Types of Coughs:
by Lauren Feder, M.D.

Nearly every parent can recall waking up in the middle of the night to come to the aid of a coughing child. Although most coughs are self-limiting and gone in a few days, some can be disconcertingly severe and persistent. A cough is the body’s way of clearing the lungs of mucus, fluid, and other irritants, and can be triggered from infections, lung conditions, irritants, acid reflux from the stomach, allergies, asthma, and nervous habits. Some kids keep on playing despite a cough, while others are prevented from sleeping and sapped of energy. Remedies, medications, and home treatments can offer relief when the cough is interrupting sleep or interfering with daily activities and breathing.

 In my book Natural Baby and Childcare, I address coughs due to colds, flu, allergy, bronchitis, croup, and whooping cough. Asthma and other breathing difficulties are not discussed at length here, but can be life-threatening. All of my patients with asthma and lung conditions have inhalers and other standard forms of treatment available to them. In my experience, the use of homeopathy, gemmotherapy, and other types of natural medicine can greatly improve a child's breathing, reducing dependency on prescription medicine. See your healthcare provider for the treatment of conditions such as asthma and wheezing.

 Most coughs begin as a viral infection. Often described as a “productive” or dry cough, this cough feels “loose” and makes it easier for your child to bring up the phlegm. In general, younger children will not necessarily spit out the mucus.  Most will cough up the phlegm and swallow it. If there is any mucus, it usually begins looking clear in appearance. As the illness matures, the mucus begins to change consistency and color. Over the years, the knee-jerk reaction to the appearance of yellow-green phlegm has been to administer antibiotics, though this tendency is waning due to the overuse of antibiotics and the resultant antibiotic resistance. Keep in mind that viral infections can be as colorful and yellow-green as bacterial infections.

In addition to the variety of coughs that accompany colds and the flu, children can also suffer respiratory difficulty with other infections, including bronchiolitis, bronchitis, pneumonia, respiratory syncytial virus (RSV), croup, and whooping cough. 

Bronchiolitis and RSV
Bronchiolitis is an infection of the smaller air passages in the lungs, called the bronchioles.  The infection affects infants (2-6 months of age) and is characterized by inflammation in the lower airways, leading to difficulty breathing.  Most commonly, bronchiolitis results from the respiratory syncytial virus, known as RSV. RSV is also the most common cause of viral pneumonia in infants. Symptoms of RSV include fever, runny nose, severe cough, fussiness, poor appetite, vomiting, wheezing, and pauses in breathing (apnea). Bronchiolitis is more common in the winter and spring and in infants who are formula fed. Premature infants and multiple-birth babies are more susceptible, as well as those in daycare, those who are exposed to second-hand smoke, and those with older siblings in the home. Boys are more commonly affected than girls. Bronchiolitis is usually treatable at home with supportive therapy, suctioning of mucus, and breathing treatments as needed.  RSV is the most common reason for the hospitalization of babies under one year of age. There are no conventional medications used to treat the virus, and antibiotics are ineffective as this is a viral infection. 

Bronchitis is an infection of the main large airways in the upper lungs (bronchi). Acute bronchitis can result from a variety of different infections, including the common cold, sinusitis, and tonsillitis, as well as from irritants such as dust, fumes, and smoke.  In children, most cases of bronchitis are viral infections. Pneumonia is a complication of bronchitis.  Symptoms of bronchitis include low-grade fever, chills, fatigue, muscle aches, sore throat, and usually a runny nose preceding the cough. The cough often begins dry and becomes more loose-sounding and productive as the illness progresses. The mucus is yellow-green and may be heard rattling in the chest and throat. In severe cases, the cough can cause gagging or vomiting. Bronchitis can last up to several weeks.  Conventional treatment for bronchitis is supportive, including rest, liquids, steam, and cough medicine. Antibiotics would be ineffective for viral infections.  See your practitioner if your child has difficulty breathing, a fever of 101F for more than three days, or chest pains.

Pneumonia is an inflammation of the lungs in which the small air sacs fill with mucus, pus, and other fluids. Pneumonia is classified according to location of the inflammation—either lobar (a lobe or section of the lung) or bronchial (patches throughout the lungs)—and can be due to infection or irritants. While pneumonia can occur any time of the year, it is worse in the winter and spring, affecting boys more than girls. Up to fifteen percent of children with respiratory infections also have pneumonia, which can follow a cough or cold. Usual confirming symptoms of pneumonia are cough, fever, and difficult or rapid breathing. Additional symptoms can include chills, lack of appetite, irritability, headache, chest pain, vomiting, and abdominal pain. Children with pneumonia look and act sick. Seek immediate medical attention if there are any signs of oxygen deprivation such as blue lips or face.

Symptoms of bacterial pneumonia in children include fatigue, productive cough, chest pain, lack of appetite, vomiting, and diarrhea. Antibiotics are the standard treatment for bacterial pneumonia, along with chest percussion and supportive therapies. Viral pneumonia, commonly caused by RSV, is differentiated by a slower involvement in the lungs.  Wheezing is usually due to a viral chest cold, and the pneumonia is generally less contagious than the original cold virus that caused it. Walking pneumonia is a milder case in which your child is able to continue her daily activities and does not appear sickly.

Whooping Cough
Whooping cough, or pertussis, is caused by the Bordetella pertussis bacterium.  Within two weeks after the initial common cold symptoms, the cough becomes more severe, with fits of rapid, successive coughs followed by the characteristic long inspiration with a crowing sound or high-pitched whoop.   Thick mucus builds up in the lungs, triggering the cough. Depending on the severity of the cough, a child may experience choking, gagging, and vomiting.  In between attacks, the child looks normal.  For severe prolonged coughs or if you suspect your child has whooping cough, see your practitioner. The pertussis vaccine is given as a part of the DTaP (diphtheria, tetanus, and acellular pertussis) series beginning at two months of age. 

Croup (Laryngotracheobronchitis)
Croup is caused by a virus, allergy, or inhaled foreign body, and most parents initially are unnerved simply by the sound of it. In the typical scenario, your child suddenly wakes up in the middle of the night with a barking seal-like or brassy cough. The barking sound is caused by swelling of the vocal cords in the larynx.  Croup may begin suddenly or following a cold. When caused by a virus, it is contagious and more common in the autumn and winter months, and in children less than five years old. Symptoms are usually worse at night, and may include hoarseness and fever. The first two nights are usually the worst, and the illness lasts up to six days.

In general, croup is not a medical emergency and is managed at home – often with a phone call to the doctor for guidance and reassurance. However, if your child is having difficulty breathing as a result of narrowed breathing passages, seek immediate medical attention. Signs to look for:
Panicked look on the face or agitation with difficulty breathing
Must sit up and unable to sleep or play because of cough and labored breathing
Gasping or high-pitched sound when breathing in (known as stridor)
Retraction of the neck muscles (indentation in the middle of the child’s neck with each inspiration) and ribs in order to breathe
Lips or face turning blue