Sunday, November 19, 2006

Help Doctor, my child is having a COUGH!


When my kids start to cough, my wife, my mom, my mother-in-law start to panic and push me to do something about it. Aiya, it's only a cough, why panic? But that's just because I have the necessary knowledge to discern between a dangerous cough and a benign (non dangerous) cough. So in this blog, I will share with you some points on how to handle your child who is coughing.

Why do kids cough?

Cough is important because it is the body’s way of clearing foreign objects and secretions from the respiratory tract. The cough itself is a symptom of an underlying disease and not the disease itself. Now, don't fall into the trap of assuming that treating a cough means giving cough syrups! If only life were so simple! The most important thing about treating a cough is to know the cause. Some coughs need to be treated with antibiotics, others may need to be treated with puffers (medication that is inhaled).

What are the common causes of cough in children?

A useful way to think about coughs is to divide them into into long term (more than 3 weeks) and short term coughs (less than 3 weeks)

Short term coughs

These are usually caused by infections or allergies. The infection may be isolated to the upper airways (ie the throat) or lower airways (the lungs). If the child is coughing and has a fever, it is advisable to bring her to the doctor to exclude pneumonia (lung infection). A child with a sore throat and a fever will need to be seen by a doctor.

Long term coughs

Some of the common conditions that can cause a long term cough are Asthma, Post Nasal Drip (this is when the mucous from the nose drips down to the throat and the child coughs to get rid of it) and Gastro-oesophageal reflux disease (When the stomach contents goes back up the food pipe.

When is a cough harmful?

The cough itself is not harmful. The important thing is to find out the cause of the cough. Conditions such as pneumonia and asthma which may have harmful complications if not treated early.

What tests should be done.

For any cough lasting more than 3 weeks, a Chest X-ray is advised to rule out important or uncommon causes for the cough like pneumonia, TB, developmental problems, inhaled foreign bodies and other diseases. Once the chest X-ray is shown to be normal, the most likely remaining causes of a long term cough are post-nasal drip syndrome, asthma and reflux disease.

Allergic Rhinitis/Post nasal drip syndrome

These children typically wake up coughing in the morning to clear the throat. They may frequently be having a runny nose but without a fever. You should approach your doctor who may assess the child and prescribe preventive medications.


These children may have an audible wheeze and be very short of breath after exercising. They may also wake up coughing in the middle of the night with an incessant cough. Asthma affects one in five children in Singapore so it is quite a common condition. When properly treated, the child should be able to function like any normal child.

You should be suspicious of Asthma if
  1. There is a family history of Asthma

  2. The child has eczema (sensitive skin) or allergic rhinitis (sensitive nose)

  3. Cough incessantly in the middle of the night

  4. Wheezes

  5. Gets very short of breath when excercising
Asthma needs to be properly managed by your doctor. Children who wake up more then 2 nights per month coughing or has a wheeze one or more times every week need to be treated with preventive medications.

Gastro-esophageal Reflux Disease

The child may complain of abdominal discomfort and may have reflux of milk after feeds. A trial of anti reflux medication for 2 weeks may alleviate the symptoms of cough.

The 100 Day Cough

There is a common saying amongst Singaporeans about the 100 day cough. This is a cough that follows a throat infection which may last up to 8 weeks. The important thing to note is that you should only conclude that the cough is a 100 day cough when all the other important causes of the cough has been eliminated.

OK, I hope that is enough information for the meantime. This is in no way complete and you may want to refer to these articles for more information:

Your Child's Cough
Patient information on Asthma

Always check with your doctor if you are in any doubt!


Dr Leslie said...

Hope you all are finding this useful. Please leave your comments by clicking on the comments at the end of the blog

Anonymous said... 3yrs old gal is asthmatic..we put her on ventolin whenever she coughs badly. Doc will prescribe seretide sometimes. We understand that the former provides immediate relief compared to the latter. But apart from that - any difference between these 2? Can u obtain the drugs over at the pharmacy or do we need docs prescription to get one? Thanks.

Dr Leslie said...

This is very good question and very relevant. I will write a series of blogs on Asthma soon.

The most important step for you now is to grade the Asthma. This is done from the history of how many wheezes your child gets and how often she gets it. Once the grading is done, the treatment plan can be instituted.

Seretide is what we call a preventer. It should be used as long term medication over a few months rather then as and when your child gets an attack.

Asthma is a condition that you should learn to manage with the help of your doctor. The medications need to be used correctly which is why it should be prescribed.

Anonymous said...

thanks..I look forward for yr articles.
Based on history, hers is inherited from me - both myself and my sister-in-law (husband's sister) had childhood asthma, and eczema in our teens (even until now). We knew both medical condition (asthma and eczema) are somehow related.
In my gal's case, cold drinks or food is strictly prohibited. However, sometimes when she kena flu, fever, running nose, her coughing will follow next. Hence it is our SOP to standby salbutamol whenever she is sick. And how does salbutamol differ from the other? I knew my PD give her in oral form - and she tends to be drowsy after taking it. But it makes her sleep better. As these drug contains steriod, I m concerned the effect of prolong usage. But I hate to see her coughing so badly.

Meihua said...

love reading this blog. May I ask if giving the child Vitamin C helps? What kind is suggested? Thanks.

Dr Leslie said...

Vit C is good for maintaining a healthy immune system. So if your child is not eating enough fruits rich in Vit C, supplemental Vit C will help.

Joey Anna said...

Hmmm, I am just curious to find out my childhood problem... ...

My mum thinks all 3 of us cough too much. And all of us were put on pharmacy medicine till about 7.

I was on Woods, and then Actified daily till the age of 5 and a half. When my phlegm increased, I was given Rhenathiol (which is so sweet I like! hahaha). (Basically, all 3 of us were on cough mixtures everyday for more than 5 years.)

We visited the doctor every fortnight, cos my mum thinks we simply can't stop falling sick.

I ate the milky yellow antibiotic and milky pink one aaalll the time.

Finally at Pri 1 or 2, I think, I couldn't breathe. So memorable, as it as CNY eve. But my father is asthmatic, so we have the inhaler. After using the inhaler, I was alright, but diagnosed with asthma the following day. My elder bro was earlier diagnose with asthma, and many, many years later, younger bro too. Both hold inhalers. I am lucky I don't.

Funny thing is, I never ever had a relapse till date. And it is now qualified as childhood asthma and does not counts as a medical condition when signing up for things like blood donation.

I have been taking Vitamin C and cod's liver oil since maybe 2 or 3 years' old???

Hmmm, so what was it? Just a weak immune system? I still phlegm up very easily with dust and cold temperatures now... Which leads to runny nose, nose blocked, cold, flu etc. It is very irritating. But I hate medicine so much, I wouldn't take anything already. Just let it heal on its own.

(Climbing Great Wall and winter Beijing is scary. I have concluded that all asthmatic people, childhood or not are doomed to die of asthma! (Especially with Theresa Teng's episode in the back of my head.) LOL. okok, I know. Warp logic. But I got so scared I will never put myself under such conditions if possible. And if needed, I will go and request an inhaler. Almost died. At least, I did have that feeling of last breath. Very dangerous. hahaha.)

I wonder if there are other children like me... ...

Joey Anna said...

Oh, btw, ventolin is by far the best cough medicine I've taken. But for 3 year olds??? Very strong in my opinion.