Children’s cough: what is cough?

A cough is a critical reflex action designed to promote clearing of the upper airways. The material being coughed up maybe as a consequence of many conditions – from a lung or sinus infection to an accidentally inhaled foreign object (for example, food or small toy).

A cough may also be a symptom of compromised lung function (for example, wheezing) or reflect rare conditions (for example, anatomical malformations).

All children will cough occasionally but recurrent cough, difficulty breathing with cough, or coughing up purulent or bloody material warrant a thorough and timely evaluation. A wet (with mucous) cough will sound different than a dry or scratchy cough or a “barking” (sounds like a dog or seal) cough.

Acute cough – cough lasting less than four weeks. Chronic cough – cough lasting longer than four weeks.

Since children’s cough may be associated with a broad array of situations, it is helpful to consider possible causes under various categories. These would include:

Infection

The number one cause of cough in children would the common cold (URI – upper respiratory infection). Generally this cough is secondary to drainage of mucous down the back of the throat, thus stimulating the cough reflex center.

Most children cannot “cough up” phlegm efficiently. Generally their cough pushes the drainage from one area of the back of the throat to another. Children commonly will swallow the mucous after coughing and during sleep.

Children have been known to cough with such force that they may vomit up previously swallowed mucoid material.

Irritation and swelling of the vocal cord region caused by a viral infection may produce a characteristic “barky” cough (sounding similar to that of a dog or a seal). Such a viral infection is termed croup.

A sinus infection is generally a complication of a URI and may be associated with consistent thick and purulent (green or yellow) nasal drainage either onto the facial region or down the back of the throat. This drainage will also stimulate the cough center as described.

Lower airway infections (i.e. those inside the chest cavity) include viral illnesses (pneumonia, bronchitis, etc.) or bacterial causes (pneumonia, pertussis whooping cough etc.).

Nasal allergies

The amount of watery nasal drainage produced as a consequence of nasal allergy may be considerable. The material may commonly drain down the back of the throat (“post nasal drainage”) and trigger the cough center in the rear of the throat.

Foreign body

Any object that does not pass from the back of the mouth into the esophagus runs the risk of aspiration into the windpipe (trachea). This is most common in young toddlers due to their infatuation with smaller objects and their intense oral fixation. Any object that can pass through the opening of a vertically oriented toilet paper cardboard tube is considered a risk object.

Older children or adults who incompletely chew food prior to swallowing may also aspirate material.

Wheezing

Narrowing the functional diameter of the smaller airways make it difficult to breath (exhalation worse than inhalation) and can cause a characteristic sound during respiration. Wheezing is a consequence of two phenomena – narrowing the airway secondary to tightening of the muscles that wrap around this lung region, as well as thickening of the lining of the airway as a consequence of inflammation.

In children the most common trigger to produce these reactions is the virus that causes the common cold (URI). Certain viruses (for example, respiratory syncytial virus ) are notorious in this regard. The environment (grasses, dust, mold etc.) may also trigger such a reaction. In older children intense physical activity or cold air may also trigger a wheezing episode.

Gastroesophageal reflux disease (GERD)

Regurgitation of stomach contents and/or acid may trigger a reflex cough and should be considered when the more common causes of cough have been eliminated. This is more common in infants and young children. These young children and infants may not have obvious spitting up of liquids or solids during such episodes; however, they become very irritable.

Benign motor tic

Children may occasionally have repetitive throat clearing as manifestation of a tic. They do not seem to be in any distress during these episodes and the child may stop them voluntarily and they do not occur during sleep. Parents will often describe such cough as “he/she has a tickle in her throat”.

Rare causes

Various rare causes of cough need to be considered when the more obvious or routine mechanisms have been eliminated. A partial listing includes: cystic fibrosis, congenital heart disease, heart failure, congenital malformations of the airway, lungs or major blood vessels of the chest, etc.

Many of the causes (etiologies) of acute cough discussed above may also persist greater than four weeks and thus be classified as chronic cough.

