Hearing a child who coughs constantly and who may not be able to rest for him at night coughing fits, is always a source of great concern for parents. Instinctively they would like to find the miraculous solution, which in a few moments will make their children pass the trouble and, if they cannot identify it, they are alarmed.
In most cases, however, a cough is a passenger annoyance, which is accompanied by one of the many upper respiratory tract infections which can affect especially the little ones (who have not yet developed a sufficient 'baggage' of antibodies), especially during winter season. Immediately resorting to drugs to eliminate it can be counterproductive or even harmful.
To better understand what cough is, how many types exist and how to deal with it in an 'intelligent' way, we turned to Adima Lamborghini, pediatrician of free choice in Silvi (Teramo) and member of the Study Center of the Federation of Paesena pediatricians and , head of the Bronchopneumology Unit of the Bambino Gesù Pediatric Hospital in the city.Read also: Child always sick: why?
In this article
- what is cough;
- all types of cough in children;
- acute cough from postnasal discharge;
- acute cough and vomiting, what relationship is there;
- nocturnal cough, because it comes;
- reflux cough;
- natural cough remedies: which ones really work
- how to treat cough: contraindications to drugs;
- when to worry and when to go to the pediatrician;
- cough from foreign body inhalation
What is cough
The first thing to say is that the cough itself it is not a disease, but a reflex: A physiological defense mechanism of the organism, which serves to remove irritating materials from the respiratory tract such as microbes, environmental pollutants (smoke, smog, perfumes) or, more rarely, the presence of a foreign body.
"In practice - explains Cutrera - the irritating material present in the airways is enveloped by mucous secretions emitted by the lining of the airways and violently expelled through coughing. "Just think that a cough determines an air flow that can reach speeds of 800-1000 kilometers per hour during expulsion!
"In this sense, coughing is something positive, albeit annoying, not necessarily to be eliminated. What we need to do is instead evaluate the causes and try to eliminate them", says Lamborghini.21 PHOTOS
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Acute or chronic, dry or oily etc: all types of children's coughs
Coughing can have different characteristics and causes. There is for example a very typical cough, similar to the cry of a seal, caused by acute laryngitis (barking cough), or the convulsive and stubborn cough typical of whooping cough.
"There may be one acute cough, which lasts a few days or at most a few weeks and usually follows a cold or an upper respiratory infection, or a chronic cough, which lasts for more than two months and can be caused by diseases such as bronchial asthma, rhinosinusitis, sometimes gastroesophageal reflux, or even more serious but rare diseases such as cystic fibrosis or immune deficiency"explains Cutrera.Warning: often what is perceived as a chronic, long-lasting cough, is actually the succession of more episodes of acute cough, quite typical in preschool children, which every year can undergo numerous episodes of airway infection .
Is Covid-19 cough?
i main symptoms of Covid-19 in the pediatric population are:
- Dry cough
- Sore throat
- Nausea / vomiting
- Muscular pains
- Nasal congestion / runny nose
- Breathing difficulties
Unfortunately, these are the same symptoms that are caused by the flu or other viral infections, which is why distinguishing the coronavirus from these diseases is difficult. The only one different symptom that can manifest itself in the case of coronavirus compared to other flu syndromes is the loss of taste and smell, but remember that Covid can also be totally asymptomatic.
Acute cough from postnasal discharge: the most common among children
The most common cough in pediatric age is the acute cough that follows a cold or in general a respiratory infection of the upper airways, often of the type viral, and that in the first two to three days it can be associated with fever, usually not elevated.
“The main cause of this cough is lo postnasal discharge, that is, the fact that the mucus that forms in the nasal cavities flows backwards, towards the nasopharynx and throat, causing irritation of the upper airways ”, says Lamborghini.
Sometimes this cough appears as shoal, to then evolve into more form oily in the following days, as the production of mucus by the muciparous glands present along the airways increases. Other times, however, it presents itself with variable characteristics during the day: in some moments drier and more irritating, in others more greasy and full of phlegm.Read also: Phlegm in children
La acute cough it is typical both in the early hours of sleep - when the change of position from vertical (standing) to horizontal (lying) brings mucus from the nasal passages to the throat - and in the early morning or waking hours, because the airways try to expel the mucus that has accumulated in the throat during the night: this is why it is a typically fat cough, rich in phlegm.
"During the day, however, the mucus tends to become more fluid and transparent, dripping back towards the throat with an irritating effect that gives rise to a drier and more irritating cough. It is no coincidence that children often report that they also have a sore throat, despite the fact that the throat itself is not affected by infections ”, the pediatrician explains.
Another factor that promotes cough in the presence of colds and nasal congestion is the fact that there is a tendency to breathe through your mouth, letting in cold air, dust, germs, which stimulate the cough reflex.10 PHOTOS
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"Acute cough is very frequent in the first years of life, especially in children who go to the nursery or kindergarten, true 'receptacle' of viruses and germs" says Cutrera, specifying that it is estimated that children contract on average 6-8 viral infections affecting the upper respiratory tract each year, usually accompanied by cough.
