Understanding your child’s cough

Featured pediatric expert

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Dr. Clarisse Casilang

Dr. Clarisse Casilang is board certified in pediatrics and is a member of the CHOC Medical Group treating kids and teens in Orange County. Dr. Casilang graduated from St. George’s University School of Medicine. She completed her pediatrics residency at the University of California San Francisco (UCSF) in Fresno, CA, and went on to complete the Pediatric Global Health Fellowship in the Dominican Republic and Children’s Hospital of Philadelphia (CHOP). Dr. Casilang on staff at CHOC Hospital in Orange and has published research on the attitudes toward mobile health development in the Dominican Republic.

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Transcript

Melanie Cole, (Host): Welcome to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County. Together, we can keep kids happy and healthy. I’m Melanie Cole. And today we’re talking about coughs in kids, understanding your child’s cough. Joining me is Dr. Clarisse Casilang. She’s a Board Certified Pediatrician with Children’s Health of Orange County and a Fellow of the American Academy of Pediatrics. Dr. Clarisse Casilang, I’m so glad to have you join us today. And as a mother of two, I know that when my kids were little and they would cough, I’d spin my head right around. Cause we never know really what it is or whether it’s something like choking or whether now they’re sick. And in this COVID time, we hear somebody cough and go, oh my God. So can you tell us what a cough is really?

Dr. Clarisse Casilang: That’s an excellent question, Melanie, and I’m really grateful for the opportunity to share with families that cough actually is a natural and important reflex. I work in the urgent care and so we are seeing a lot of kids and actually that’s the most common complaint we get is cough. But I try to emphasize to parents that it’s not necessarily a bad thing.

If anything, it’s an important way for their child to clear out any debris, any mucus buildup, and if they are developing a cough and it’s lasting a few days, then it’s most likely a cold or an upper respiratory infection. But it can be even as simple as, like you’re saying clearing your throat, if there’s something that’s in the airway.

So it’s a very important reflex, and we need it to protect our airway and be able to breathe properly. And so hopefully with this talk, we’ll be able to educate families on what to do if there is a cough and when to get worried.

Melanie Cole, (Host): Well, certainly great information and like a fever, which alerts us and helps our body to fight, you said a cough is this clearing mechanism and little kids don’t have that robust ability to clear. So it is a good thing, but for parents, it can be worrisome. What are some of the most common coughs in children? And can they sometimes develop into a habit cough. Cause I’ve heard that’s a thing.

Dr. Clarisse Casilang: Yeah, that’s a great question. It’s true that, the cough, when it is occurring in children, it’s typically can be because of the common cold and the most common cause of the common cold are viral illnesses. And so when we talk about upper respiratory infections, we’re talking about runny noses. We’re talking about buildup in congestion. Sometimes you can even get a scratchy throat. And so the most common cause of that would be viruses. And even before the time of coronavirus, we had all these other kinds of viruses that cause colds. And so those could include things like rhinovirus, as well as a enterovirus or adenovirus.

So there’s a plethora of viruses that are out there. And most of the time, that’s what’s causing the common cold. And it’s usually more common in the wintertime and that’s because most kids are indoors. They’re spreading their germs a little bit easily because they are in mostly close quarters. And typically for preschool aged kids, the average is actually six to eight colds in a year. That’s actually normal. And as they develop their immune system, whether that’s naturally through getting exposed or through getting vaccinated, then that kind of gets less and less as they get a little bit older, especially after the age of six.

The time that we do worry if it is a chronic cough, is if the cough doesn’t resolve after about three to four weeks. So, if it’s been about a month or two and your child’s still having a cough, there’s actually a whole line of reasons that could be. Sometimes that can be asthma. Sometimes that can be seasonal allergies.

And in the example, you’re sharing, it can also be a habitual cough. So I would say that the most important thing is kind of looking at the duration of your child’s cough. So if it’s lasting about three to four weeks, that probably warrants a little bit of either a workup or a followup with your primary care doctor.

Melanie Cole, (Host): Well, I know that you docs are seeing an increase in RSV right now and other respiratory viruses aside from COVID. And I remember when my kids were little, my son got pertussis. And even though we’re vaccinated, it was the scariest cough I have ever heard in my life. But I digress. We’re not talking about those coughs just yet.

So let’s talk about the first thing we do when our child is coughing. Obviously we start with our medical home, pediatric guru, your pediatricians. And then what, what happens do we use over the counter? Do any of those things work? Tell us a little bit about how you even figure out what a cough is.

Dr. Clarisse Casilang: That’s an excellent question, Melanie. Typically if a coughs starts, a lot of times you’ll see other symptoms. So, you might see a runny nose. You might notice nasal congestion because again, cough is there to help clear any sort of debris or secretions. So my advice for parents, if they’re noticing that their child is having a cough, is kind of taking a look and seeing if there’s anything that’s coming up as well.

So whether that’s a runny nose, or congestion. And if your child is under the age of one, one of the best things you could do is add normal saline to their nose, whether that’s through drops or through spray, because that’s one way to help clear out any debris. And if you do have one, nasal suction and there’s different ones on the market, they have both suctions. There’s a freea suction that helps get out the nasal congestion. And typically I’ll suggest that the best time to do that is before meal times. Especially if you have a little one that’s bottle fed and who’s breastfeeding because they’re actually obligate nose breathers. And so they’re gonna need to have a clear nose to have air exchange.

And so the best time to do it would be before mealtime. And right before other bedtime or nap time. And so that’s one of the best remedies I seen for children that are a little bit younger and actually having a humidifier at night has been shown to help clear out some of those secretions as well. And then keeping your child hydrated.

