Kids' coughs: How to tell when it's serious

When Tess Duke woke up in the night with a barking cough and difficulty breathing, her mother, Jane, didn’t panic. A registered nurse, she recognized the “ark, ark, ark” cough of croup and tried to help her daughter with a bit of cold air and then some steam from the shower. But when the four-year-old started gasping and losing the colour in her face, Jane knew it was time to head to emergency.

Fortunately, most kids' coughs don’t warrant a midnight visit to the ER. “In the majority of cases, coughing is caused by an upper respiratory infection, otherwise known as the common cold,” says Norman Saunders, associate professor of paediatrics at the University of Toronto and co-editor of Caring for Kids: The Complete Canadian Guide to Children’s Health. So how do you know what’s trouble and what’s not? Listen up. The sound of your child’s cough —and when you hear it—can clue you in to what’s causing it.

Asthma

Sounds like a persistent, wheezy cough and shortness of breath that’s often worse at night, after exercise or exposure to cold air, smoke or dust mites.

Treat it with prescribed medication and avoiding identified asthma triggers. Diagnosed children can lead a fairly symptom-free life if they learn to control their asthma effectively, says Sheldon Spier, director of paediatric respiratory medicine at the University of Calgary. Always start the medication at the first cough or wheeze — the later asthma meds are taken, the longer it takes to stop the wheezing. Also, get kids to review proper puffer techniques with their doctor or pharmacist too, says Spier. For example, a spacer and a mask will help deliver the medication more effectively for younger children. Find out more at asthmaincanada.com.

Seek medical help if wheezing is severe, breathing is difficult or your child needs to use her asthma inhaler more than every four hours.

Bronchiolitis

Sounds like rapid breathing and wheezy exhalation. This kids' cough is caused by a viral infection. It sounds exactly like asthma and usually occurs from late fall to early spring in children under the age of one.

Treat it with lots of fluids, rest, and a cool-mist humidifier in your child’s room to help loosen mucus. Mild cases usually improve within a week.

Seek medical help if your child is having difficulty breathing. Some children will need oxygen, which requires hospitalization, or epinephrine to open up the airway.

Sinusitis

Sounds like hacking and coughing that occurs whenever your child lies down. The cough is caused by mucus dripping from the nose and sinuses to the back of the throat, and may be accompanied by green nasal discharge.

Treat it with plenty of fluids and a vaporizer in your child’s bedroom to help relieve her stuffy nose. Use warm water or saline nose drops to wash out dried mucus. Avoid medicated nose drops or sprays, however (see Do’s and Don’ts for Coughs and Colds).

Seek medical help if your child has a fever, chills or continuing cough and thick green discharge that lasts 10 or more days. Sinusitis is bacterial and requires antibiotics to treat it.

Common cold

Sounds like a wet, phlegmy cough that is often accompanied by fever. Most children come down with at least six to 10 colds a year.

Treat it with saline nose drops only, for a child who’s under six months of age, as over-the-counter products may have undesirable side effects. “Benadryl, for example, usually makes kids sleepy, but with babies it wires them,” says Ari Brown, a paediatrician in Austin, Texas, and author of Toddler 411: Clear Answers and Smart Advice for Your Toddler. Older kids can take ibuprofen or acetaminophen to relieve fever and accompanying aches. Warm broths are comforting, and a cool-mist humidifier will help loosen mucus.

Seek medical help if the cough or fever hasn’t improved after five days, other symptoms last longer than 10 days, or new symptoms such as a middle-ear infection develop (signs of the latter include earache, vomiting and high fever). See a doctor immediately if your baby under three months has difficulty breathing or a fever over 39°C (102°F), refuses feedings, or is vomiting or otherwise very sick. Babies from three to 12 months with the same symptoms should be seen within 24 hours.

Croup

Sounds like a barky seal-like cough and hoarse speech. A high-pitched, gasping inhalation, called stridor, may occur too, if the airway becomes markedly swollen. Croup is most common in children under five years of age.

Treat it with warm, moist air to help relax the airway. Sit with your child in a steamy bathroom with the door closed for five or 10 minutes. Sometimes, a blast of cool night air does the trick too.

Seek medical help if your child’s cough becomes worse. Head to the ER if more severe symptoms arise, particularly a bluish tongue or lips, or stridor that goes on for more than 10 minutes. Steroid medications can reduce inflammation safely and quickly.

Habit cough

Sounds like a dry, brassy cough that typically starts after a respiratory illness, often in school-aged children. Although it’s often psychological — the habit may start or worsen due to stress — coughing can irritate the throat and perpetuate the cycle.

Treat it with throat lozenges for kids over age seven (plain-tasting so kids don’t start popping them like candy), which can help suppress the urge to cough. Identify situations that trigger the cough and try stress-reducing breathing techniques.

Seek medical help if the cough persists. Your doctor may refer your child to a psychologist for an assessment.

Whooping cough

Sounds like staccato-like coughing attacks followed by a whooping sound. Your child may turn red or even blue, before finally catching his breath, and may vomit afterwards. While infants and adults don’t usually whoop, they can stop breathing for up to 30 seconds. Children who haven’t been fully immunized are the most vulnerable to whooping cough, also known as pertussis. Since immunizations wane with age, it can be spread by adults who don’t realize they have it, warns Saunders.

Treat it with a cool-mist humidifier if your house is dry. It will help ease your child’s cough, which could continue on and off for months. Coughing is necessary to clear the airway of mucus, so avoid cough medications (see Do’s and Don’ts for Coughs and Colds).

Seek medical help if your child is under the age of two, as pertussis can be life-threatening. While the infection isn’t as serious in older children, they should still be examined by their doctor. Antibiotics, such as erythromycin, shorten the infectious period to five days, but don’t significantly reduce symptoms once coughing spasms have started. Other members of the household will need a preventive antibiotic or vaccine booster.

Tips to keep in mind

Do wash hands often to prevent the virus from spreading to the rest of your family and significantly reduce future colds.

Don't use over-the-counter cough medications. “A lot of kids are treated in emergency after overdosing on cough medicine, and there is no strong evidence they work,” says Norman Saunders, associate professor of paediatrics at the University of Toronto. In fact, a recent US study found that over a two-year period, more than 1,500 babies and toddlers were hospitalized due to bad reactions. Combining cough syrup and pain relievers could result in an overdose of a shared medicinal ingredient, such as acetaminophen.

Do disinfect humidifiers regularly and empty the water after each use to avoid unhealthy bacteria. Find more on cool-mist humidifiers at hc-sc.gc.ca.

Don't be surprised if your doctor recommends the use of a puffer to treat your child’s lingering cough. “Doctors are trying to be more aggressive about treating kids who may have asthma but haven’t been officially diagnosed,” says Ari Brown, a paediatrician in Austin, Texas.

Don't use medicated nose drops or sprays. The Canadian Paediatric Society doesn’t recommend these for children under six. They provide only brief relief and may worsen congestion if used for more than two to three days.

This article was originally published on February 2007.