How to recognise the different types of cough in children

As we are now well into the thick of winter, I thought it would be good to talk about cough in children, particularly what different coughs mean and how they may be treated.

There are many causes of cough and they are often related to the age of your child.  Viruses are the most common cause of cough in children. Children can be expected to have from six to 12 viral infections over the year, especially if they have lots of siblings or they attend daycare or kinder. To most parents, their child may seem constantly sick, particularly in the first year that they attend daycare.

Many parents seek an opinion as to whether there is another cause for their child’s cough, especially if it is long lasting or keeps coming back. Many times I have felt quite helpless lying in bed listening to one of my children cough.

So what are the most common causes and types of cough in young children and infants, and how long should you expect the cough to last?

• Viral induced cough: This is the most common cause of cough in children and is due to upper respiratory tract infections caused by viruses. The illness starts with the symptoms of a cold, with a runny, blocked nose and a cough. Antibiotics usually aren’t needed and won’t help (unfortunately!) A viral induced cough can last for three to four weeks and the treatment is usually just to ensure adequate fluids, rest and paracetamol or ibuprofen if needed.

• Bronchiolitis: is a cause of cough in children under 12 months of age, and is due to viral infections. The illness starts in the same way, with the symptoms of a cold. The difference is that after a few days the baby may start to work harder to breathe and develops fast, noisy breathing (wheeze) with cough and fever. The baby then starts to feed poorly (often taking less than half their normal feeds) and may become lethargic or sleepy. The treatment is small, more frequent feeds at home or the baby may need to go to hospital for a feeding tube and possibly some oxygen. Antibiotics are not needed as bronchiolitis is caused by a viral infection. Babies with bronchiolitis are often sickest on the second or third day of the illness and are sick for seven to 10 days. However, the cough may last for two to four weeks.

• Asthma: is a term used to describe cough in children over the age of 12 months and is usually triggered by viral infections. It is a very similar illness to bronchiolitis and is often called asthma when the child starts to respond to Ventolin, which is a medicine used to open up the airways. Cough alone is not usually suggestive of asthma as asthma more commonly appears with wheezing and tightness in the chest. As the asthma becomes worse, it causes rapid breathing; and you might see your child working harder to breathe, with sucking in noticeable at the neck or at the base of the ribs. Some children may only get asthma symptoms when they are exercising. Treatment is with Ventolin, and possibly a preventer if your child is using a lot of Ventolin and/or they have asthma symptoms between attacks. Each child needs a clear asthma management plan. Attacks can be short-lived or prolonged, especially if quite severe.

• Croup: causes a harsh, barking cough, usually in children under five years of age, and is caused by viral infections. Unlike bronchiolitis and asthma, croup affects the upper airway NOT the lower airway. Croup begins with symptoms of a cold and then causes swelling of the voice box (larynx) and wind pipe (trachea). The swelling of the upper airway can cause a harsh noise when the child breathes in, called “stridor”. The stridor is usually worse at night, peaking on the second or third night, and the illness usually lasts three to four days. The treatment is to keep your child calm and to make sure they are drinking enough fluids. Oral steroids are sometimes given to reduce the swelling, or your child may need to go to hospital if they are struggling to breathe or look very sick. In the past, steam treatment or vaporisers were used to relieve symptoms of croup. These treatments are no longer recommended as they have not been shown to help.

• Whooping cough: is a cause of cough in children of all ages and is due to a bacterial infection. The illness starts with symptoms of a cold and a cough. After a week, the cough starts to come in spells or paroxsyms, and is often followed by vomiting. In young infants, especially those less than six months, the cough may cause the infant to go very red and then blue in the face, or even have periods when they stop breathing or can’t catch their breath. These babies are the most vulnerable and may need to go to hospital as they are at risk of developing severe complications, including pneumonia or brain inflammation. In older children and adults, the cough may be milder and more persistent, and you may not think of whooping cough. Often other family members have a cough. It is very important to make sure your children and yourself, especially if you are pregnant, have had the whooping cough vaccine. Treatment with antibiotics helps to lessen the severity of the illness and its contagiousness to others if started within two weeks. The cough can last for up to three months.

• Pneumonia: is a cause of cough in children of all ages and is an infection of the lung due to both viral and bacterial infections. The illness presents with fever and cough and difficulty breathing (fast, labored breathing). Management includes a chest x-ray, fluids and antibiotics. Other treatment is determined by how sick your child is. Children may be managed at home with oral antibiotics or they may need antibiotics through a drip and possibly oxygen in hospital if they are very unwell. Most children improve within two to three days and take up to 10 days to recover.

What are the other causes of cough? If the cough is more prolonged and an infection seems unlikely, then other causes may be sought. In infants, structural problems may be causing the cough. Toddlers may have swallowed an object or “foreign body”. Older children may have hay fever or a chronic runny nose with itch causing their cough or they may have more of a habit cough, which usually disappears during sleep. Sometimes the cough may need prolonged courses of antibiotics. In most of these cases, depending on the severity and complexity, expert assessment is needed for further investigations and treatment.

What about over-the-counter cough medicines?
Over-the-counter cough mixtures and decongestants from the chemist or supermarket have not been shown to have any positive effect on reducing the symptoms of cough, or reducing the length of time a child is sick with the viral or bacterial infection causing the cough. Sometimes these medicines can do more harm than good, especially if recommended dosages are not followed or the use delays the time it takes to seek proper medical care.

So, as you can see, there are a myriad of causes and ways that cough can present in children. By understanding a bit more about the nature of your child’s cough, you may able to determine what the cause is and what to do next. Just remember, viral infections are still the most common cause!

If you are worried about your child’s cough, then see your GP. If it is more complicated, your child may need a referral to a paediatrician or respiratory physician to tease out what is going on. If your child is acutely unwell, please seek medical care more urgently by going to a hospital emergency department or calling 000 for an ambulance.