Winter is the season of the cough, the wheeze, the whoop,
the bark, and the rattle, sniffle, and honk.
Copyright Jessica Snyder Sachs, as first published in
We spend so much more time indoors, where it's easier for
respiratory infections to spread from person to person. Children, with more
immature immune systems, get colds and the flu more often than grown-ups. And
they have their very own diseases, like croup.
That's why millions of moms (and dads) will be awake
tonight, trying to figure out how to relieve their kids' coughing and
congestion and fretting over whether to call the doctor or even make a midnight
run to the emergency room.
Most of the time, all our kids need is a little
symptom relief and comforting -- even when they sound terrible. Sometimes, a
parent's wisdom lies in not giving her child medication. But some symptoms do
warrant immediate medical attention, while others linger long enough to make
you wonder if they signal asthma.
Art by Courtney
What you need to
The very common cold
Babies and kids get six to eight colds a year, but sometimes they sound sicker
than they are. "What parents usually hear are the random snorts and sniffles
of air passing through mucus and secretions in the nose and throat," says
pediatric pulmonologist Peter Scott, M.D., of Children's Healthcare of Atlanta.
There's no need to worry as long as your child seems reasonably comfortable and
active, continues to eat and drink, and starts to get better after a few days.
In the meantime:
Try saline drops to loosen nasal congestion. They're
especially helpful for babies too young to blow their noses. Use three or four
times a day.
To relieve a nighttime cough, elevate your child's head with
a wedge beneath the mattress.
Offer liquids to lubricate an irritated, cough-prone throat.
For babies, nurse or bottle-feed more frequently. For children, give water or
diluted juice (semi-frozen if you want, for its pain-soothing chill). "But
there's no need to push fluids -- normal intake is fine," says Dr. Scott.
Go easy on cold preparations. Never give babies under 6
months decongestants or cough suppressants, says Dr. Scott. Some decongestants
can act as stimulants and keep an older child (and you) awake if taken within
four hours of bedtime. Some moms find that over-the-counter cough suppressants
help their kids, although studies haven't shown them to be effective. If
coughing interferes with your child's sleep for four or five nights, talk to
your doctor, who may prescribe a stronger prescription cough suppressant.
See the doctor if your baby is under 3 months and has a
fever over 100.5 degrees. And call if a child of any age has symptoms -- cough,
congestion, mild sore throat -- that linger for longer than a week.
RSV: a risk for infants
Respiratory syncytial virus (RSV) is either a minor nuisance
or an emergency. Most kids get it by age 1, but parents usually think it's just
a cold. But around 2 percent of the time, the virus causes bronchiolitis, an
inflammation of the small tubes of the lungs. Even this condition is not
usually life-threatening, but it can be in some babies under 6 months, and in
preemies up to 1 year.
Maribelle Lewis, a medical technologist in Palisades Park,
New Jersey, suspected RSV when her 3-month-old daughter, Aiyannah, developed a
persistent wheezy cough but no fever. "Her extreme lethargy tipped me
off," says Lewis.
Aiyannah's pediatrician gave her an inhaler with medication
to open her airways. But over the next two days, Aiyannah stopped nursing and
became even more listless. When Lewis took her baby back, the pediatrician sent
her to the hospital, where Aiyannah received intravenous fluids and intensive
respiratory therapy (inhaled steroids). Today Aiyannah is a healthy, happy
Some babies with severe RSV do spike a high fever, but
others never get hot at all. Always call your pediatrician if your child's
wheezing or coughing makes it difficult to breathe, or if there's a loss of appetite
and unusual lethargy.
Anxiety over avian flu may be dominating the news, but even
the old-fashioned kind can prove severe, with symptoms that often begin like a
cold but become more debilitating and long-lasting.
It often hits more abruptly, with a sudden high fever, dry
cough, and a headache. There can also be muscle aches, sore throat, and a runny
nose. Kids -- but rarely adults -- sometimes also have stomach problems, like
diarrhea or belly pain.
For most babies (6 months and up) and children, treat
flu-related cough and congestion much like those of a cold (with acetaminophen
or ibuprofen, but never aspirin). Just expect more lethargy and feverishness.
One exception: If you suspect flu in an infant under 2 months, go to the doctor
right away; from 3 to 6 months, call.
And for a child of any age, watch out for that sore throat.
If it's severe, there's a fever over 101, and it lasts more than a day, see the
doctor to rule out strep. Also bring your kid in if his ear hurts (flu can
cause ear infections), if a fever doesn't go away in three or four days, or if
a cough persists more than a week. But it's fine to call earlier.
Sinusitis and pneumonia
Around 10 percent of the time, a child's cold or flu will progress to sinus
inflammation, or sinusitis, which may include a wet, or phlegmy, cough, bad
breath, and thick yellow or green mucus. Sinusitis may also bring headache and
The underlying cause is a bacterial infection, so it always
warrants a trip to the doctor, who will likely prescribe antibiotics to clear
it. Once you're back home, you can help your child breathe better by letting
her inhale steam over a hot (but no longer boiling) pot or cup of water.
"We were a bit too sanguine," admits Marina Budhos, a mom in Maplewood,
New Jersey. Last February, her son Sasha, 4, had been coughing for nearly two
weeks, though he never had a fever. Then, in the middle of one night, he woke
up crying inconsolably. His breathing was labored, and he looked exhausted.
"We brought him in the next morning, and the nurse took one look at him
and said, 'He's a mess.'"