This is why, despite being acute forms, sometimes these coughing episodes can seem chronic: “Parents see that the child is always coughing and worry, thinking that something is wrong. In reality, it is often just a succession of acute 'crises', due to the fact that one passes from one cold to another ”.
Acute cough and vomiting: what is the relationship
Acute cough reaches its peak within two to three days of its onset, possibly causing two to three sleepless nights due to continuous awakenings, sometimes also accompanied by vomiting for the strain caused by the constant coughing. The disorder usually resolves within a few days (but also a couple of weeks), when the cold also tends to regress spontaneously.Read also: Acute laryngitis (or barking cough) in children: symptoms, remedies
Cough at night, because it comes
“The triggers are mainly two” explains Lamborghini. The first, as we have already seen, is postnasal discharge, that is the descent of the mucus towards the nasopharynx and throat, and its accumulation during the night hours.
“The second cause is a typical one vasodilation which occurs when we lie down, due to an increased blood supply to the lung. This causes greater stimulation of cough receptors, perhaps already irritated, and leads to a certain persistence of dry cough, nocturnal. This phenomenon is particularly evident in whooping cough, characterized by greater damage to the surface of the bronchi and trachea ”.Read also: Whooping cough in children: symptoms, risks and vaccine
When the child exhibits a recurring cough, one is often thought of cough caused by gastroesophageal reflux. “It's actually quite a rare event,” explains pediatrician Adima Lamborghini. “In any case, the first thing to do if there is this suspicion is to see how things are going by applying some hygiene measures, such as avoiding certain foods in the evening, not going to bed immediately after eating, having small and frequent meals. If there is indeed a link to reflux, the cough may improve already. Cases to be treated pharmacologically for reflux are, on the other hand, very rare ".
Natural cough remedies: which ones really work
As we have said, cough is a natural defense mechanism of the body and therefore should not be blocked. There are a few ways to try though relieve discomfort which can cause. Let's see them.
- clean the nose well
- do nasal washes
- warm milk and honey (if the baby is over a year old)
- natural remedies (echinacea, snail slime and homeopathic have no scientific value)
- sleep with the head a little raised
- steam room
- aerosol with physiological (and not with cortisone, except specific cases)
- adequate temperature in the house (not too high)
- humidify the environment
- no smoke
Cleaning the nose: how to learn to blow it well
One of the reasons why coughing is so common in children, in addition to the fact that they are particularly prone to upper respiratory tract infections, is the fact that they cannot blow their nose well, so they are unable to remove excess mucus. this way. "So the first thing to do, even for preventive purposes, is teach children to blow their nose well"suggests Lamborghini.
How? "A little trick is to ask them to blow their noses until they move a cotton ball hanging from a string in front of them. This way the child sees what is happening, and has a signal - the movement of the ball - that he is actually blowing the right way. You can start with both nostrils open, and then ask to blow by closing one at a time. "
If there is mucus inside the nasal passages, this way it comes out. "In addition, blowing the nose, increasing the pressure inside the nasal cavity, also has the advantage of uncorking the ears and promoting the correct motility of the Eustachian tubes, reducing the risk of ear infections due to tubal malfunction" concludes Lamborghini .
A method typically recommended to alleviate the discomfort of coughing is nasal washing with vials or sprays of physiological or hypertonic solution. You can give it a try, but Lamborghini points out that there is no evidence that this strategy really does any good. "Among other things, it is a very superficial cleaning, which does not go deep into the retronasal cavities, and therefore does not help the removal of the mucus that is accumulating in the deeper areas. From this point of view, it is better to try with nasal showers or douches, that are able to clean in depth ".
Lots of hydration
It is very important to make the child drink a lot to avoid the thickening of secretions, which can favor the appearance of bacterial superinfections. Sometimes the child doesn't want to drink because he has fear of vomiting, but you have to find a way to convince him: hydration when you have a cough and cold is very important.
Hot milk with honey
It has now been widely demonstrated: honey contains substances capable of temporarily deactivating the reactivity of cough receptors, attenuating it without however suppressing it. For this it is widely recommended, also by the World Health Organization, as long as the child is at least one year old. Not surprisingly, honey is now the main component of many "natural" cough products for children: but the original, that is a teaspoon of honey every now and then, is fine. It can also help to calm the most intense "crises", which can lead to vomiting.
Honey for children: since when can it be given, which and in what quantities. All indications
The combination with hot milk is a winner because the benefits of honey are added to those ofthermal effect of hot milk, which makes the cough less dry. In this sense, other hot drinks are also good, such as herbal teas that may be pleasing to the child.
Natural remedies such as echinacea, snail slime, homeopathy
Read also: Colds: Remedies for children are not very effective
There is no scientific proof that they are really needed.
Nanna with the head raised
Make the baby sleep with his head a little higher than usual, perhaps by inserting an additional pillow under the mattress.
"It may have a partial effectiveness in the milder forms of laryngeal, barking coughs, while in those whose origin is the nose, it is not very effective. On the contrary: it could make things worse because the intense humid heat can increase nasal congestion", says Lamborghini. .
