children s health issues
Cough in Children
Evaluation of Cough in Children
Not every cough requires immediate evaluation by a doctor. Knowing which symptoms may indicate a serious cause can help parents decide whether contacting a doctor is needed. The following symptoms are of particular concern: A blue tint to the lips and/or skin ( Cyanosis ) A loud squeaking noise ( Stridor ) when the child breathes in Difficulty breathing An ill appearance Spasms of uncontrollable, repetitive coughing followed by a high-pitched intake of air (sounds like a whoop) Children who have warning signs should be taken to a doctor or the emergency department right away, as should those whose parents think they may have inhaled a foreign body. If children have no warning signs but have a frequent harsh or barking cough, parents should call the doctor. Doctors typically want to see such children within a day or so, depending on their age, other symptoms (such as fever), and medical history (particularly a history of lung disorders, such as asthma or cystic fibrosis). Otherwise healthy children who have a cough occasionally and have typical cold symptoms (such as a runny nose) may not need to be seen by a doctor. Children with a chronic cough and no warning signs should be seen by a doctor, but a delay of a few days to a week is generally not harmful. Doctors first ask questions about the child's symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the cough and the tests that may need to be done ( see Table: Some Causes and Features of Cough in Children ). Information about the cough helps a doctor determine its cause. Therefore, a doctor may ask What time of day does the cough occur? What factors—such as cold air, body position, talking, eating, drinking, or exercise—trigger or relieve the cough? What does the cough sound like? Did symptoms begin suddenly or gradually? What are the child’s other symptoms? Does the cough bring up sputum or blood? A nighttime cough can be caused by asthma or postnasal drip. Coughing at the beginning of sleep and in the morning when waking usually is caused by inflammation of the sinuses ( Sinusitis ). Coughing in the middle of the night is more consistent with When children are 6 months to 6 years old, parents are asked about the possibility of swallowing a foreign body (such as a small toy) or small, smooth, firm foods (such as peanuts or grapes). Doctors also ask whether the child has had any recent respiratory infections, frequent bouts of pneumonia, allergies, or asthma or has been exposed to tuberculosis or other infections, as may occur during travel to certain countries. A physical examination is done. To check for breathing problems, doctors observe the child's chest, listen to it with a stethoscope, and tap (percuss) it. Doctors also check for cold symptoms, swollen lymph nodes, and abdominal pain. Tests may or may not be needed depending on symptoms and the causes that doctors suspect. For children with warning signs, doctors typically measure the oxygen concentration in blood using a clip-on sensor ( Pulse oximetry ) and take a For children without warning signs, tests are rarely done if the cough has lasted 4 weeks or less and cold symptoms are present. In such cases, the cause is usually a viral infection. However, testing may be done if an infection such as COVID-19 is present in a school or day care center. Tests also may not be needed if symptoms strongly suggest a cause. In such cases, doctors may simply start treatment for the presumed cause. However, if symptoms persist despite treatment, tests are often done. 