One of the things that will help with stuffy nose is actually making sure they’re hydrated so that they’re not getting so much dry mucus in there, but getting it nice and moist. And so we recommend at least, eight ounces per age group. So if their age, for example, one, then they would need eight ounces per day of liquids up to age eight.

So 64 ounces for anyone over age eight. The other thing we like to recommend and studies have shown is, honey. The only caveat is that we don’t recommend honey for babies that are under one because of the risk of botulism. But if your child is a year or older, depending on their age, you can give them a tablespoon to two of honey, per day.

And that helps with the cough as well. And for kids a little bit older, and they understand the concept of having a cough lozenge or a cough drops, that’s recommended as well as using some of like Vick’s Vapo Rub if they’re a little bit older as well. One thing that I would say that’s really important is that when your child does have a cough and it’s getting a little bit worse, the things you want to look out for is there like work of breathing.

So, for example, if they have their abdominal moving up and down really fast, or their nose is flaring up and down really fast, those are the signals that they’re really having trouble breathing, and that would always be an emergency and a reason to get evaluated. So hopefully that helps in terms of what can I do to clear their secretions to prevent the cough, but then also noticing, okay, when is the cost actually worrisome?

Melanie Cole, (Host): Well, thank you for that great information. I love using Vicks on the kids. It’s a sweet time, but I’ll tell you, the bulb business is really a thankless job that parents have to do is clearing that out. But it is important. Now what about those over the counter remedies? Because they’ve gone up and down in Vogue, really Delsym, Robitussin, all those kinds of things at night.

Do these things work to help our children stop coughing so they can get a good night’s sleep? Do we not want to use them? What about those over the counter cough remedies?

Dr. Clarisse Casilang: The over the counter cough remedies typically advertise that they are going to stop the cough or suppress the cough. And like we were mentioning earlier, cough is actually a good reflex to have. If you notice on the market, or if you go to the pharmacy, a lot of times there’s not anything available for anyone under six.

And it’s for that reason, is that under six, you actually want the cough to be there to clear out all those secretions and the nasal congestion. And so studies effectively are showing that over the counter medicine is actually not effective in the case of coughs, but when it is effective, it’s usually, items that have things like honey in them, to help soothe the throat.

The other over the counter medications that we recommend, especially if your child has a fever would be Tylenol or ibuprofen and that’s dosing is based on their weight. The other over the counter medicines, like I was mentioning about was using the normal saline and that can be available at the pharmacies.

But the reason why over the counter medicine can be harmful is because a lot of times there’s different ingredients in there and they can have Tylenol already in there or ibuprofen in there. So if they’re mixing both, the separated, or single dose type of medicines with these combination medicines, it can be really harmful.

But typically, a lot of times it’s actually not needed. Kids are very resilient and their immune systems are really strong. So a lot of times it’s observing our child. And if those worrisome signs aren’t there, a lot of times they’ll clear it on their own.

Melanie Cole, (Host): I’m so glad you brought up that sometimes those medications contain similar ingredients and then you’re doubling up on the dose. That’s an important thing for parents to note. As we get ready to wrap up, when do we know that it’s time to maybe see a specialist that this cough has now become chronic or worrisome, that it could be allergies that draining down the back of the throat, whatever is the reason. When is it time that parents should really get concerned and call our pediatricians?

Dr. Clarisse Casilang: That’s a great question. And what I try to consult families is that when that cough is three to four weeks time. That’s sort of when you’re creeping on chronic cough and when it’s four weeks and you’re noticed, you know, what, it’s really not getting better. And actually it’s worse at certain times of the day, especially in the nighttime, then we do consider things like asthma or allergies causing that cough and that does warrant a further evaluation or follow up with your pediatrician. And based on what your pediatrician and, the family decides, then they can definitely involve a specialist like a pulmonologist, depending on what’s found.

I think when your child’s reaching that three to four week mark, that definitely warrants an extra visit to your doctor.

Melanie Cole, (Host): And do you have any final thoughts you’d like to leave us with just about not worrying and that these coughs really are a defense mechanism for our children?

Dr. Clarisse Casilang: Thanks Melanie, for the chance to sort of reiterate again, that yes, cough is so important. It’s a really important reflex to have. And our job as parents, as pediatricians is to help make them more comfortable. So whether that is using the home remedies, like we mentioned, and finding ways to help clear out their secretions, that’s really the point that we’re trying to come across. And so if you have the time, healthychildren.org does have some awesome resources and other home remedies that you can try before you reach out to your doctor.

And again, the worrisome things would be, if your child’s breathing really fast, they’re using other muscles in their body to breathe. They are having a fever that’s greater than five days, and they’re not staying hydrated on their own, either because they’re refusing to drink or they’re having a lot of vomiting.

Those are the key red flags that would warrant earlier visit to your doctor.

Melanie Cole, (Host): What great information for parents. I hope that you took all that down parents because you heard it from a pediatrician. A Fellow of the American Academy of Pediatrics and a Board Certified Pediatrician with Children’s Health of Orange County. Those are the experts, and we love our pediatricians because they are helping us to raise our children safely.

And that’s really for parents, what it’s all about. Thank you so much, Dr. Clarisse Casilang for joining us today. And for more pediatric health and wellness tips, please visit. health.choc.org for more information, and to get connected with one of our providers. Thanks for listening to Long Live Childhood, a pediatric health and wellness podcast presented by Children’s Health of Orange County.

Together, we can keep kids happy and healthy. Please also remember to share on your social channels as we’re all learning from the experts at CHOC together. I’m Melanie Cole. Thanks so much for joining us today.

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