A cough in the night

 I remember when I was pregnant with my first child, many friends and acquaintances with children remarked that becoming a mom would probably be easier since both my husband and I are both pediatricians.  When my children first came along, I didn’t really feel that my pediatrician skills were that helpful.  My mom brain and my doctor brain did not seem to get along very well.  In fact, they weren’t even on speaking terms.  But now that my children are school-aged, I get what they were saying…especially this winter.

This winter has really been a doozie for our family.  I feel like I hear coughing every day!  If it’s not coughing_t751x500my kids coughing, it’s neighbors or friends from school.  As we have made our way through this winter virus season, I the thought process that goes through my head is that of an analytical pediatrician rather than a mom and I wanted to share some of those thoughts with moms out there who are trying to tease out whether to WORRY about the coughing they hear in the night.

Before I wrote this, I did some online reading to see what was already out there so that I wouldn’t be repeating information.  I will also go through what I know about commonly recommended home remedies.

One of the things I noticed in my online searches is that there are A LOT of home remedies.  Most of them are harmless and may be helpful.  #1 is buckwheat honey vs. over-the-counter cough syrup.  Buckwheat honey is the winner HANDS DOWN for children over one-year-old.  (For children less than one there is a risk of botulism from honey so it is a no-no.)  Paul et al[1] did a study that was published in the Archives of Pediatric and Adolescent Medicine in 2007 that demonstrated honey was BETTER than cough syrup.  Plus, honey is yummy.  What could be better?  I recommend giving it melted in warm water or warm herbal (decaffeinated!) tea if your child doesn’t dig the idea of a spoonful of the sticky stuff.  Please remember that the American Academy of Pediatrics policy on cough syrup also isn’t helpful for children under 6 years of age, and may have significant health risks for smaller children.  All the more reason to try buckwheat honey!

The next most common recommendation is a humidifier.  There is a 2010 study by McDevitt et al[2], in Environmental Health that shows that air humidification in the home may reduce the risk of upper and lower respiratory tract infections if your home is heated by radiators, and although a bit less so, for forced air heat as well.  This is for generalized home humidification.

The smaller vaporizers or cool mist humidifiers are for smaller spaces.  If you choose to use one of these, do be cautious with what you put in the humidifier and how clean it is.  Take a peek inside.  If it’s coated with dust when you fill it for the first time each winter, or if you notice mold growing in the pan, then you might be spraying mold or dust out into your child’s room rather than just humidifying.  Keep the machine clean and use distilled water.  And check with your doctor before putting any medicine into the machine.  I suspect there are some helpful remedies that I am unaware of, but I worry that children with a propensity to wheeze could actually become much sicker if whatever is put into the machine triggers further asthma exacerbation.

This brings up asthma.  It has been my experience, that sometimes wheezing in children goes under recognized.  Night cough is a hallmark of wheezing that can only be heard with a stethoscope.  If your child doesn’t have a runny nose, or fever, and you hear them coughing all night every night, they may be wheezing.  The other telltale sign is cough when running and playing.  If you hear BOTH night cough and cough with increased activity, then it may not be a cold.  It takes a stethoscope to hear true wheezing so ask your doctor to check.  Also be aware that there is something called cough-variant asthma.  In this case, children seem to cough relentlessly but there is no appreciable wheeze when doctors listen with a stethoscope.

My personal belief is that asthma or wheezing should NEVER keep a child from playing sports or being as active as their peers.  If cough is keeping your child out of sports or from being able to keep up with friends, that is a big red flag worth discussing with your doctor.  Don’t worry too much that the first time your child wheezes they will be diagnosed with asthma.  Sometimes wheezing can be caused by viruses or by certain environmental exposures that will never occur again.

If the child in your house who is coughing is under one year, many of these recommendations do not apply at all.  That will be a topic for another day.  In the meantime, I would recommend calling your pediatrician.



[1] Ian M. Paul, MD, MSc; Jessica Beiler, MPH; Amyee McMonagle, RN; Michele L. Shaffer, PhD; Laura Duda, MD; Cheston M. Berlin, MD. Effect of Honey, Dextromethorphan, and not Treatment on Nocturnal Cough and Sleep Quality for Coughing Children and Their Parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1146.

 

[2] Theodore A Myatt, Matthew H Kaufman, Joseph G Allen, David L MacIntosh, M Patricia Fabian, James J McDevitt.  Modeling the airborne survival of influenza virus in a residential setting: the impacts of home humidification. Environmental Health 2010, 9:55.

 

Kathryn Bucklen, MD About Kathryn Bucklen, MD

Kathryn A. Bucklen, M.D., is a pediatrician at St. Louis Children’s Hospital and an Assistant Professor of Pediatrics at Washington University School of Medicine. She received her undergraduate education at New York University and is a graduate of the Wake Forest University School of Medicine. Katie completed her residency at the Children’s Hospital of Pittsburgh. She is board certified in Pediatrics, and a fellow of the American Academy of Pediatrics. She is a former medical advisor to her children’s preschool, and has a long standing interest in helping parents negotiate nutrition, exercise and the health of their children. She is the mother of two boys aged four and six.

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  1. [...] these techniques to sooth their painful gums and don’t expect them to sleep well.  If they are coughing a lot at night, be sure to see your pediatrician as this can be a sign of wheezing, asthma, or reactive airway [...]

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