John C Kim and International Adoption Video

Wednesday, March 26, 2008

On bad coughs during colds

Bad coughing after three days of the cold is a common and yucky complaint. I understand they can really affect the family's quality of life, i.e. sleep.
Bottom line: if they have fever, particularly high fevers, it is more likely to be a pneumonia or influenza depending on the season.
What is most important is how fast they're breathing, and how overall sick they are. If they are breeding fast and seem sick, I would be more concerned about a pneumonia, that should be treated right away.
  • Coughing like this can be simply a URI or upper respiratory tract infection, most likely a good news bad news scenario. Usually this kind is cold is caused by a virus. Most commonly rhinovirus. Also parainfluenza, Boca virus, metapneumovirus, RSV, influenza, adenovirus, etc. you get the picture. Most of these viral illnesses are not very treatable. The good news is, they are generally self-limited. The expected course is a cold like that would be between five and seven days. The exception is influenza, which can occasionally cause significantly more severe disease. That is treatable within 48 hours with an anti-influenza medication called Tamiflu .
  • After seven days, and there is worsening of symptoms, this is most likely a sinus infection. This is usually caused by a bacteria. This is usually heralded by worsening of cough, rhinorrhea, fever, poor sleep, and headache. Green snot, is no longer considered predictive for a bacterial sinus infection. This should be treated with an antibiotic.
  • -the other causes of a cough in this case are postnasal trip. This can sometimes be helped with antihistamines like Benadryl. I can be helpful particularly because for most kids at help some sleep. Sometimes Astelin which is a nasal antihistamine can help. We use it in children over six years of age.
  • Re: cough suppressants, generally I avoid them as they interrupt the normal and even healthy expectoration of yucky stuff in the lungs. However, it really messes up kids sleep. So the products that seem to help our products that contain Guaneficin. The benefit of this is not very substantial over placebo. But they are not many significant side effects. This is the stuff that is in the Robitussin type products.
  • -With respect to codeine and other narcotic products, they generally have not been shown to be of any help more than Robitussin or honey, and they have quite a few more side effects like constipation, nausea and occasionally more severe ones like confusion and lethargy.

  • Other causes of cough are ear infections; there is a reflex on your ear drum that if you touch it makes you cough. Sometimes, cough like this is a sign of asthma, and many times you can't tell that they are wheezing by listening to them. Sometimes they don't wheeze at all, they just cough. Occasionally in small children, a bad cough like this can be caused by swallowed foreign body, like toy part or coin in the lungs, although their cough is usually quite severe and they usually have fevers.
  • -sometimes bad coughs like this, can be a result of a pneumonia. They can be relatively mild, what we call walking pneumonia. These kinds of pneumonias can be treated and should be treated in order to decrease your child's infectivity.

Nasal steroids like Veramyst do not work until you have given it to them regularly for at least a week. It doesn't totally kick in until about two to three weeks.

The bottom line is that if the cough is weird or is pretty severe, we should take a look at your child in the office, and coughs can occasionally be a little complicated.

No comments:

Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.