Cough

Cough is the most common symptom of respiratory disease, and is a result of irritation of nerve receptors in the throat, trachea (windpipe) and bronchial tubes. A recurrent cough is often due to recurrent respiratory infections but other causes may be responsible. Although it is often seen as a trivial symptom it can be very upsetting for both child and parents, especially when it occurs at night and disturbs the sleep of the family.

How to work out the cause of the cough

• A cough that is worse in the morning is often due to an infection.
• A cough that is accompanied by a fever is likely to be due to an infection.
• A cough that is bad every year at a certain time of year may well be due to hayfever. Other symptoms such as itchy nose or throat, sneezing or itchy eyes may make the diagnosis clear.
• A cough that is associated with wheezing is likely to be due to asthma.
• A cough occurring mainly at night may be due to asthma.

Most coughs are due to upper respiratory infections. These are usually caused by viruses and will get better with no treatment. A fever and 'cold'-type symptoms are often present.

The only necessary action is to ensure that the child drinks plenty, and if the child is hot or uncomfortable, paracetamol can be given to make the child more comfortable. Usually the symptoms will ease off after 4 or 5 days, although a mild cough may persist for weeks. Worsening symptoms after 4 or 5 days may indicate a bacterial infection and in this case an examination by a GP is advisable. If necessary, antibiotic treatment will be prescribed. Sometimes after an infection an older child may develop a 'habit' cough. They seem well in every other way, and the cough tends not to occur at night.

Persistent cough in a child with hayfever symptoms may improve with antihistamine medication or a nasal inhaler, both of which can be prescribed by a GP.

Night cough or cough with wheeziness may be due to asthma, and examination by a GP is advisable for assessment and treatment. Persistent cough in a child with known asthma usually indicates that the asthma is inadequately controlled, and medication may need to be altered. A visit to the asthma nurse or GP at the child's surgery is required. Treatment will involve both 'reliever' and 'preventer' inhalers, and it may take some weeks before the right combination of medication is established.

Many people underestimate the effect of parental smoking on children. If both their parents smoke young children are twice as likely to have a recurrent cough and wheeze than if their parents do not smoke.

A cough that develops after a 'choking' episode may be due to something that has been inhaled and is lodged in a bronchial tube (this commonly occurs with peanuts). If there is any suspicion that this might be the case it is wise to arrange for the child to be seen by a GP. Surgical removal of the inhaled object is usually required.

Babies often cough because of reflux of milk into the bronchial tubes. This is due to poor coordination of breathing and swallowing and the fact that the baby spends a lot of time in a horizontal position. Symptoms improve as baby spends more time in an upright position and coordination improves.

Medication available for treatment of cough

Many different products are available for the relief of cough. In general they are not very effective. Cough is a normal healthy response to irritation of the nerve receptors in the mucus membranes of the respiratory system, and thus it is not usually advisable to try to get rid of the cough.

Cough suppressants (such as pholcodine or codeine) are not recommended for children.

Aromatic inhalations e.g. Karvol can be used in infants over 3 months and do sometimes help when a child's nose is blocked due to excessive amounts of mucus.

Expectorant medication (ipecacuana and ammonium chloride) is supposed to help a child cough up phlegm, but there is little evidence that these products are effective.

Soothing cough linctus such as simple linctus for children sometimes eases a dry irritating cough and is certainly safe.

There are many many different cough medicines available over the counter, and most contain two or more active ingredients. In general these medicines are of dubious benefit, and may be harmful if they are used over a prolonged period, or in doses greater than those recommended. Any child with a cough that is disturbing sleep or that continues for more than a week should be seen by a doctor.

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