Sasha had pneumonia, which occurs when a respiratory virus
settles into the chest and causes an inflammation of the lung's air sacs.
Sometimes the cause is bacterial, typically as a secondary infection after a
cold or flu.
Unfortunately, figuring out whether a child's congestion is
in the lungs is maddeningly difficult, even for doctors. "That's why we
spend so much time with our stethoscopes on your child's chest," says Joshua
Needleman, M.D., a pediatric pulmonologist at Children's Hospital at
Montefiore, in New York City. Three red flags:
Coughing that lasts two weeks or more
Coughing plus fast breathing and a high, persistent fever
Coughing that returns a few days after a cold appears to go
Pneumonia can come on quickly, with fever, shaking, and
chest pain, or slowly, with fatigue, weakness, and headache. See your
pediatrician, who'll examine your child and most likely have her chest x-rayed.
If he sends you home, treat symptoms with rest, fluids, and children's pain
relievers (but not cough suppressants, which may interfere with your child's
ability to clear congestion out of the lungs). But don't be surprised if the
doctor hospitalizes your child to make sure she's getting enough oxygen and to
bring the infection under control.
Croup, an infection of the larynx (the voice box) is a rite
of early childhood for millions of families. When Jennifer Lopez's son Noah, 3,
woke up barking one night, she turned on the hot shower and sat with him
upright on her lap in the steamy bathroom. "He was coughing so deep in his
chest, we could just feel his pain," says the Gainesville, Florida, mom.
When Noah's breathing became more labored -- his nostrils flaring and his belly
and chest heaving -- his parents called the pediatrician, who sent them to the
emergency room. There, Noah got an injection of steroids -- a standard treatment
that's safe in kids as young as 3 months -- and was given an inhaler with
medication to help open his airways. He went home three hours later.
"The family did everything right," says
pediatrician Ari Brown, M.D., author of Baby 411. They elevated their child's
head and headed for a steamy bathroom. (The opposite -- going out into the cool
night air -- can also ease croup for many children.) Even more important, the
Lopezes sought immediate medical care when they saw signs that Noah was struggling
Another sign of extreme airway narrowing is when croup's
classic bark turns into a high-pitched squeal, called "stridor." If a
steamy bathroom or a whiff of chilly air doesn't make the squeal disappear in
20 minutes, head to the emergency room, says Dr. Brown.
Sandy Knight thought she knew what to expect when her
3-month-old son Luke got his third cold: "It always started the same, with
a runny nose. Then toward the end, he'd get a nighttime cough."
But this cough sounded different. Instead of a little
"cough-cough," Luke would hack on and on and then pause, as if
gagging. "My husband and I would sit there on edge, just waiting for Luke
to take a breath." Somewhat sheepishly, Knight, of Austin, Texas, took
Luke to his pediatrician the next morning. "I'm probably being a silly
mom," she began. Far from it, given what Knight described -- prolonged
coughing followed by a gag or gasp. The doctor swabbed Luke's nose and throat
for analysis. The diagnosis: pertussis, a.k.a. whooping cough, a serious
bacterial infection that can lead to pneumonia, seizures, even death. Luke and
both of his parents got a five-day course of antibiotics, and everyone was
This highly contagious disease has been making a disturbing
comeback across North America. It's the only vaccine-preventable disease that's
on the increase, with more than 18,000 reported cases in 2004, up from around
10,000 in 2003. Babies are especially vulnerable until they get the third of
four diphtheria-tetanus-pertussis (DtP) vaccinations, usually at 6 months.
Those under 3 months are at special risk of pertussis-related apnea, in which
they stop breathing altogether and need emergency help.
Pertussis starts like a common cold, with a runny nose,
sneezing, and cough, with or without fever. After a week or two, the cough
tends to worsen, with severe and prolonged coughing jags punctuated by gags and
gasps and, occasionally, vomiting. In spite of its name, babies under 1 rarely
"whoop." Nor do adults (kids do). Any suspected case of pertussis
warrants a trip to the doctor, as antibiotics may be needed.
The best prevention: Stay on schedule with baby shots and
remain vigilant for signs of pertussis until full protection kicks in around 6
months. Though your baby's first DtP shot may produce a spike in temperature,
studies have shown it does not cause lasting harm -- and certainly nothing to
compare with the disease's dangerous symptoms.
By the time your child becomes a teenager, though, his
immunity will start to wane. That's why the Centers for Disease Control and
Prevention now recommends that all kids at age 11 or 12 get the new Food and
Drug Administration- approved Tdap vaccine (Boostrix), which adds pertussis to
the tetanus-diphtheria booster -- and that adults get it every ten years (sooner
if you're around an infant). This should help curb the spread of whooping cough
to young children.
Coughs and congestion may always be a part of early
childhood. They'll become less frequent as our kids strengthen their immunity
through regular vaccinations and, inevitably, a touch of actual sickness. In
the meantime, your watchful vigilance protects them from serious dangers, and
your TLC eases these rites of passage.
When to call 911
Pneumonia, croup, whooping cough (pertussis), RSV, and asthma can each make a
baby or child struggle to breathe. This is an emergency. Call 911 if your
pauses more than 10 seconds between breaths
breathes very rapidly for more than a minute
turns gray or blue
his nostrils are flaring
the muscles between or below the ribs (or the chin) are
moving inward, a phenomenon called retraction
PARENTING contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill&Wang/FSG)
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