Two causes of acute cough which generally have a shorter than four-week lifespan include: upper respiratory infections (generally a maximum of 2-week duration) and croup (generally 4- to 6-day duration).

Males are more likely to have chronic cough than females.

Causes of chronic Children’s Cough

(in addition to those listed above for acute cough) include:

1. Irritation of the airways: pollution, primary or secondhand smoke, and an allergen may also produce persisting cough. Elimination or reduction of the offending irritant is therapeutic.
2. Increase in cough receptor sensitivity: Some children seem to have a more sensitive response to irritants than their peers. The mechanism for this increase in cough receptor sensitivity is not well defined at this time. Possibilities under consideration include inflammation, erosion of the surface cell layer of the airway or a sensitization of the airway. The diagnosis may be explored in research centers using a cough-inducing irritant (capsaicin) as a quantifiable stimulant. Interpretation of such data is in the infancy stage.
3. Habit cough: This cough has both a psychological and physical component. While often triggered by the common upper respiratory infection, the duration of cough symptoms far exceeds the duration of the viral infection. Parents will describe a distinctive quality of cough: short, dry, single episodes that may mimic a benign motor tic. Unlike a tic, the cough may be quite loud and disruptive to the classroom setting. The cough is commonly present during a medical evaluation but it does not characteristically interfere with play, sleep, talking, or eating. No specific diagnostic evaluation exists and habit cough is a diagnosis of exclusion. Counseling is generally an effective management technique.
4. Otogenic cough: A minority of individuals have a branch of the nerve used in the cough reflex lining the ear canal. Irritation of the canal (Q-tips, ear wax, drops etc.) may cause irritation of this nerve and thus induce a persisting and non-productive cough. While this is a relatively rare cause of children’s cough, removal of the offending agent is curative.

   How is the cause diagnosed?

   Taking a thorough history and conducting a comprehensive physical examination generally leads to a narrow list of diagnostic possibilities. Laboratory studies, X-ray studies and specialized testing by allergists or pulmonary specialists may occasionally be necessary to establish or confirm the cause of childhood cough.

   Issues to be evaluated while taking a history of childhood cough include:

   • Duration and intensity of cough,
   • Character of the cough (for example, the “bark” of croup),
   • Events leading up to the cough (for example, possibility of foreign body aspiration),
   • Events which affect cough (for example, physical activity produces increase in cough and shortness of breath in wheezing),
   • Precipitating events associated with cough (for example, GERD symptoms associated with feeding),
   • Progressive worsening of symptoms and development of fever (for example, pneumonia as complication of upper respiratory infection),
   • Environmental influences (for example, nasal allergy), and
   • Possible emotional component (for example, benign motor tic).

   Testing may include:

   • Chest X-ray and/or sinus X-rays,
   • Pulmonary function tests – determines the adequacy of lung inspiration and expiration effort and capability,
   • Allergy testing,
   • Nasal swabs for specific infectious agents (for example, respiratory syncytial virus, pertussis whooping cough).
   • Specialized X-ray studies to help define anatomy (for example, barium swallow), and
   • Endoscopy and bronchoscopy (insertion of a flexible device with camera to evaluate the upper airway.

Cold and Cough Allopathic Medicine

Deciding among the OTC (over-the-counter) allopathic remedies for cough and cold symptoms can be intimidating, especially when it concerns children. A basic understanding of the types of drugs contained in these medications can help you make an informed choice. Examples of OTC drugs used for symptoms associated with cold and cough include:

• Decongestants
• Antihistamines
• Cough medicine (expectorants, suppressants, etc.).

Moreover, a number of studies have demonstrated potential side effects due to the nature of the allopathic chemicals/drugs included in these formulations. Occasionally a single dose of an anti-inflammatory drug dexamethasone (Decadron) is indicated.

Bacterial infections (for example, pneumonia, sinus infections) respond well to selected antibiotics.

Wheezing is treated with various inhaled medications, and if there is a concern regarding aspiration of a foreign object it may require removal by bronchoscopy.

