As far back as I can remember, my son, Michael, had a recurring cough that just would not quit.
It usually started after he'd caught a cold from his big sister. But often we couldn't pin it to anything. Neither could his doctors -- and we saw many in our years-long quest to find relief from The Cough. At night, he'd cough so hard that he'd wake up and often vomit in bed. We tried everything: over-the-counter and prescription antihistamines and cough syrups, antibiotics, inhalers and nebulizers. When allergy tests determined that Michael was allergic to dust mites, we bought special casings for his pillow and mattress, replaced curtains with a shade, and tried to convince him to put away his menagerie of stuffed animals (which he adamantly refused to do). I even subjected the poor kid to an endoscopy, during which doctors slid a thin flexible tube down his throat while he was under anesthesia. In the end, we never did get a definitive diagnosis, and The Cough mysteriously faded away when he was about 13.
Not all coughs are as tough to figure out as my son's was. Chronic cough is typically defined as one that lasts more than four weeks. "It's the single most common reason that parents call my office for a new-patient evaluation," says Ray S. Davis, M.D., professor of clinical pediatrics in the division of allergy immunology and pulmonary medicine at Washington University School of Medicine, in St. Louis. But decoding a cough is not a matter of, say, equating a dry, hacking cough to one cause and a wet, loose cough to another, he explains. It's also important to know that a cough is a symptom, not a disease.
I wanted to write this story because I know how eager parents are to get to the bottom of their child's chronic cough. And with the terrifying enterovirus D68 on the scene -- of which cough is a main symptom -- it's even more crucial to understand what's going on. These are the questions you should ask yourself, and what I wish I'd learned sooner.
Probably. The most common cause of cough in kids is an upper-respiratory infection from one of more than 100 cold viruses. Your child may have a mild fever from the virus and develop a cough, explains William Berger, M.D., clinical professor in the department of pediatrics at the University of California, Irvine, and a Parents advisor. "Children typically get about eight to ten colds a year and most last five to seven days,'' Dr. Berger adds, though the cough may last much longer than the runny nose. "Since kids are constantly swapping germs, it may seem like the same cold and cough is going on forever, when it's more likely that your child has a new cold and cough, back to back." As congestion builds and mucus drips down the throat, some kids can't cough it out. So they swallow it. All that mucus can also upset a child's stomach or trigger the gag reflex, which can cause her to throw up.
What to do If your child has trouble breathing or her symptoms get worse, contact your doctor, who may have her tested for enterovirus D68. In most cases though, a cold needs to run its course. Besides general TLC, give your child lots of fluids: water, warm decaf tea, even an ice pop all help. Stay away from carbonated drinks or citrus juice, which can irritate the throat. And avoid multi-symptom cold and cough preparations; if you combine them with other medicines, it may increase the risk of overdose from overlapping ingredients. (Keep in mind that the American Academy of Pediatrics does not recommend cough and cold medications for kids under 6.) Try a cool-mist humidifier or vaporizer at night; use saline nasal spray or a suction syringe to clear nasal congestion. For children over 1 year only, offer 1/2 to 1 teaspoon of honey in tea or on toast as needed to help loosen the cough. "Parents often worry when a cough is persistent, especially when it sounds harsh," explains Carrie Quinn, M.D., a pediatrician at the Kravis Children's Hospital at Mount Sinai, in New York City. "But there are questions you should ask to determine how serious the cough is. Is he playing normally or is he lethargic? How is he eating?" See a doctor if the cough is lingering after two to three weeks, or if your child experiences breathing difficulties, vomiting, or a spike in fever.
If a cough lasts more than ten days and shows no signs of getting better, and your child's nasal discharge is thick and yellowish-green, he may have sinusitis, an inflammation of the mucus lining of the nose and sinuses. It creates pockets of air along the brow, the cheekbones, and the nose; as congestion builds, sinuses become a breeding ground for bacteria. In addition to a chronic cough, kids may have postnasal drip, bad breath, low energy, and puffiness and dark circles around the eyes. Older children may complain of headache. Even a low-grade sinus infection can cause a never-ending cough.
What to do Your primary-care doctor may prescribe an antibiotic to zap the infection and nasal sprays to ease symptoms. If, after a few days, your child seems no better, she may need another round of antibiotics or a different medication. Acetaminophen, ibuprofen, and/or warm compresses can help with headaches or facial pain. Your doctor may refer you to an otolaryngologist, who can examine your child's ears, nose, and throat with special instruments to see what's going on. He'll also be able to notice any structural issues, such as a deviated septum, that can make a child more susceptible to sinus problems.