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Healthy
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What to do About Coughs
Since clean air is needed to breathe and uncluttered airways (the windpipe and the bronchi) to breathe through, it is important to realize that the cough mechanism is very useful in whooshing debris from the airways. It also can be helpful in getting rid of mucus and pus when infection is present. At times it can be a bit annoying, like the night time cough of someone with drippy sinuses. But that reflex--the cough--can be a lifesaver.
Coughing is frequent in childcare programs. When the children come to the childcare or preschool program, they don't leave their coughs at home. It is useful for caregivers to know a bit about how and why children cough and to be aware of some potentially serious and significant coughs.
Our air passages are lined with innumerable hair trigger nerves. When stimulated by an inhaled gnat, irritation from tobacco smoke, a bit of food which went down the wrong way, or mucus from infection in the airway, these nerves send an immediate message to the brain, which in turn, directs the coughing reflex.
Here is what happens: First, the individual inhales deeply. (An adult immediately inhales about 2.5 liters of air. Think of the size of a 2-liter soda!) The vocal cords close and seal the air within the chest. Then the chest muscles and diaphragm tighten and compress the chest, building up the pressure of the air contained within. The vocal cords then snap open and air explodes to the outside at rates of up to 100 miles an hour! A good plan to rid the airways of irritants!
There are many causes of coughing. Coughs generally have special sound characteristics that tell us a little of what's happening to the child. The most benign and harmless cough is the fake cough that babies can taunt us with. After they realize what an attention getter a real cough is, even babies less than a year old will sometimes come out with a false cough.
Perhaps the most common cough is that caused by postnasal drip--drainage from the sinuses and the area behind the nose--from allergy or infection. The cough comes from irritation of nerve endings as the mucus or pus slides down the back of the throat. This is usually a light, repetitive cough that is often worse at night. The child may have other signs of drainage as well, such as a runny or stuffy nose.
In contrast, bronchitis causes a deeper, harder cough. The child may show other signs of being ill, though not always. Fever may or may not be present. The cough can be dry and raspy, or "juicy." A particular form of bronchitis, croup, has a most characteristic cough and needs to be respected. In this viral disease the voice box (larynx) and the entire airway are involved. The cough sounds like a seal or dog barking because of the involvement of the vocal cords. These children are sick and the parents need to be notified immediately. The description "croupy cough" is serious and significant, and must be restricted to those with this ominous bark.
The cough of pneumonia, like that of bronchitis, is deep and may be accompanied by chest pain. These children, too, are sick and the parents need to know. If caregivers feel that a child in their care has one of these deep coughs, they should immediately call the parent. The parent may be well advised to contact their child's physician.
Whooping cough is extremely serious. Fortunately, it is rare since it is preventable through immunization. Whooping cough has a characteristic cough, which gives it the name. There is a series of coughs, one right after another without any time to inhale between the coughs. Finally, after an exhausting series of coughs, the air-hungry child inhales mightily, so mightily, in fact, that it produces the telltale whoop. If a child has this cough, the parents should be immediately contacted and the child should be seen by a physician.
Finally, the cough which indicates a potentially life-threatening situation is the cough which accompanies choking on, or "aspirating," a foreign object such as a peanut or part of a toy. The cough may be immediate and severe. On the other hand, if the airway is largely blocked, the cough may be muffled and ineffective, or the child may not even cough at all. When the airway is blocked, the child cannot take enough air and oxygen into the body. The child may rapidly develop a bluish discoloration of the nail beds and lips. This is an emergency! A child who is not breathing can have permanent brain damage in about four minutes, and can die in about six minutes. Generally, if the child is breathing, crying, or coughing, and you have reason to believe he or she has an airway obstruction, you should call emergency medical assistance. This child will need immediate transport to an emergency department in an ambulance with trained personnel. If the child has an airway obstruction and cannot breathe, cough, or cry, first aid procedures, such as the Heimlich maneuver can be lifesaving. Caregivers should be trained in first aid procedures, and there should always be someone immediately accessible who is certified in infant/child CPR. Many programs require that all caregiver staff maintain current certification.
The fake, "who'd-a-thought-it" cough of the baby, the tickle cough of postnasal drip, and the deeper cough of bronchitis or pneumonia are all moderately common. Less common but more serious is the barky, croupy cough. Even worse is the muffled cough, or the absence of cough or breathing, of a choking child who may need your immediate help in order to survive.
The ability to cough is life sustaining. By listening carefully, caregivers can get a fairly clear idea of what's going on with the child and determine when medical help is necessary.
By Don Palmer, MD. Don Palmer, M.D., is the Chairman of the Child Care Committee, Alabama Chapter, American Academy of Pediatrics
Resources
Health Central: www.healthcentral.com
Mayo Clinic's Health Oasis: www.mayohealth.org
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