GERD may be treated via thickening of formula for infants and/or oral medications depending of severity of symptoms and complications of acid reflux into the esophagus. Treatment of rare conditions (for example, cystic fibrosis) utilizes a team approach to control and minimize the course of these diseases.

Due to the diversity of causes (etiologies) of childhood cough the therapies available need to be directed to the proper causative agent.

• Routine upper respiratory infections (“common cold”) respond best to rest, fluids, and tender loving care. Multiple studies have demonstrated no benefit for the various over-the-counter (OTC) medications.
• Use of a cool mist humidifier may be very helpful for the treatment of the laryngeal (“voice box”) swelling associated with croup.

Homeopathic Treatment for Acute and Chronic Children’s Cough

Ambra Gresia

Asthmatic breathing with eructation of gas. Nervous, spasmodic cough, with hoarseness and eructation, on waking in morning; worse in presence of people. Tickling in throat, larynx and trachea, chest oppressed, gets out of breath when coughing. Hollow, spasmodic, barking cough, coming from deep in chest. Choking when hawking up phlegm. Palpitation, with pressure in chest as from a lump lodged there, Palpitation in open air with pale face.

Kalium Bichromicum

Voice hoarse; worse, evening. Metallic, hacking cough. Profuse, yellow expectoration, very glutinous and sticky, coming out in long, stringy, and very tenacious mass. Tickling in larynx. Catarrhal laryngitis cough has a brassy sound. True membranous croup, extending to larynx and nares. Cough, with pain in sternum, extending to shoulders; worse when undressing. Pain at bifurcation of trachea on coughing; from mid-sternum to back.

Drosera Rotundfolia

Affects markedly the respiratory organs and is the principal remedy for whooping-cough. Drosera can break down resistance to tubercle. Phthisis pulmonal; vomiting of food from coughing with gastric irritation and profuse expectoration. Spasmodic, dry irritative cough, whooping cough. yellow expectoration, with bleeding from nose and mouth, laryngitis. Rough, scraping sensation deep in the faucet and soft palate.

Causticum

Hoarseness with pain in chest; aphonia. Larynx sore. Cough, with raw soreness of chest. Expectoration scanty; must be swallowed. Cough with pain in hip, especially left worse in evening; better, drinking cold water; worse, warmth of bed. Sore streak down trachea. Mucus under sternum, which he cannot quite reach. Pain in chest, with palpitation. Cannot lie down at night. Voice re-echoes. Own voice roars in ears and distresses. Difficulty of voice of singers and public speakers.

Sambucus Nigra

Chest oppressed with pressure in stomach, and nausea Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnea. Spasmodic croup. Dry coryza. Sniffles of infants; nose dry and obstructed. Loose choking cough. When nursing child must let go of nipple, nose blocked up, cannot breathe. Child awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. Millar’s asthma.

Dry heat while sleeping. Dreads uncovering. Profuse sweat over entire body during waking hours. Dry, deep cough precedes the fever paroxysm.

Pulsatilla Pratensis

Capricious hoarseness; comes and goes. Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucous expectoration. Pressure upon the chest and soreness. Great soreness of epigastrium. Urine emitted with cough. Pain as from ulcer in middle of chest. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side. Smothering sensation on lying down.

Conium Maculate

Dry hacking cough, almost continuous; worse, evening and at night, when lying down, talking or laughing, and during pregnancy. Expectoration only after long coughing.

The patient has a cough at night on lying down. They are restless at night and tend to sit up many times due to coughing spells. A tickling sensation in the throat pit may be prominently present. A few individuals may complain of an unusually dry spot in the larynx. In some cases, a headache on coughing may arise.

Hydrocyanicum Acidum

Noisy and agitated breathing. Dry, spasmodic, suffocative cough. Asthma, with contraction of throat. Whooping-cough. Paralysis of lungs. Marked cyanosis; venously congested lung.