Aerosol with physiological solution
Do you really need it? In reality, there is no definitive answer to this question. In theory it might be of some use, but in practice there is no solid scientific data on what the effects of this practice actually are. If the child tolerates it, you can still give it a try and observe the situation, to see if the treatment gives any benefit or not.
Absolutely avoid the aerosol with cortisone, except in very specific cases (for example for acute laryngitis). Read also: Too many aerosol prescriptions, an entirely Del Paeseno phenomenon. That's when you REALLY need it
Humidify the environment
It is useful if the environment is dry, otherwise it is useless or, if the humidity becomes excessive, it can become counterproductive.
Adequate temperature in the house
"The temperature should not be too high, better not to exceed 18-19 degrees by day and 17 at night "advises Adima Lamborghini, also suggesting to avoid sudden changes in temperature as much as possible.
Read also: Aerosol therapy and children
It is essential to never let the child stay in places where they smoke. And also pay attention to third-hand smoke, the one that sticks to clothes and hair and that can be inhaled by the child if, for example, you pick him up after smoking on the terrace or in the garden. Smoking is always irritating to the airways (as well as being extremely harmful to health).
How to treat cough: contraindications to drugs
Medicines can only be used if the cough remains very intense despite having adopted the suggested remedies e only after consulting the pediatrician.
Especially in children, drugs must never be administered on their own initiative, even when it comes to over-the-counter drugs, which can be purchased without a prescription! Very often, in fact, for certain medicines there is a lack of studies that prove the safety and efficacy in children, and it is not enough to reduce the dosage to be sure of their safety. In short, when it comes to children, caution is always mandatory. Let's see the indications of for various categories of drugs:
- nasal decongestants: it is true that they reduce edema and secretions in the nasal cavities helping to breathe better, but since 2007 their use has been banned for children under the age of 12, since they have a vasoconstricting effect that can give even serious adverse reactions;
- mucolytics or mucus fludifying: it makes sense to use them only if the cough implies a chronic pathology such as cystic fibrosis. In the vast majority of acute manifestations, on the other hand, mucolytics have proved useless, if not even potentially harmful;
- "central" cough suppressants (they act at the level of the nervous system to calm the cough stimulus): they can give major side effects, for which they should be administered only in case of actual and absolute necessity, under strict medical supervision (in the USA their use is prohibited for children under six years of age);
- local sedatives of the upper airways, such as syrups containing honey or other substances with emollient effects. Always under medical supervision;
- cortisone: only for extremely specific cases (such as acute laryngitis) and never for acute cough from accumulation of nasal mucus;
- antibiotics, often administered too lightly: they are indicated only if a bacterial superinfection is in progress, otherwise they are absolutely useless (and harmful due to the risks associated with the phenomenon of resistance)
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When to worry and when to go to the pediatrician
Given that an acute cough, which appears together with or immediately after a cold, is a frequent and normal phenomenon, which certainly bothers the child (and his parents) but should not cause particular concern, the doctor should be consulted as soon as possible when the cough:
- goes with shortness of breath or a high respiratory rate (this could be asthmatic bronchitis);
- is accompanied by a high fever for two or three days (or the fever returns after a couple of days of remission), which may lead to suspicion of a bacterial superinfection;
- è persistent or stubborn and interferes with the child's normal daily activities, including feeding;
- has been going on for a few weeks;
- goes with a elevated malaise of child;
- it manifests itself systematically at the end of physical exercise (even a run to the playground): it could be a symptom of asthma.
In addition, it is good to consult the pediatrician when the reasons for the onset of the cough are not clear or if you suspect that the child may have inhaled a foreign body.
Cough from foreign body inhalation
It can happen that a cough appears suddenly, with no apparent cause. It could be due to the inhalation of a foreign body: food, a small piece of a game or something else. In these cases the child goes encouraged to stay calm and cough, because the coughing could alone cause the foreign body to escape, alerting the emergency system anyway, with a phone call to 112 or 118.
Only if the child stops coughing, crying and talking, and therefore the obstruction of the airways has become complete, it is necessary to intervene with the appropriate unblocking maneuvers.
“Sometimes, however, the event of inhalation of the foreign body is not so evident. Maybe the parents did not notice and initially the cough is not very evident. What happens in these cases is that one can occur pneumonia after some time, due precisely to the presence in the lungs of the foreign body, which is covered with mucus and in the long run becomes infected ”explains Lamborghini. In these cases it is necessary to intervene with an (extremely delicate) intervention of bronchoscopy for removal of the foreign body.
Questions and answers
When do babies cough?
There are several types of cough in children. The most frequent is the acute one that arises following a cold or an upper respiratory infection. Other types of cough are barking (laryngitis), whooping cough, cough from inhalation of a foreign body, and chronic cough caused by underlying diseases.
Cough in the child: when to worry?
Coughing is usually not a concern. But the doctor should be consulted as soon as possible when coughing:
- it is accompanied by shortness of breath or a high respiratory rate (it could be asthmatic bronchitis);
- lasts for a few weeks;
- bad ear
- airway infections
- 1-2 children years