Children cough, endlessly, everywhere, that's a fact.
It's one of the commonest reasons for children
to be brought to my outpatient clinic
or to the emergency department for that matter.
I'm going to talk to you a bit about what's
normal in childhood cough, what's abnormal,
and what are the key features that should make you seek help.
The things that I described towards the end of this talk
are incredibly rare.
I'm not here to scare you.
I'm here to reassure you that what your child is doing
is probably normal.
What's a normal cough?
Healthy 10-year-olds will have around 11 bouts
of coughing in a normal 24 hour period, that's healthy.
Young children will have up to 12 colds in a year.
When children get a cold, they will
cough for two to three weeks.
With that in mind, you can imagine
that it's difficult to find a point when they're not
coughing, and that's normal.
So how do you treat a normal bog-standard cough?
Well the first question is, do you need to?
Most children with a cold will cough for one, two, maybe three
weeks, and then they'll be fine.
And actually that cough will be part
of the way in which they clear the chest of any secretions
that are causing irritation.
If your child is coughing to the extent
that they're getting no sleep, that they're
in pain or significant discomfort,
or they're vomiting all the time,
you may want to do something to relieve
those coughing symptoms.
And at that point, it's reasonable to give them
an over-the-counter cough syrup.
You need to recognise that these aren't going to make your child
better any sooner, but they may make them feel a bit more
comfortable.
The other thing paracetamol, ibuprofen,
again over-the-counter can relieve
some of the pain associated with coughing.
So that's a normal cough.
What's abnormal?
What should get your spidey senses tingling?
Well thankfully, the most common causes of an abnormal cough
are still not too worrying.
Your child may have a bit of gastroesophageal reflux.
That's when stomach acid comes up
from the stomach up to the upper airways
and irritates the airways or the vocal cords
and makes some cough, particularly
at night or on exercise, and actually
sounds a lot like asthma.
Persistent bacterial bronchitis is a name
for a low level bacterial infection, which
causes your child to have a wet cough that just doesn't
go away even between colds.
There's also a quite unusual cause for a persistent cough.
We call it habit or psychogenic cough.
And it occurs in a context where children look very well and yet
they cough and cough and cough.
What is odd about this cough is that it's
much more prominent in the daytime,
and they hardly ever cough at night.
They cough an awful lot more in front of their parents,
particularly if their parents are worried or in front
of a paediatrician, but they won't really
cough when they're having fun.
Quite often they won't cough on the weekend.
And they won't cough if a nurse is watching.
The key thing is if a habit or psychogenic cough
has been identified, don't worry.
The answer is calm indifference, reassurance.
Don't talk about it, don't notice it, it will go away.
So let's talk about asthma.
Asthma is a condition where we have reversible narrowing
of the airways.
What that means for your child is wheezing and coughing,
quite often in response to a virus or exercise.
And the cough is particularly prominent at night.
Thankfully, most children with asthma
are readily controlled on inhaled steroids
or a blue inhaler, and you have seen these before.
And the key thing is if it is asthma,
it gets better with these treatments.
So we've talked about abnormal cough.
What then are the key red flag features
that should make you seek an urgent paediatric opinion?
We've talked about a wet cough that doesn't go away.
If you add to that a child that has also had severe breathing
difficulty maybe at birth, has had a runny nose since birth,
and maybe gets recurrent chest infections,
these may be a sign of immunodeficiency,
so a weakness in the immune system, or more
rarely a condition called PCD or primary ciliary dyskinesia,
where the hair cells that line the upper and lower respiratory
tract don't waft mucus out effectively.
I guess the final red flag you'd like
to look out for is a child whose cough is worse with eating
and drinking or perhaps doesn't like to eat and drink,
maybe the child who vomits a lot and has done severely
since they were born, this child may possibly have cough related
to aspiration.
That's passage of food and drink into the lungs, perhaps
through an abnormal connection between the breathing
tubes and the feeding tubes, something
we call either a fistula or a laryngeal cleft,
or perhaps due to severe gastroesophageal reflux.
So at this point, I think it's probably
helpful to go back to where we started.
Children cough, it's what they do, it's normal,
it's even healthy.
If you have doubts based on anything that I've said,
that's why you have a GP, that's why we have paediatricians.
Thank you for watching.
I hope that that's been informative.
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for more content on this and other childhood subjects.
We'll see you soon.