| Coughs in Children | ||
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General Guidelines for treating coughs Many night time coughs responds to a warm bath or shower before bedtime and elevating the head of the bed. A general dosage guideline for Robitussin DM is one cc per year of age up to 4 times a day.
Emergencies |
Coughs are one of the more common problems seen in a pediatric office. At times a sign of a serious problem, at other times just an annoyance, a cough is a reflex just as the knee jerk seen in tapping the patellar tendon with a rubber hammer is a reflex. In the production of a cough, a cough receptor along the respiratory tree is irritated and sends a signal to the brain. From the conscious or unconscious part of the brain a signal is sent back to the diaphragm causing contraction of the diaphragm muscles which leads to the forceful expulsion of air which we know as a cough. The purpose of this forceful air expulsion is to clear irritants away from the respiratory tree and help move them toward the mouth where they can be cleared. A cough is a protective reflex. Without this we would not be able to clear our lungs when liquids, food, or phlegm went "down the wrong pipe" and secretions may eventually pool in our lungs leading to potential problems. Cough receptors line the entire respiratory tree from the nose, back of throat, larynx, trachea, main bronchial tubes to the tiny bronchiole. Coughing is a symptom of irritation of one or more of these receptors. Arbitrarily, coughs can be divided into upper and lower airway origins. Coughs from upper airway cough receptors are often from secretions or drainage that irritate receptors in the back of the nose, throat, or an entry to the windpipe. Coughing moves these away from possibly going down the wrong pipe. Because the irritants are often drainage from the nose or sinuses, sometimes decongestants, by decreasing these secretions help coughs. Cough drops work by coating receptors in the back of the throat to make them less accessible to irritants. Lower respiratory tree coughs may also be from secretions but these are usually from the surrounding bronchiole than from draining from above. Cough receptors deep in the lungs send a message to the brain to tell the body to cough which helps move irritants out of the lungs. This is a case where plenty of fluids may help thin secretions to allow the lungs to sweep them out and the drying effect of antihistamines may be harmful. Lower airway coughing may result from narrowing and spasm of the bronchial as seen in wheezing. Adequate relief of bronchospasm with bronchodilators often resolves this type of cough. Similarly, narrowing of the main airway as seen in croup may trigger cough receptors leading to the seal-like bark seen in croup, a common viral illness. A cough is a symptom, not a disease. Whenever possible, obviously the best possible approach to a cough is to resolve the irritations which are causing the cough--reduce or thin secretions, relieve bronchospasm and bronchial swelling, and when possible kill any infection leading to cough. Thus there are many causes of cough--drainage from cold or "sinus," airway swelling from croup, bronchospasm from asthma, secretions from airway inflammation or infections. It makes a big difference whether the cough is from a little posterior drainage or pneumonia and it may not be so easy for patients or physicians to tell the two apart just by listening or examining the patient. Remember, a cough is a symptom of a problem, not a disease. Whenever appropriate, the reason for the symptom should be determined. Most cough medicines are cough suppressants which act in the brain not in the lungs. There they decrease or prevent the brain from responding to nerve impulses from cough receptors that have been irritated. The receptor says 'cough'; the brain ignores it, and the cough is blunted. Over the counter cough medicines have Dextromethorphan (DM); prescription medicines often have the narcotic codeine or hydrocodone. All of these work in the brain to stop coughing. While few physicians or patients may believe it, careful medical studies have shown dextromethorphan is nearly as effective as codeine without codeine's side effects. If a cough is a protective reflex and cough suppressants merely tell the brain not to cough, should they be used? As with the treatment of runny noses, how much it interferes with the child's daily activities as well as the benefits versus the potential problems should be weighed. For example, a child who coughs for 20 minutes in the morning on first arising will probably not benefit from a cough medicine. By the time it gets into his system the cough is probably resolved and this cough probably does not signal any underlying problem other than not clearing the airway well while asleep. A child who is coughing from an asthma attack should have his asthma treated rather than the cough suppressed. used by permission www.thisolddoc.com
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