Treating 'barking cough' in children

Dear Dr Donya,

Hi, it's Angie again. My seven-month-old daughter has been suffering from a cough with phlegm. I took her to my pediatrician and according to him, she has what they call "barking cough" and has prescribed Inolin drops to be taken three times a day. He has also suggested using nebulizer (fine spray) three times a day.

However, I heard from a friend of mine that unless the child has a lung problem, it is not advisable to use nebulizer. This has really confused me. Please could you advise me on this matter. The baby has no other symptoms and is active as usual with a normal appetite. I have also been giving a home remedy of kencur (a root of the kamferia galanga plant) with honey.

I would like to ask one more thing about giving children vitamins. If they are eating their meals and have a good appetite, is it necessary to give them vitamins? My kids are aged eight, four years old and the other is a seven-month-old baby.

-- Angie

Dear Angie,

Your daughter has "croup", which is a viral infection of the voice box (larynx) and the airway just beneath it. It is usually part of a cold. The swelling of the vocal cords causes hoarseness. Your child may have a simple cold for several days and then one night unexpectedly develop a loud, barking cough. The swelling and narrowing of the airway may make breathing difficult.

The worst symptoms are seen in children under three years old. Medicine is less helpful than either mist or drinking warm, clear fluids. Younger children can be given a half to one teaspoon of corn syrup, which is needed to thin the secretion. Cough suppressants are not recommended for the initial course of croup. If you've taken your child to the doctor, they may prescribe a corticosteroid such as dexamethasone. Corticosteroids are medications used to provide relief for inflamed areas of the body.

If your child's croup is serious, children may need a breathing treatment using epinephrine (adrenaline) via a nebulizer. Epinephrine is a medication that helps reduce swelling of the airway. Sometimes, upper and lower airway problems come together so the doctor may use "bricanyl or ventolin" bronchodilater, which makes it easier for the child to cough and breathe.

Nebulizer helps to deliver medicine in smaller particles to the lower airway, necessary or not depending on the particular problem.

For vitamins, I would say they are not necessary if your children eat well and grow well.

-- Dr. Donya