Is a persistent cough in children worrying?
Advice for parents whose child has a persistent cough
Coughs during the winter months are common and can last for weeks without causing any harm to your child. So how do you know when you child needs to see a doctor?
If you are worried about your child, follow your instinct and speak to a doctor straight away. Most doctors will be able to get an idea if your child could have a chest infection or other serious lung condition.
Below are some points that will help you understand better the average duration of coughs and colds and what signs to look-out for that could mean a more chronic/persistent infection like bronchiectasis
How long should a cough last?
The normal duration of chesty symptoms in children is longer than commonly believed: an acute cough usually clears up within 25 days, and the common head cold by 15 days. If it is longer than these durations then see a doctor each time.
When should you worry about a cough in a child?
If your child has a wet-sounding cough every day for ≥4 weeks this needs investigated by your doctor.
When do you not have to worry about a cough?
If the your child has a recurrent acute cough ( acute means lasting less than than 25 days) with cough-free periods of at least a week between bouts it is probably due to a viral infection.
Does my child need a chest X-ray?
A chest x ray is not usually required in children who seem generally well and have no worrying signs. Your doctor will ask more questions about the duration of the cough, listen and feel to see if it is wet and assess if your child’s chest is clear on examination.
What is a Recurrent lung or chest infection?
A recurrent infection or ‘chronic’ infection is defined as three or more episodes of bronchitis, bronchiolitis, or pneumonia per year and usually needs further investigations such as a chest X-ray and in some cases a CT scan.
Last year the guidelines for doctors changed for assessing a child with a chronic cough or chest infection.
One major change was to make sure GP’s didn’t miss children with recurrent chest infections who could develop early bronchiectasis which requires very different treatment than just treating a regular chest infection.
Bronchiectasis can be genetic but it can also be a result of repeated infections that cause pooling of secretions in the lungs and further infections.
What will your doctor do?
Your GP will first take a history which means they ask you a lot of questions about the cough- when it started , if anything makes it worse, like eating or lying flat or if it’s just worse when sleeping.
They will want to know for how long your child has had the cough and if they have needed any antibiotics in the last year and how many chest infections they have had in the last 12 months.
Your GP will want to know if your child has had a a fever, how high it has been, if they are eating and drinking normally or breast feeding normally. Also if they are wetting nappies or if their urine is concentrated.
They will want to know if anyone else is sick at home, if you have travelled anywhere and if anyone in the household had been abroad in a country were TB ( Tuberculosis is common)
They will ask you about your child’s brith history in case they were premature which can increase the risk of certain chest infections.
Vaccinations are important as whooping cough and haemophilus influenzae are still common and can both cause a chronic cough.
Your GP will listen to your child’s chest, look at the movement of the chest and throat and count the number of breathes per minute to decide if they are having to work hard to get air into the lungs.
They should ALSO feel the chest, as sometimes ‘bubbling’ can be felt in the chest wall but not heard when listening with the stethoscope. You may even have felt this bubbling your self when lifting your child so always tell your GP if that is the case.
Your GP will also listen to your child’s heart to make sure everything is Ok and take their pulse rate.
If a child is breathing fast or showing signs of having to use their chest and throat muscles to breath in then your GP will send you and your child to hospital. If they are wheezy your GP may give them a nebuliser before sending them to A and E which help them breath better. they may also give them a liquid steroid too if they are worried that they could get worse before reaching hospital.
In some cases your GP may call an ambulance and do all of the above things while waiting.
Other causes for a cough other than a chest infection in young children are:
Whooping cough
An inhaled object in the lung usually something small inhaled by a toddler
Asthma or a wheezy chest
Tonsillitis/throat infection
Infectious disease such as Tuberculosis (TB)
A wheezy chest and tonsillitis both are common causes of a cough. A wheeze doesn’t always mean asthma and your child may be wheezy for the first few years of life yet by the age of 7 ‘grow-out’ of it.
Tonsillitis on the other hand may be a longstanding problem into your child’s teenage years.