Coughs and Colds in Children – When To Be Worried?

Early in a child’s life, it is normal for them to get a cold every month, sometimes twice a month. This is because there are hundreds of different cold viruses, and young children only start to build up immunity to them when they start spending time with other children. Overtime they build up their immunity and therefore get colds less often. We especially see this in families where the firstborn child is well and never sick until they start nursery. Babies with older siblings, however, tend to catch colds as they have a brother or sister at home to catch bugs from. This helps them build up their immunity sooner.

When should you be worried?

Almost always, children with a cold develop a cough and this is something parents worry a lot about. It is normal for that cough to last a few weeks, even up to 4 weeks. In fact, the coughing, although distressing for the child and parent, is doing an important job. Young children are very bad at blowing their nose, so the mucus can fall backwards into the throat, especially at night when they are lying down. A big cough is the best way for the child to clear the phlegm from the throat, and prevent it going into the lungs and causing more severe problems like pneumonia. The cough is the body’s way to fight the infection and protect itself. When you need to be worried is when the child has other problems than coughing. Ask yourself these questions:

- Is my child drinking ok and staying hydrated?
- Is my child breathing ok and not distressed or wheezy?
- Is my child having periods of normal playing and activity?
- Is the fever improving after a few days and not getting worse?

If the answer to all of these is yes, then good news! Give it a few weeks during which time the cough should slowly improve while the answers should remain yes to all of the above questions. Seek medical advice if the child is deteriorating, or if you are starting to say no to some of the questions.

The snot can be different colours, but again, it is all about how the child is as a whole. If the child has pneumonia, we would expect tiredness, persistent fever and breathlessness. If the child has asthma, you would expect to see breathlessness, decreased activity and expect to hear a wheezing sound.

When is it allergy?

One should consider allergy if the cough lasts a long time such as a few months, if your child gets an itchy nose a lot, and if what is running from their nose is clear, watery liquid. If there is associated wheezing, it makes allergy even more likely. It can be hard to be sure, however, as children can get one cold after another and therefore extend their coughing for several months. With normal colds though, we often see the cough improving as the child recovers from the first cold, just as they catch another.

Allergy is more likely if the child has other allergic problems like eczema or food allergy. Has something new happened at home like a pet arriving? Does the cough go away when the child is on holiday away from home? Is it seasonal and only there in the summer? Allergy cough is normally worse at night when exposure to dust mites is at its worse from the mattress and pillows in the bedroom. In Dubai, doctors often label a cough as allergy, but the best course of action is to get some allergy tests to confirm it before staying on allergy medication long term.

Is it coronavirus?

Children can get coronavirus but it seems to be a generally mild illness, much like other cold viruses. There are some very rare complications leading to more serious illnesess (e.g. PIMS – Pediatric Inflammatory multi-system syndrome) but the risk is very low, perhaps 1 in 5000 children may get this.

There is no specific treatment for a coronavirus cold, so if your child has a cough and has been in contact with the coronavirus, watch over them and make sure their drinking, breathing and activity is ok. Normally if children get a virus, it is not necessary to check which one it is, but with COVID-19 going around, we do need to test most coughs in children in nursery or school to reduce risk of spreading it. The best and most accurate test is still the nose test, so it is important to talk to your child and support them when having the test.

What medicines can I give?

Coughing is a good thing and is the best way to clear mucus. Keep your child hydrated with plenty of fluids to keep the mucus less thick and easier to clear. Saline drops in the nose for young children is important, so they can still drink from the bottle and breathe through their nose. Cough medicines should be avoided, especially those that make the child drowsy as there could be a risk of accidentally overdosing. Treat the fever with paracetamol or ibuprofen and consult your doctor if you are worried.

More and more families are also starting to use nebulisers at home. If you have one, you could try a salty water (saline) nebulizer and continue using it if it helps your child. However, we recommend to only use Ventolin if the child has wheezing and breathlessness as it won’t help a cough or sore throat but will only make your child agitated and restless.

When it comes down to it, a cough or cold is nothing for moms and dads to be worried about if the child is otherwise ok. Give your child lots of cuddles and fluids but check with your doctor if you start to see more worrisome symptoms or behavior.

In doubt? Reach out to Dr. David here if you want to book a consultation or call 800 1999