Cina Maritima

Gagging cough in the morning. Whooping-cough. Violent recurring paroxysms, as of down in throat. Cough ends in a spasm. Cough so violent as to bring tears and sternal pains; feels as if something had been torn off. Periodic; returning spring and fall. Swallows after coughing. Gurgling from throat to stomach after coughing. Child is afraid to speak or move for fear of bringing on paroxysm of coughing. After coughing, moaning, anxious, gasps for air and turns pale.

Light chill. Much fever, associated with clean tongue. Much hunger; colicky pains; chilliness, with thirst. Cold sweat on forehead, nose, and hands.

Spongia Tosta

A remedy especially marked in the symptoms of the respiratory organs, cough, croup, thyroid gland swollen. stitches and dryness in throat, burning stinging and sore throat etc. Tickling causes cough. Clears throat constantly. Laryngeal phthisis. Goiter.

Great dryness of all air-passages. Hoarseness; larynx dry, burns, constricted. Cough, dry, barking, croupy; larynx sensitive to touch. Croup; worse, during inspiration and before midnight. Respiration short, panting, difficult; feeling of a plug in larynx. Cough abates after eating or drinking, especially warm drinks. Wheezing asthmatic cough, worse cold air and lying, head low and in warm, with profuse expectoration and suffocation. Oppression and heat of chest.

Swelling and induration of glands; also exophthalmic; cervical glands swollen with tensive pain on turning head, painful on pressure; Goiter. Itching; measles.

Corallium Rubrum

whooping and spasmodic coughs, especially when the attack comes on with a very rapid cough, and the attacks follow so closely as to almost run into each other. Often preceded by sensation of smothering, followed by exhaustion. Profuse, nasal catarrh. Cough that results from PND (post nasal dripping). Hawking of profuse mucus. Throat very sensitive, especially to air.

The cough appears in quick, short attacks that follow each other in quick succession, hysterical cough. Dry, spasmodic, suffocative cough; very rapid cough, short, barking, whooping-cough. Extreme exhaustion is felt along with the cough. A vital symptom that attends the above symptoms are extremely sensitive air passages to air (inhaled air feels cold).

Millifolium

Millifolium is an antiviral medicine. Cough with bloody sputa or in any lung disease with accompanying cough. Shortness of breath, difficulty in breathing, oppression of chest. Hemoptysis after injury or following violent exertion.

Pulsatilla Nigricans

Capricious hoarseness. Dry cough in evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucous expectoration. Expectoration bland, thick, bitter, greenish. Short breath, anxiety, and palpitation when lying on left side.

Phosphorus

Cough from tickling in throat; worse, cold air, reading, laughing, talking, from going from warm room into cold air. Sweetish taste while coughing. Hard, dry, tight, racking cough. Congestion of lungs. Burning pains, frothy or blood-stained sputum. The phlegm may be salty or sweet to taste. Strong odors may trigger a cough. Pneumonia, with oppression.

Bryonia Alba

Soreness in larynx and trachea. Hoarseness; worse in open air. Dry, hacking cough from irritation in upper trachea. Cough, dry, at night; must sit up; worse after eating or drinking, with vomiting, with stitches in chest, and expectoration of rust-colored sputa. Frequent desire to take a long breath; must expand lungs. Difficult, quick respiration; worse every movement; caused by stitches in chest. Cough, with feeling as if chest would fly to pieces; presses his head on sternum; must support chest. Croupous and pleuro-pneumonia. Expectoration brick shade, tough, and falls like lumps of jelly. Tough mucus in trachea, loosened only with much hawking. Coming into warm room excites cough. Heaviness beneath the sternum extending towards the right shoulder. Cough worse by going into warm room.

Throat: Dryness, sticking on swallowing, scraped and constricted. Tough mucus in larynx and trachea, loosened only after much hawking; worse coming into warm room.

Sambucus Nigra

Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnea. Spasmodic croup. Dry coryza. Sniffles of infants; nose dry and obstructed. Loose choking cough. When nursing child must let go of nipple, nose blocked up, cannot breathe. Child awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. Millar’s asthma.

