.
Instead, it’s best just to stick to establishing if the cough is ‘wet’ or ‘dry’, says Dr Warren Lenney, Honorary Medical Advisor at the British Lung Foundation.
“If it is a dry and tickly cough in the throat, then it is less likely to be a problem,” he says.
“If it is a wet cough from the lungs, with lots of gunk, then it may be a sign of illness.”
Parents should ask themselves how long the cough has been going on, and if it is interfering with sleep and feeding. Three to four days is a useful guideline for seeing a doctor.
Dr Lenney adds: “The need to see a specialist depends on additional symptoms beyond a persistent cough. If the child has lost a lot of weight, for example, then a parent could seek further medical advice for their child. X-rays can show abnormalities that might require more specialist attention.”
Antibiotics are generally not effective, or recommended, for treating acute coughs triggered by simple head colds.
Instead, GPs should only prescribe them if a bacterial infection is to blame.
Dr Suri says: “There’s evidence of increased parental satisfaction if a child receives an early antibiotic prescription for coughing with head colds.
“But systematic review of the evidence shows that antibiotics are not beneficial and may be associated with side-effects.”
His view is supported by a study of 305 children with coughs caused by a common cold, presented earlier this year at the annual meeting of the American College of Chest Physicians, which revealed those given only antibiotics recovered no quicker than the children given nothing at all.
Children can also develop habitual coughs, which start with a viral infection and then become a habit.
“Habitual coughs which last six or eight weeks should be seen by a specialist to make sure there is not an underlying cause,” explains Dr Khan.
“However, in most cases they are simply a learnt behavior and the best way to deal with them is distract the child when they start coughing and not pay attention to the cough. By doing this, normally a child stops coughing within days.”
There is a checklist (listed below) which parents can use to identify a more serious cough. For example, if a child has a persistent fever or fast or shallow breathing then a trip to a hospital specialist could be necessary.
Most coughs will resolve themselves within 14 days but a minority can take three to four weeks to disappear.
A ‘persistent’ cough is roughly defined as one lasting eight weeks and this should be looked at by a specialist because it could indicate cystic fibrosis, TB, asthma, immune deficiencies or severe bronchitis.
And a cough in the first four weeks of life should always be looked at to ensure it is benign and not something more serious.
COUGH WARNING SIGNS:
* Onset of cough within the first few weeks of life
* Cough without feeding
* A cough lasting for 8 weeks
* A cough getting worse by the third week
* Associated difficulty in breathing or laboured breathing
* Night sweats, weight loss, coughing up blood
If you are unsure as to whether your child's cough is serious then do visit your GP or healthcare professional for more advice.