Kid's Cough

Asthma
Cough Clues: A persistent cough that’s often whistling or wheezy, lasts longer than 10 days, and worsens at night or after your child exercises or is exposed to pollen, cold air, animal dander, dust mites, or smoke.
Other Symptoms: Your child is wheezing or has labored, rapid breathing.
Likely Culprit: Asthma, a chronic condition in which small airways in the lungs swell, narrow, become clogged with mucous, and spasm, making breathing difficult. Common asthma triggers include environmental irritants, viral infections, and exercise.
Bronchiolitis

Cough Clues: A phlegmy or wheezy cough that’s often accompanied by fast, shallow, or difficult breathing.
Other Symptoms: Your child starts out with cold symptoms, such as sneezing or a stuffy nose, that last about a week. He may develop a fever up to 103 degrees. He’s lethargic and makes a wheezing sound when he exhales.

Likely Culprit: Bronchiolitis, an infection of the tiny lower airways in the lungs called bronchioles. It’s usually caused by respiratory syncytial virus (RSV) and most often occurs from late fall to early spring. Not to be confused with bronchitis (a frequent upper-respiratory infection in older kids and adults), bronchiolitis is common among babies and toddlers.
“Almost all kids will get a bout of it by age three,” says Dr. Susanna McColley, MD, division head of pulmonary medicine at Children’s Memorial Hospital, in Chicago, Illinois.

The Common Cold
Cough Clues: A wet cough without wheezing or fast breathing, day or night.
Other Symptoms: Sneezing, a runny nose, watery eyes, and a mild fever (usually less than 101.5 degrees Fahrenheit).
Likely Culprit: The common cold, a viral infection of the nose, sinuses, throat, and large airways of the lungs. Coughing usually lasts the entire length of the cold (about seven to 10 days) but can linger twice as long, with mild improvement each day.
What to Do: Keep nasal passages as clear as possible; congestion and postnasal drip worsen this cough. For babies and toddlers who can’t blow their noses, use nasal saline drops and a bulb aspirator to suction a runny nose.
An over-the-counter nasal decongestant may help kids older than two; ask your pediatrician for her recommendation. If your child’s cough and stuffy nose persist for more than 10 days without improving, return to the doctor. Your child could have sinusitis (a bacterial infection that’s often brought on by a cold) or another problem such as asthma, allergies, or even enlarged adenoids, which inhibit breathing.

Croup
Cough Clues: A distinctive, shrill, dry, seal-like bark, which frequently starts in the middle of the night. “The sound is unlike any cough you’ve ever heard before,” says Dr. Widome.

Other Symptoms: Your child’s illness follows a circadian rhythm: better during the day, worse at night. She may also have a slight fever. In severe cases, your child may develop stridor, a harsh, high-pitched sound every time she inhales—similar to the noise kids make after a long crying jag.

Likely Culprit: Croup, a contagious viral infection that causes the throat and windpipe to swell and narrow. It typically affects kids between six months and three years. (Adults and older children have wider windpipes, so swelling is less likely to affect breathing.)
What to Do: Sit with your child in a steamy bathroom for five minutes; the humidity will help move mucous from her lungs and calm her cough. At night, if the temperature is chilly, bundle her up in warm pajamas but don’t be afraid to open her bedroom window and run a humidifier in the room; the cold, moist air may reduce airway swelling. Call your doctor right away if the cough worsens or she’s having trouble breathing. She may need medicine to reduce inflammation. Otherwise, croup often runs its course in three to four days.

The Flu
Cough Clues: A mildly hoarse, throaty cough that comes in frequent spells and can be either wet or dry.
Other Symptoms: Your child feels listless and complains that his throat is scratchy and sore, his head hurts, and the muscles in his back and legs ache. He may also have a runny nose, fever, and nausea.
Likely Culprit: The flu, a viral respiratory illness that’s most common from November through April.
What to Do: Call the doctor if your child has a fever above 101.5 degrees Fahrenheit, is throwing up, has diarrhea, or is uninterested in eating or drinking (your doctor will recommend steps to prevent dehydration). Give your child plenty of fluids and use a humidifier to alleviate congestion in his airways. Also, to ward off future bouts of the flu, ask your pediatrician about getting your child an annual flu shot; experts recommend the vaccine particularly for babies six to 23 months, as this age range is most susceptible to complications associated with the flu.

GERD
 Cough Clues: A wheezy, crackly, persistent cough after your child eats. Coughing episodes typically worsen when she’s lying down.
Other Symptoms: She may feel a burning sensation or may vomit or belch when swallowing. A baby might be fussy or have been labeled as colicky. Toddlers may develop wheezing and picky eating habits.
Likely Culprit: GERD (gastroesophageal reflux disease), caused by a weak or immature band of muscle between the esophagus and stomach that allows acid to flow back up. Sometimes the irritating juices can enter the lungs, causing a chronic cough.
What to Do: Have your child see the pediatrician if her wheezy cough lasts longer than two weeks. He may recommend keeping a baby upright for at least 30 minutes after feedings and for babies and older children, elevating the head of their mattress while they sleep. With older children, he may also suggest avoiding foods and beverages that cause symptoms, such as caffeinated sodas, chocolate, peppermint, spicy foods like pizza, acidic foods like orange and tomatoes, and fried and fatty foods, and not eating within two hours of bedtime. Prescription medicine can also control GERD symptoms.

Whooping Cough
Cough Clues: Dry, hacking coughing fits—as many as 25 coughs in a single breath. When your child inhales sharply to catch his breath, he makes a high-pitched whooping sound. Listen to the cough here.

Other Symptoms: Before the cough starts, your child has a week of cold-like symptoms but no fever. In infants, the illness can be severe and cause mucous to bubble from the nostrils. It can also lead to convulsions and make a baby stop breathing if he gets tired.

