By Greg Dworkin, MD

Acute Coughs In Children

With the onset of cold weather, there is an upswing of a very common complaint – coughing in a child, especially at night. Children’s coughs generally fall into two categories; acute (lasting less than two weeks) and chronic (lasting more than two weeks). While there is some overlap, these classifications are helpful in distinguishing the underlying reasons behind the coughing. Chronic coughs are sometimes a sign of a more significant problem, and will be dealt with in a future article. Acute coughs are far more common, and it is likely that your child has had at least one already this season.

Acute coughs are one of the most common reasons for a visit to your child’s doctor, and the usual culprit is an upper respiratory infection (URI). These viral infections are so common because there are literally hundreds of viruses that can cause similar symptoms. In your child’s lifetime, he or she may have many colds or URIs without ever getting the same virus twice (each exposure generally conveys lifetime immunity). Between day care, school, family and friends, the chance of being exposed to one of these viruses is very high, especially in colder weather when people spend so much time indoors. If it’s one your child hasn’t had yet, a cold usually ensues.

My grandmother (in addition to chicken soup) used to counsel us to take seven small rocks and put them in a pocket. By removing one rock a day (she said), we’d be better when all the rocks were gone. There was wisdom in this folk remedy since most URIs will indeed be gone in a week, but the cough they engender may take a further week to disappear.

There are many remedies sold over the counter for coughs. Unfortunately, there is little chance that they will work as intended. The major ingredients are expectorants, decongestants, antihistamines, cough suppressants, and alcohol. Expectorants thin secretions so they can be brought up and out of the lungs. Don’t expect your five-year-old to spit out the mucus, that won’t likely happen before seven or eight years of age. Until then, most children will swallow the secretions, leading to loose stools or loss of appetite. Decongestants will help you breathe through your nose, but won’t do much for a cough. They may keep your child awake, so many products will add one of the three other ingredients (antihistamines, cough suppressants, or alcohol) just to make them sleepy. Many medical studies have looked for, but have not found, any benefit from cough medicines for pre-schoolers and have found only marginal benefit for older children.

Coughs that have unusual characteristics should be looked at by your doctor. For example, very high fever may sometimes indicate pneumonia, or a barking, seal-like quality to the cough may indicate croup. A history of asthma is another reason to seek early medical care, and any child who appears ill should prompt at least a call to your doctor’s office.

With supportive care, most acute coughs will vanish on their own. Since a normal young child can have 10 to 14 colds per year, this is a fortunate thing. Ask your doctor if you have any questions about your child’s cough.

Next week: Chronic coughs in children.

Greg Dworkin, MD, is a pediatric pulmonologist at Danbury Hospital and medical advisor to the Open Airways program.