Moschus

Tightness of chest, is obliged to take a deeper breath. Sudden constriction of larynx and trachea. Difficult respiration; chest oppressed; hysterical spasm of chest; asthma. Spasm of glottis. Impending paralysis of lungs. Asthma, with intense anxiety, fear, and smothering sensation. Cough ceases, mucus cannot be expectorated. Globus hystericus.

Mephitis Putorius

Sudden contraction of glottis, when drinking or talking. Food goes down wrong way. False croup; cannot exhale. Spasmodic and whooping-cough. Few paroxysms in day-time, but many at night; with vomiting after eating. Asthma, as if inhaling Sulphur; cough from talking; hollow, deep, with rawness, hoarseness, and pains through chest. Violent spasmodic cough; worse at night.

Senega

Hoarseness. Hurts to talk. Bursting pain in back on coughing. Catarrh of larynx. Loss of voice. Hacking cough. Thorax feels too narrow. Cough often ends in a sneeze. Rattling in chest. Chest oppressed on ascending. Bronchial catarrh, with sore chest walls; much mucus; sensation of oppression and weight of chest. Difficult raising of tough, profuse mucus, in the aged. Asthenic bronchitis of old people with chronic interstitial nephritis or chronic emphysema. Old asthmatics with congestive attacks. Exudations in Pleura. Hydrothorax. Pressure on chest as though lungs were forced back to spine. Voice unsteady, vocal cords partially paralyzed.

Throat: Catarrhal inflammation of throat and faucets, with scraping hoarseness. Burning and rawness. Sensation as if membrane had been abraded.

Mercurius Sulphuricus

Throat. Heat and sensation of constriction in throat. Dryness of tongue and throat. Burning in mouth and throat. Respiratory Organs. Roughness in throat and hoarseness. Sensation of heat in larynx. Increased expectoration of mucus from larynx” and trachea. Dyspnea; in children; hydrothorax.

Coccus Cacti

Constant hawking from enlarged uvula; coryza, with inflamed faucets; accumulation of thick viscid mucus, which is expectorated with great difficulty. Tickling in larynx. Sensation of a crumb behind larynx, must swallow continually; brushing teeth causes cough. Faucets very sensitive. Suffocative cough; worse, first waking, with tough, white mucus, which strangles. Spasmodic morning cough. Whooping cough attacks end with vomiting of this tough mucus. Chronic bronchitis complicated with gravel; large quantities of aluminous, tenacious mucus, are expectorated. Walking against wind takes breath away.

Bromium

Whooping cough (Use persistently for about ten days). Dry cough, with hoarseness and burning pain behind sternum. Spasmodic cough, with rattling of mucus in the larynx; suffocative. Hoarseness. Croup after febrile symptoms have subsided. Difficult and painful breathing. Violent cramping of chest. Chest pains run upward. Cold sensation when inspiring. Every inspiration provokes cough. Laryngeal diphtheria, membrane begins in larynx and spreads upward. Spasmodic constriction. Asthma; difficulty in getting air into lung. Better at sea, of seafaring men when they come on land. Hypertrophy of heart from gymnastics. Fibrinous bronchitis, great dyspnea. Bronchial tubes feel filled with smoke.

Nux Vomica

Catarrhal hoarseness, with scraping in throat. Spasmodic constriction. Asthma, with fullness in stomach, morning or after eating. Cough, with sensation as if something were torn loose in chest. Shallow respiration. Oppressed breathing. Tight, dry hacking cough; at times with bloody expectoration. Cough brings on bursting headache and bruised pain in epigastric region.

Throat: Rough, scraped feeling. Tickling after waking in morning. Sensation of roughness, tightness, and tension. Pharynx constricted. Uvula swollen. Stitches into ear.

Rumex Crispus

Nose dry. Tickling in throat-pit causes cough. Copious mucous discharge from nose and trachea. Dry, teasing cough, preventing sleep. Aggravated by pressure, talking, and especially by inspiring cool air and at night. Thin, watery, frothy expectoration by the mouthful: later, stringy and tough. Rawness of larynx and trachea. Soreness behind sternum, especially left side, in region of left shoulder. Raw pain under clavicle. Lump in throat.