Likely Culprit: Whooping cough (also known as pertussis), a highly contagious bacterial infection of the throat, windpipe, and lungs. Children who haven’t received their immunizations are most vulnerable. (Babies routinely get their shots at two, four, and six months; additional boosters between 12 and 18 months; and then again between four and six years. Immunity wanes as we get older. Therefore, adults may carry pertussis but get only a mild cough.)
What to Do: Call the doctor if your child’s cough worsens instead of improves after a week. Babies usually need to be hospitalized to control the cough and have mucous suctioned from their throat. The illness is treated with antibiotics, though the cough can last for many weeks or even months.

Cough Facts Every Parent Should Know

Cough Suppressants: If your child’s cough is keeping him up at night, a suppressant may help him sleep. Ask your pediatrician for a recommendation. However, you should know that inhibiting a cough, especially if your child has a mucousy, lower-respiratory cough, can actually exacerbate or prolong the illness, says Dr. Shubin.

AD
 Expectorants: They’re meant to loosen mucous, but studies show they’re not very helpful. “Water is a good expectorant,” Dr. Shubin says.

Multisymptom Cold Relievers: Because these formulas contain more than one drug, be sure to read labels carefully. Your child may suffer side effects such as sleeplessness (common with antihistamines) or irritability (typical of decongestants), says Dr. Meredith Messinger, MD, an attending physician at Long Island College Hospital, in Brooklyn, New York.
Throat Lozenges: Cough drops increase saliva production, which can soothe your child’s throat and loosen his cough. But don’t give them to children under the age of four, Dr. Shubin says. Like any hard candies, lozenges pose a choking hazard.

Bronchitis

Acute bronchitis is swelling and inflammation of the main air passages to the lungs. This swelling narrows the airways, making it harder to breathe and causing other symptoms, such as a cough. Acute means the symptoms have only been present for a short time.

Acute bronchitis almost always follows a cold or flu-like infection. The infection is caused by a virus. At first, it affects your nose, sinuses, and throat. Then it spreads to the airways leading to your lungs. Sometimes, bacteria also infect the airways. This is called a secondary infection.

Chronic bronchitis is a long-term condition. To be diagnosed with chronic bronchitis, you must have a cough with mucus most days of the month for at least 3 months.

Symptoms

•Chest discomfort

•Cough that produces mucus; it may be clear or yellow-green

•Fatigue

•Fever -- usually low-grade

•Shortness of breath that gets worse with activity

•Wheezing, in people with asthma 

Even after acute bronchitis has cleared, you may have a dry, nagging cough that lingers for 1 to 4 weeks.At times, it may be hard to know whether you have pneumonia or only bronchitis. If you have pneumonia, you are more likely to have a high fever and chills, feel sicker, or feel short of breath.

Bronchiolitis

Bronchiolitis is swelling and mucus buildup in the smallest air passages in the lungs (bronchioles), usually due to a viral infection.

Bronchiolitis usually affects children under the age of 2, with a peak age of 3 - 6 months. It is a common, and sometimes severe illness. Respiratory syncytial virus (RSV) is the most common cause. More than half of all infants are exposed to this virus by their first birthday.

You can catch the virus if you come into direct contact with nasal fluids or airborne droplets from someone who has the illness. This may happen if the person sneezes or coughs near you. Bronchiolitis is seasonal and appears more often in the fall and winter months. It is a very common reason for infants to be hospitalized during winter and early spring.

Risk factors for bronchiolitis include:•Living in crowded conditions•

Symptoms: some children may have few or minor symptoms.Bronchiolitis begins as a mild upper respiratory infection. Over a period of 2 - 3 days, the child develops more breathing problems, including wheezing and a "tight" wheezy cough.

Symptoms include:•Bluish skin due to lack of oxygen (cyanosis) - emergency treatment is needed •Breathing difficulty including wheezing and shortness of breath•Cough•Fatigue•Fever•Muscles around the ribs sink in as the child tries to breathe in (called intercostal retractions)•Nasal flaring in infants•Rapid breathing (tachypnea)

TEST: Culture of a sample of nasal fluid to determine the virus causing the disease

Treatment Sometimes, no treatment is necessary. Antibiotics do not work against viral infections. Most medications do not help treat bronchiolitis.

Supportive therapy can include:

•Drinking plenty of fluids. Electrolyte-balanced drinks, such as Pedialyte, are also okay to use in infants.

•Breathing moist (wet) air to help loosen sticky mucus. You can use a humidifier to moisten the air your child is breathing. Follow the directions that come with the humidifier.

•Getting plenty of rest.

Children in the hospital may need oxygen therapy and fluids given through a vein (IV).Rarely, antiviral medications, such as ribavirin, may be used to treat extremely ill children.

Usually, the symptoms get better within a week. Breathing difficulty usually gets better by the third day.

Possible Complications•Airway disease, including asthma, later in life•Respiratory failure•Additional infection, such as pneumonia

Call your health care provider immediately, or go to the emergency room if the child with bronchiolitis:

•Becomes extremely tired

•Has bluish color in the skin, nails, or lips

•Starts breathing very fast

•Has a cold that suddenly worsens

•Has difficulty breathing

•Flares nostrils or retracts chest muscles in an effort to breathe

Most cases of bronchiolitis are not easily preventable because the viruses that cause the disorder are common in the environment. Careful attention to hand washing, especially around infants, can help prevent the spread of respiratory viruses.

Family members with an upper respiratory infection should be especially careful around infants. Wash your hands often, especially before handling the child.

At this date, there is no RSV vaccine available. However, there is an effective product, called palivizumab (Synagis), for infants who are at high risk of developing severe disease from RSV. Ask your child's doctor whether this medication is right for your child.