COUGH AND COLDS IN CHILDREN

The combination of cough and colds is frequently seen, not just in children but in adults as well. Millions of people miss out on important school days or workdays because of conditions that stem from coughs and colds. This article aims to differentiate the different causes of cough and colds.

Please note that due to the Covid-19 Pandemic, if your child has a cough and a cold it is important to talk to your doctor to see if your child should be tested and self isolate. Please read our article about Covid - 19 in children or more information.

Important points your healthcare provider should know about

One of the first questions a doctor may ask pertains to symptoms. Let the healthcare team know if your child has experienced any difficulty in breathing, chest pains, consistent snoring when asleep, difficulty performing regular exercises and activities, and bluish discoloration of the skin. For infants, it’s also important to mention if you’ve noticed your baby having brief episodes of “forgetting to breathe” - this is also called apnea.

Sometimes cough may not be due to inflammation in the lung airways or tissues. Other common causes include congenital anomalies involving the bronchi or trachea, acid reflux (gastroesophageal reflux disease or GERD), or some immunocompromised conditions. A family history of certain respiratory illnesses may also lead to more frequent episodes of cough and colds.

Important diagnostic tests

For most of the medical conditions covered in this article, laboratory tests or imaging are not always required, but depending on a case-to-case basis, may be requested to support the diagnosis or rule out other serious illnesses.

Some additional tests may include radiographs or x-rays (chest, upper airways, or sinuses), CT scans, MRI scans, fluoroscopy, imaging with contrast materials, laryngoscopy, bronchoscopy, pulmonary function tests, sputum culture, or lung biopsy.

Important signs and symptoms to watch out for

Most of the time, coughs and colds are benign or easily managed. However, there are certain factors, signs or symptoms that could need a closer look from a healthcare provider to rule out any serious or life-threatening disease. These include:

• failure to gain weight
• clubbed digits
• a family history of inherited lung disease
• a history of recurrent non-respiratory infections
• persistent fever episodes
• less active child
• difficulty tolerating regular exercise
• consistently fast or labored breathing
• shortness of breath
• coughing out or vomiting of blood
• bluish discoloration of the skin (cyanosis)

Important causes of cough and colds in children

Common cold

The common cold is also known as infectious rhinitis. It’s usually a viral infection that enters the respiratory tract. This illness is most common during early fall up to late spring and can cause about 6-12 episodes per year in young children. It spreads through direct hand contact and by inhalation of droplets in the air that contain the virus. Common causes of the common cold are rhinoviruses, respiratory syncytial viruses, parainfluenza viruses, and adenoviruses.

The two main symptoms are nasal discharge (or runny nose) and nasal obstruction. Sometimes children may also experience headache, fever, and body aches. Children less than a year old usually present with fever and a runny nose, while older kids may also complain of a sore throat or a hoarse voice. Other symptoms include difficulty sleeping, increased irritability, and a decreased appetite. These symptoms may last for as long as 10 days; cough that occurs with the common cold can last for up to 2 weeks in some cases.

The common cold is usually treated with supportive care, with a focus on adequate hydration, loosening nasal secretions, and soothing any irritation or itchiness. Increased water intake (preferably warm fluids), saline sprays or drops for the nose, antihistamines, analgesics, and zinc lozenges are some medications that may be prescribed. Antibiotics are not recommended. Not all of these medications may be given to very young children.

Sinusitis

Sinusitis is the inflammation of the sinuses, usually due to a viral or bacterial infection. People who have viral respiratory tract infections, allergic rhinitis, gastroesophageal reflux disease (GERD), an immunocompromised state, exposure to smoke, or certain anatomic defects (like a cleft lip or palate) may be at higher risk of developing sinusitis. The most common organisms causing bacterial sinusitis include Streptococcus pneumoniae, nontypeable Haemophilus influenzae, and Moraxella catarrhalis.

Patients with acute sinusitis typically have symptoms of an upper respiratory tract infection (fever, cough, or a runny nose) that either does not improve after 10 days, or initially improves but suddenly becomes worse.

Bacterial sinusitis is treated with oral antibiotics. Hospital admission may be needed for children who are very young or fail to respond to the initial treatment.

Sore throat

Also known as acute pharyngitis, a sore throat is due to inflammation of tissues in the pharynx. This includes redness, swelling, and the presence of sores or pus. Some known risk factors include exposure to allergens, air pollutants, tobacco smoke, hot food, and hot liquids. A sore throat may also be infectious in nature and is usually caused by viruses or bacteria. These spread from person to person through contact with oral or nasal secretions, especially during winter, spring, and fall. The most common causes include the influenza virus, parainfluenza virus, adenovirus, and group A streptococci (GAS).

Symptoms include cough, colds, hoarseness, inflamed eyes (conjunctivitis), oral sores, diarrhea, and rashes.