Dulcamara

Cough worse cold, wet weather, with free expectoration, tickling in larynx. Cough, hoarse, spasmodic. Whooping-cough, with excessive secretion of mucus. Winter coughs, dry, teasing. Asthma with dyspnea. Loose, rattling cough; worse wet weather. Must cough a long time to expel phlegm. Cough after physical exertion.

Dry coryza. Complete stoppage of nose. Stuffs up when there is a cold rain. Thick, yellow mucus, bloody crusts. Profuse coryza. Wants nose kept warm, least cold air stops the nose. Coryza of the new born.

Belladonna

Drying in nose, faucet, larynx, and trachea. Tickling, short, dry cough; worse at night. Larynx feels sore. Respiration oppressed, quick, unequal. Cheyne-Stokes respiration. Hoarse; loss of voice. Painless hoarseness. Cough with pain in left hip. Barking cough, whooping cough, with pain in stomach before attack, with expectoration of blood. Stitches in chest when coughing. Larynx very painful; feels as if a foreign body were in it, with cough. High, piping voice. Moaning at every breath.

Throat dry, as if glazed; angry-looking congestion; red, worse on right side. Tonsils enlarged; throat feels constricted; difficult deglutition; worse, liquids. Sensation of a lump. Esophagus dry; feels contracted. Spasms in throat. Continual inclination to swallow. Scraping sensation. Muscles of deglutition very sensitive. Hypertrophy of mucous membrane.

Chamomilla

Hoarseness, hawking, rawness of larynx. Irritable, dry, tickling cough; suffocative tightness of chest, with bitter expectoration in daytime. Rattling of mucus in child’s chest. Parotid and submaxillary glands swollen. Constriction and pain.

https://youtu.be/qwxxbyGORAc

Ferrum Phosphoricum

First stage of all inflammatory affections. Congestions of lungs. Hemoptysis. Short, painful tickling cough. Croup. Hard, dry cough, with sore chest. Hoarseness. Expectoration of pure blood in pneumonia. Cough better at night.

Mouth hot; faucets red, inflamed. Ulcerated sore throat. Tonsils red and swollen. Eustachian tubes inflamed. Sore throat of singers. Subacute laryngitis with faucet inflamed and red (2x). After operations on throat and nose to control bleeding and relieve soreness. First stage of diphtheria. Ranula in vascular, sanguine constitutions.

Hepper Sulphuricum

When swallowing, sensation as if a plug and of a splinter in throat. Quinsy, with impending suppuration. Stitches in throat extending to the ear when swallowing. Hawking up of mucus. Hoarseness, with loss of voice. Cough troublesome when walking. Dry, hoarse cough. Croup with loose, rattling cough; worse in morning. Choking cough. Rattling, croaking cough; suffocative attacks; has to rise up and bend head backwards. Anxious, wheezing, moist breathing, asthma worse in dry cold air; better in damp. Palpitation of heart.

Cuprum Metallicum

Cough as a gurgling sound, better by drinking cold water. Suffocative attacks, worse 3 am (Am c). Spasm and constriction of chest; spasmodic asthma, alternating with spasmodic vomiting. Whooping-cough, better, swallow water, with vomiting and spasms and purple face. Spasm of the glottis. Dyspnea with epigastric uneasiness. Spasmodic dyspnea before menstruation. Angina with asthmatic symptoms and cramps.

Ipecacuanha

Dyspnea; constant constriction in chest. Asthma. Yearly attacks of difficult shortness of breathing. Continued sneezing; coryza; wheezing cough. Cough incessant and violent, with every breath. Chest seems full of phlegm, but does not yield to coughing. Bubbling rales. Suffocative cough; child becomes stiff, and blue in the face. Whooping-cough, with nosebleed, and from mouth. Bleeding from lungs, with nausea; feeling of constriction; rattling cough. Croup. Hemoptysis from slightest exertion. Hoarseness, especially at end of a cold. Complete aphonia.

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