Cough in Children
Why see a doctor?
So why see a doctor for a cough? Some reasons are scary and obvious – struggling to breathe, very unwell, worsening fevers, and pain. Children with known wheezing or chronic health concerns also can be at higher risk.
The main reason is, first, reassurance it is a benign cough that has to run its course as you fight off one of the endless preschool viruses. Second, even a benign cough can be helped, ideally to improve sleep even if it cannot be stopped.
A cough is generally good. It is your body clearing mucus and preventing it from settling into the chest. A child’s body responds strongly to viruses and may produce mucus for 2-3 weeks with each infection, so it is 2-3 weeks of a cough. Most are the worst nights and mornings as mucus builds up.
The average child in daycare has one viral infection a month, and as each can last weeks, it is normal to have a child with a runny nose and cough almost every day for a year or two. Fevers tend to happen early and then improve, and usually, there is no pain beyond a mild sore throat or general aches. A child with a new fever several days into an illness or new ear or chest pain is worrisome, even if most are still viral – 75% of ear and lung infections are (in a vaccinated child) still viral and do not benefit from antibiotics.
What not to do
Be cautious with any recommendations for nasal swabs. It is normal to have bacteria in them (the nose and upper airway are full of good bacteria that help keep us healthy), and even if you have a bacterial illness that needs treatment, a nasal or sputum test does not tell you what the actual cause is.
Be VERY cautious with PCR testing. It is overly sensitive and can detect every virus your child has had in the last six months, and still not tell you accurately why your child is sick today. It is common to be told based on (expensive) “respiratory multiplex PCR testing” that your child is unwell because they have 3 viruses at once! They don’t.
This is a very brief and superficial summary. Of course, if you have any worries, a visit with a doctor is recommended, and I would never assume it is “just a cough.” Thankfully, most coughs will improve with time, and there are medicines (NOT antihistamines – it will rarely if ever help!) that may reduce the symptoms. Coughs past a month, trouble breathing, pain, and worsening fevers are always symptoms that need investigation, so even if most visits end with “don’t worry, it will get better with time” there is still a value in that.
About Author
This article is written by Dr Leo Hamilton, who is a US board-certified Paediatrician since 2003. Dr Leo relocated to Singapore in 2011, caring for expat and Singaporean children from newborns at delivery to teenagers. Beyond his background in Hematology/Oncology, he has an interest in asthma, behavioural issues (primarily ADHD), teen health, and modern management of routine childhood illnesses such as ear infections, bronchiolitis, and pneumonia.
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