Cough

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When to see the doctor

• If the cough persists for longer than a week or two after a cold.
  
• If there is a sudden onset of cough.
  
• If the cough is significantly interfering with your child’s sleep or daily life.
  
• If there is any difficulty with breathing.
  
• If there is an associated high fever.

In the majority of children, however, the child is well except for the cough, and you don’t need to see a doctor.

What causes it?

There are many causes of a cough in children, including infections (both viral and bacterial), irritations (cold air, smoke, inhaled foreign body), allergies (asthma, though strictly speaking it is not always allergic), as well as psychological causes (habit cough).

By far the most common cause of cough is a viral infection; as part of and after a cold, your child may cough for a while. The next most common cause of coughing is asthma. With asthma your child will usually have other symptoms as well, such as a wheeze, but sometimes a cough, especially at night or after exercise, may be the only feature. Other causes of a cough are relatively uncommon.

What are the symptoms?

The nature of the cough, and any associated symptoms, will vary according to its cause. A cough that follows a cold will be loose and sometimes produce mucus. Often it is worse at night, because of post-nasal drip from a still congested upper respiratory tract. The cough may persist for weeks after the other symptoms of the cold have disappeared.

The cough of asthma is worse at night or after exercise, and there may be an associated wheeze and breathing difficulties, such as shortness of breath. A barking, hoarse cough could mean your child has croup, while a sudden onset of a cough following a choking episode may suggest an inhaled foreign body.

Is there a test?

Most children with a cough do not need any investigations. The diagnosis is made on the basis of careful history taking and physical examination by the doctor. A chest X-ray will be ordered if the doctor thinks your child has pneumonia or to make sure they haven’t inhaled something. A blood test may be helpful in working out if there is an infection.

How is it treated?

If the cough is due to asthma, it is treated with medications, depending on the nature and extent of the symptoms and the age of the child.

The most common cough, the one that follows a cold, does not need any specific treatment. In that case, most children don’t need antibiotics, because the original infection was due to a virus and antibiotics only treat bacteria. The cough is likely to be due to prolonged irritation of the respiratory tract, rather than to ongoing infection. Cough medicines and expectorants (medicines that are supposed to help cough up mucus from the lungs and airways) have not been shown to make any difference to a cough. Vaporisers and humidifiers similarly have not been demonstrated to relieve coughing. There are dangers in young children accidentally swallowing the vaporiser solution (usually containing menthol or eucalyptus).

Usually the cough will improve with the passage of time, however you treat it.

How can I prevent it?

If the cough is due to asthma, it can usually be prevented by appropriate treatment. You can minimise the risk of inhaling foreign bodies by not letting toddlers and infants eat nuts or play with small objects that can be easily inhaled. The cough that is caused by a viral infection cannot be prevented.

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