It’s important to rule out cases of pharyngitis that are due to GAS. A rapid strep test may be done to confirm if GAS is the cause of the infection. In this case, antibiotics should be started. Otherwise, supportive care with medications for fever and pain may be given.

Croup

Croup is also known as laryngotracheitis or laryngotracheobronchitis. It is a common viral infection that causes swelling along the main airway; if severe, it may eventually block air flow into the lungs if not treated correctly. It affects children from 3 months to 5 years of age, males more often than females, and typically during late fall or winter.

Parainfluenza viruses are the main culprit in croup, but allergies or gastroesophageal reflux can also trigger this condition. Affected infants and children may have mild cough, colds, sore throat, and low-grade fever. In severe cases, the cough evolves into a barking sound (called barking cough) after 1-3 days, accompanied by hoarseness and some difficulty breathing. Kids may be more comfortable sitting upright. Symptoms may be worse at night, but eventually resolve after a week or so.

Croup is usually diagnosed based on the patient’s clinical history and physical exam. A neck x-ray helps support the diagnosis but is not required. For mild cases, medications for fever and reassurance from parents help children calm down and breathe properly. Severe cases, where kids seem to have bluish lips or has difficulty speaking or breathing, should be seen by a healthcare provider urgently.

Acute Bronchiolitis

Like croup, acute bronchiolitis is typically a viral infection caused by respiratory syncytial virus (RSV). This affects children aged 2 years and younger, affecting males more than females. Children who were not breastfed, who are exposed to tobacco smoke, and are often in crowded areas are more likely to develop bronchiolitis.

Bronchiolitis starts with clear nasal discharge, frequent sneezing, fever, and a decreased appetite. This develops into irritability and frequent, intense coughing bouts that leads to difficulty breathing. Parents may find it hard to feed them during mealtimes. Children should be brought for urgent medical care if there are signs of poor hydration or trouble breathing normally.

Acute bronchiolitis is also diagnosed based on a child’s clinical history and physical examination. Because viruses cause this illness, antibiotics are not usually prescribed. Supportive treatment, such as rest, increased fluid intake, and fever medications, are recommended.

Acute Bronchitis

In acute bronchitis, the cough that accompanies a viral upper respiratory tract infection becomes progressive, often becoming wet cough with much sputum. This may be accompanied by fever, body weakness, sore eyes, and even chest pain. This condition can last for up to 3 weeks.

Despite lasting for a few weeks, the infection gradually resolves on its own and no specific antimicrobial treatment is needed. Supportive care with humidity and frequently changing your child’s position (lying on one side, then the other) can help them expel the sputum and feel much more comfortable.

Community-Acquired Pneumonia

One of the more serious conditions is community-acquired pneumonia (CAP), which is the leading infectious cause of death in children less than 5 years old worldwide. Most commonly caused by either viruses (RSV or rhinovirus) or bacteria (Streptococcus pneumoniae, Mycoplasma, Chlamydophila, Haemophilus influenzae), these microorganisms reach all the way into lung tissue, leading to inflammation. Like other causes of cough and colds, this disease is more frequently seen during winter and fall.

Pneumonia is most often due to an infection, but non-infectious causes are also seen. These include hypersensitivity reactions, drug-induced reactions, or even food aspiration.

CAP starts with cough, colds, and fever, progressing to an increased rate of breathing and body weakness. Sometimes, children may present with difficulty feeding or loss of appetite, anxiety, chest pain, vomiting, or diarrhea.

The diagnosis is based on the child’s history and physical examination. Chest x-rays, white blood counts and blood or pleural fluid cultures may also be requested, but are not always needed to diagnose CAP. Treatment involves antibiotics and oral zinc supplementation.

Summary

Cough and colds are more often mild, resolving on their own or with supportive measures. Among the common causes of cough and colds, only a few conditions would warrant antibiotics and other medications. Despite this, there are certain accompanying signs and symptoms that would warrant further observation or an urgent consult with a healthcare professional. Parents and guardians should be aware that close monitoring of children for these symptoms is essential.

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References:

• Kliegman, R.M. et al. (2020). Part 18 The Respiratory System. Nelson Textbook of Pediatrics 21st edition. Elsevier.
• American Academy of Pediatrics (Updated 2019 Nov 21). 10 Common Childhood Illnesses and Their Treatments. Taken from: https://www.healthychildren.org/English/health-issues/conditions/treatments/Pages/10-Common-Childhood-Illnesses-and-Their-Treatments.aspx
• Wald, E.R. et al. (2013). Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years. Pediatrics (2013) 132 (1): e262–e280
• Croup and Your Young Child. (Updated 2021 Aug 11). American Academy of Pediatrics. Taken from: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx
• Bronchiolitis. (Updated 2015 Nov 21). American Academy of Pediatrics. Taken from: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Bronchiolitis.aspx

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