Parenting a sick child: When a child’s cough is cause for concern

I was recently asked by a concerned parent, “When is a kid’s cough something you should worry about?” As a pediatrician, I feel obligated to point out from the outset that, in most instances, this is a question that really needs to be discussed directly with one’s own pediatrician. There are, however, several general cough concepts I can share with you that will hopefully help you gain a better big picture perspective.

It’s first worth pointing out that a cough, at the most basic level, is simply a reflex that exists to help keep things out of the airway. Even though it may not seem like it when your child is up and coughing in the middle of the night, a cough (like a fever) can actually serve a useful purpose.

As for considering the various causes of a cough, some of the most common in children include infections, asthma, choking or having something stuck in the airway, croup, habit coughing, and certain medical conditions (usually ones children are born with). Some are easy to identify, while other causes can take a bit more sleuthing. Even when you have identified the underlying cause, it may not always give you a definitive answer as to whether to be concerned. In the case of cough-inducing infections, plenty of common colds can cause an inconvenient, annoying cough. Pertussis, on the other hand (also caused by an infection and referred to as “whooping cough”) is known for it’s nagging cough…and the fact that it can prove deadly to infants.

When it comes right down to it, figuring out when to worry about a cough needs to be treated as a problem-solving venture. The following are some of questions most worth considering and the symptoms you’ll want to be on the lookout for.

Age matters.  Any cough in a baby three months or younger warrants a visit to the doctor’s office.

At a loss. It’s one thing to cough. It’s altogether another when the cough takes one’s breath away and is accompanied by more concerning signs such as troubled, noisy, and/or fast breathing.

Time of day. Taking note of how much, how often, and even when during the course of the day and/or night your child coughs can provide some telltale clues. Mucus drainage, for example, typically tends to trigger an increase in nighttime coughing. Habit coughs, on the other hand, tend to go away during sleep.

Persistence counts. More than 2 weeks of a cough definitely warrants a check-up. Coughs associated with run-of-the-mill colds don’t usually last this long, while pneumonia, sinusitis, and other causes of persistent cough often do.

Describe the circumstances. Any history of a sudden cough – especially following a gagging or choking episode – is particularly concerning for a foreign object in an airway.

Over-exposure. Consider if your child’s cough matches that of his siblings, his preschool classmates, or others he’s recently come in contact with. While I’m on the subject, let me also take this opportunity to add that while it’s a very wise idea to take advantage of practical and effective measures to stop the spread of germs – think hand washing, vaccines, and basic disinfection of contaminated surfaces – it’s unnecessary and, more importantly, unrealistic to think that you can (or should) keep your child away from all germs.

Wet or Dry. A mucusy cough is often referred to as a “wet” cough, whereas a cough without mucus is more likely to be called a “dry” cough. While determining whether a cough is wet or dry doesn’t automatically determine the underlying cause or inherently tell you how concerned to be, it can prove to be useful information.

For better or for worse. It’s fairly straightforward but worth saying that taking note of what triggers your child’s cough and what makes it better can be key in figuring things out. Croupy coughs tend to be worse at night and better with moist air. Asthma coughs can be caused by known allergens, may worsen with exercise and respond well to albuterol or other asthma medications.

Additional warning signs. Any time a child has other accompanying symptoms of concern such as a high fever, coughing so hard they are vomiting, coughing enough that they refuse (or are unable) to drink, or cough up blood, it’s time to head to the doctor. to the doctor.

Originally posted on Omaha World Herald’s Live Well Nebraska

Coughs, Kids & Vaccines: Why parents are the key to silencing the sounds of pertussis!

You really don’t have to listen very hard to hear the sounds of the season – the rustling of fall leaves, the weekend cheers of husker fans, and lawnmowers out for one last run before being swapped out for snow blowers. But if you ask me, the most noticeable sounds this time of year are all of the coughs, sniffles and sneezes that predictably make their annual show of force during cold and flu season. For parents and pediatricians alike, these are familiar sounds that we learn to live with and treat as needed. This year, however, we are hearing a lot more than usual about another sound – a sound for which we should all be listening carefully: the sound of pertussis.

Perhaps you’ve heard of pertussis – also commonly referred to as whooping cough – from your pediatrician. Some of you may remember reading about it each time you received the standard set of vaccine information sheets describing each of your child’s scheduled immunizations, since the DTaP (the “P” part referring to pertussis) vaccine is routinely given.

Chances are that if you’ve been following the national news lately, however, you may have also heard that there’s a pertussis outbreak in California. In the world of infectious diseases, let me assure you that California isn’t very far away from Nebraska, and this outbreak is not just another news story about an isolated incident hundreds of miles away. The spread of pertussis in California is, in fact, proving to be the worst outbreak in 60 years, having already claimed the lives of 10 infants under the age of 3 months. If that’s not a reason to stop and take notice, I don’t know what is.

The fact of the matter is that pertussis is caused by one of the most contagious bacteria we know. The infection can start out seeming like a common cold, but over the course of a couple of weeks manifests itself as an escalating cough which then turns into coughing episodes sometimes severe enough to result in vomiting or the characteristic “whoop” sound that represents the dramatic effort to draw air back into the lungs.

While adults typically experience weeks (if not months) of a cough that just won’t go away, they don’t often “whoop” like kids do. Neither do babies under 6 months of age – a fact that increases their risk of life-threatening illness or death at a time when they can’t yet be vaccinated (under 2 months) or haven’t developed full immunity (under 6 months of age). Unable to draw air back into their lungs, babies may gasp, gag, or simply stop breathing altogether – making them the most vulnerable at a time when they are also the most at risk.

As someone committed to helping insure the health and well-being of all children, I’ve therefore pulled together some very important facts about whooping cough, who is at risk, and what each of us can do to prevent the spread of pertussis in hopes that we protect all of Nebraska’s children and adults against a sound you never want to hear at any time of the year….the sound of a young child with pertussis.

Make sure your child is up to date on his/her shots. DTap is recommended at 2, 4, 6 and 15-18 months, and again at 4-6 years. The best time to get your child protected against pertussis is the first day your child becomes eligible for each recommended immunization.

Get your adult tetanus booster. Immunity to whooping cough doesn’t last forever. Any adult (or teen) who doesn’t remember getting a pertussis booster shot, or hasn’t had one since they were immunized as a child needs to get vaccinated. The fact of the matter is that babies too young to be protected by the vaccine rely solely on all of us to not expose them. Sadly, an estimated 3 out of every 4 babies with life-threatening pertussis infection got it from a loved one. Prevent this from happening by rolling up your own sleeves, getting an adult booster shot, and doing your part to limit the spread of pertussis.

Be on the lookout for pertussis and contact your doctor or your child’s pediatrician with any concerns. It’s all too easy to mistake pertussis for the common cold at the outset of the infection, and while people are contagious for up to a month, antibiotics are of little benefit after the first week or so. Half of babies with whooping cough end up needing to be hospitalized.

Listen to the sound of pertussis. If my blog hasn’t already convinced you, or you simply want more information, watch my recent pertussis-focused CNN interview with Kiran Chetry on American Morning, go to www.soundsofpertussis.com and let Jeff Gordon of NASCAR fame convince you, or simply listen to what a baby with pertussis sounds like .

Now let’s all commit to doing everything we possibly can to silence the sounds of pertussis.

Originally posted on Omaha World Herald’s Live Well Nebraska