DEAR DR.PAUL: My 6 year old son keeps coughing in the morning and when he lies down. He did not get better with asthma puffers and his doctor says this might be allergies. Is this possible?
PEDIATRICIAN DR.PAUL Answers: Cough is a very common symptom in children, and it has more than one cause. Obviously you are referring to a cough that is chronic, in other words either lasts for long periods of time or keeps on coming back. This pattern distinguishes it from a cough due to the common cold or flu. The other possibility that you mention is asthma. Asthma is defined as a condition with repetitive episodes of cough and/or wheeze and/or shortness of breath. Among asthmatic children, 5% will have cough as their only symptom.
It is clear that we are not dealing with asthma as the main cause of your child’s symptoms. Your doctor, I think, correctly talked about allergies. Nasal allergies known as “Allergic Rhinitis” in children can present in a variety of ways. The obvious symptoms of a nasal allergy include nasal congestion, a runny nose and post nasal drip. However, many are surprised to learn that in children, a persistent or recurring cough can be the main or only symptom of a nasal allergy. I am not suggesting that all children with nasal allergies cough nor am I suggesting that nasal allergies are the only cause of a cough in kids. However in this situation we have to think of nasal allergies causing your child’s cough. Here are some helpful distinguishing features of a “Nasal Allergy Cough”:
- A ” Nasal Allergy Cough” usually worsens when there is a body change position. For example upon lying down or getting up in the morning. Once the child is asleep, the cough usually stops. An asthmatic cough usually occurs in the middle of the night after a child has fallen asleep.
- A “Nasal Allergy Cough” can occur with exercise. The nasal cough tends to occur at the beginning of the activity whereas an asthmatic cough tends to occur towards the end or after physical activity.
- A “Nasal Allergy Cough” does not improve with asthma puffers, but may get better with antibiotics. In some case there nasal secretions become infected resulting in a sinus infection, making the cough worse. Antibiotics in this circumstance will make the cough go away or improve but have no effect on asthma.
How do we diagnose a nasal allergy in children? First, we need to be aware that children can suffer from nasal allergies too. Specifically, by looking for the features mentioned above and examining a child’s nose, we can usually confirm the presence of a nasal allergy. A positive family history of allergies also helps make the diagnosis.
What is the treatment of nasal allergies? This depends on the child’s age and specific situation, but is based on identifying what the child is allergic to and getting rid of it. The most common causes are dust mites, pet dander, mold, pollens and cigarette smoke. In terms of medications, this ranges from antihistamines taken by mouth to the very effective cortisone based nasal sprays.
Pediatrician DR.PAUL Roumeliotis is certified by the American Board of Pediatrics and Royal College of Physicians and Surgeons of Canada. The information provided above is designed to be an educational aid only. It is not intended to replace the advice and care of your child’s physician, nor is it intended to be used for medical diagnosis or treatment. If you suspect that your child has a medical condition always consult a physician.