Cough
Respiratory season means coughing. Many different viruses cause it, but cough can also be from non-infectious causes.
In this post, we’re going to talk about why coughs are actually GOOD, what can cause them, and when to go to the doctor. In an upcoming post, I will give you some practical tips and tricks to try.
Why do we cough?
Believe it or not, coughing is actually an important protective mechanism and part of our body’s immune system. Coughing is a reflex (much like sneezing or blinking) and it helps our body clear mucus and other irritants that might cause more severe problems.
An old mentor often called coughing the “watchdog of the chest” because of how important it is. When the throat, nose or lung encounter irritants such as dirt, allergens, or germs from the environment, the initial reaction is to produce mucus that collects this debris. Coughing mobilizes that mucus and helps the body remove those irritants.
But coughs are annoying!
You’re not wrong. Coughing cause pain in the throat, chest or head, and it can interfere with normal functions such as sleep, breathing or eating, which is why parents are always so interested in finding solutions to help. But much like a fever, coughing is an integral part of healthy immune function. So when you’re trying to find a solution, remember your priority is your child’s comfort (which is what I say about fever too!)
With that said, I think we as a community of healthcare providers are often quite dismissive of coughing, which is unfortunate because it can so tremendously impact quality of life and recovery from illness.
What can cause a cough?
When we think about coughing in children, we often divide it into two large categories: acute or chronic (lasting longer than 4 weeks). Some causes we consider include:
Congestion and runny nose (which can cause postnasal drip)
Infections such as pneumonia, sinusitis, croup
Gastro-esophageal reflux
Allergies
Asthma or reactive airway disease
Habit (or tic)
Swallowed foreign bodies - we see this in toddlers a lot
There are other more serious causes of chronic cough, but these are rare. They can include blood clots, cancer, autoimmune disease, neurologic disease or heart conditions.
The Pediatrician Mom Tip: If your child has a history of underlying health conditions such as heart disease, a chronic cough may indicate worsening of the underlying condition. Always talk to your care team if you’re concerned or for new symptoms that are persistent.
What your doctor wants to know if your child is coughing
As clinicians, there are some key pieces of information that can help us piece together why a child is coughing. These are some things you should pay attention to if you are taking your child to the doctor for a cough.
When you notice it
In the morning? Only at night? Only with exercise? With feeding? When your child is anxious or stressed?
When it began and how long it has lasted
What does it sound like?
Dry or wet? Barky? Chesty?
How it has changed over time
Did it get better then worsen? Do you notice it every year at the same time?
Any associated symptoms
Fever? Runny nose/congestion? Headache? Vomiting? Sore throat? Difficulty breathing? Trouble completing full sentences?
What other sounds do you hear?
Have you noticed any stridor (high pitched sound) or wheezing? If there are other sounds, are they when your child breathes in, out, or both?
Are there any underlying health conditions in your child or in the family?
Allergies? Asthma? History of prematurity?
Why do some post-viral coughs linger so long?
The inflammation that some viruses can cause, such as RSV or CVD, can actually take awhile to go away. Even after the acute phase of the illness, an annoying cough can linger for several weeks. It can occur in spasms, or at night, or with physical activity. With that said, if your child has a prolonged cough lasting longer than 10-14 days, it is never wrong to get it checked out to rule out any secondary bacterial infections or other underlying causes.
When to call the pediatrician
This is not a comprehensive list. In general, always err on the side of calling your pediatrician if you have any concerns about your child. There is a lot to be said for a parent’s gut instinct, and I promise: your pediatrician would rather you called!
If your child is not improving within a few days, or if they seem to be getting worse, call your pediatrician. Other concerning symptoms include:
Breathing difficulty (see my video on instagram with more details).
Rapid breathing (Infant <12mo: more than 60 breaths/minute)
Retractions: when the skin pulls in between the ribs or at the base of the throat with each breath
Pauses/irregular breathing
Nasal flaring
Grunting with each breath
Additional sounds when breathing (such as stridor or wheezing)
Feeding difficulty
Persistent cough lasting longer than 10 days
Pain (eg headache, chest pain, etc)
Change in color (blue OR pale)
Excessive fatigue
Coughing up blood
Dehydration — see my prior posts for signs to look for.
Fever is persistent beyond 3-5 days
Anything else tickling your spidey sense!!
FAQs
Can reflux cause a cough?
Absolutely. This can happen because there is chronic irritation of the vocal cords due to milk coming back up (so you may not actually even see spitting up - in silence reflux the milk may only come up high enough to irritate the vocal cords). Typically you will see that these coughs are more noticeable during or right after feeding, or when laying flat.
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