Wed, 18 Oct 2000

Coughs sound awful but usually aren't dangerous

By Donya Betancourt

SANUR, Bali (JP): Coughs are one of the most common ailment of childhood and although they can sound awful at times, they usually are not a symptom of anything dangerous.

Question: What is cough?

Answer: Cough is the body's reaction to an irritant in the airway. Actually coughing is a healthy reflex that helps clear mucus or phlegm in the throat and chest.

How many types of coughs are there and what do they mean?

There are several kinds of coughs. I will separate coughs by its characteristic: * "Barking cough"

These coughs are usually caused by croup, an inflammation of the larynx (voice box) and trachea (windpipe), brought on by allergies, change in temperature at night or most commonly by viral infection. * "Whooping cough".

A cough that would actually sound like "hoop" after several bouts of rapid coughing, it is most likely a symptom of pertussis, especially so if your child had not received the diphtheria/tetanus/pertussis (DTaP) vaccination. * "Cough with wheezing".

Wheezing is heard as your child exhales (breaths out), it is a sign that something may be partially blocking the lower airway. This might be caused by swelling from a respiratory infection (such as bronchiolitis or pneumonia), asthma or by an object stuck in the airway. * "Stridor".

Stry-door is noisy, harsh breathing that is heard when a child inhales (breathes in), usually from viral croup. * "Cough with a cold".

It is perfectly normal for your child to develop either a wet or dry cough because most colds are accompanied by a cough. The cough usually lasts about a week, often after all symptoms of the cold have disappeared. * "Cough with a fever".

If your child has a cough, mild fever and a runny nose, he may have simple cold. But coughs with a fever of 102 degree Fahrenheit or higher could indicate pneumonia. If your child is listless and breathing fast, call your doctor immediately. * "Cough with vomiting".

A child may throw up if lots of mucus drains into her stomach and cause nausea. Also cough triggers the gag reflex, making your child throw up. It is cause for alarm if the vomiting persists. * "Persistent cough".

A cough caused by a cold can last weeks. Asthma, allergies or a chronic infection in the sinuses or airway can also cause prolonged cough. Your child should be examined by his doctor. * "Cough in young infants".

Young infants (less than 6 months old) risk complications from respiratory syncytial virus (RSV) which can cause bronchiolitis and pneumonia and lead to severe respiratory problems. This disease starts like a normal cold but become worse and the child begins to wheeze, cough and has difficulties breathing.

What should be our main concern?

The main concern is breathing difficulties.

* A mild breathing difficulty is breathing a little faster than usual but is able to eat and talk normally.

* A moderate breathing difficulty is breathing that requires more effort than usual with retractions of the stomach (visible in and out movements of stomach muscles when the child breathes).

* A severe breathing difficulty is struggling to take each breath. Retractions are seen of the stomach, between the ribs and above the collarbones.

What can alleviate coughing?

* Activities.

Decrease activities until the child feels better. Activities that make your child sweat will increase coughing.

* Diet

Give your child plenty of water and juices to make sure the child is well hydrated.

* Medications

This depends on what kind of cough your child has. If your child has to take any medicine for cough, it should be prescribed by the doctor. Never buy cough medicine over the counter because there are so many medicines for cough and cold, e.g. expectorants, mucolytics and mucoregulators, antihistamines, decongestants, cough suppressants, bronchodilators and even the old style cough medicine (a mixture of mucolytics, decongestants and antihistamines, which I still see over the counter here). Usually no cough medicine is better than "warm water" especially in the case of colds.

Cough suppressants (dextrometrophan, codeine) should not be administered to children under one year of age without consulting the doctor.

* Humidifiers

These are helpful, especially if a dry cough is present. If a child is having a coughing spasm that is difficult to stop, take the child to the bathroom, close the door and let the shower run on hot for several minutes. After the room steams up, sit with your child for about 20 minutes. The steam should help the child breathe more easily.

* Go to the doctor if the child:

1. is under 3 months of age

2. is having trouble breathing

3. is having a high fever (more than 102 degree F or 39 degree Celsius)

4. has been coughing for more than two weeks.

5. is coughing and also vomiting significantly.

-- The writer is a pediatrician based in Sanur, Bali. Please feel free to e-mail questions, comments and concerns to