Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Dr. Perlstein received his Medical Degree from the University of Cincinnati and then completed his internship and residency in pediatrics at The New York Hospital, Cornell medical Center in New York City. After serving an additional year as Chief Pediatric Resident, he worked as a private practitioner and then was appointed Director of Ambulatory Pediatrics at St. Barnabas Hospital in the Bronx.
A cough is a critical reflex action designed to promote clearing of the upper
airways. The material being coughed up may be as a consequence of many
conditions - from a lung or sinus infection to an accidentally inhaled foreign
object (for example, food or small toy). A cough may also be a symptom of
compromised lung function (for example, wheezing) or reflect rare conditions
(for example, anatomical malformations).
All children will cough occasionally but recurrent cough, difficulty
breathing with cough or coughing up purulent or bloody material warrant a
thorough and timely evaluation. A "wet" or "mucousy" cough will sound
different than a "dry" or "scratchy" cough or a "barky" ("sounds like a seal")
cough. It may be helpful to record the cough prior to an appointment with
a child's doctor since a "picture" may be worth a thousand words.
Most pulmonary specialists will categorize cough symptoms as "acute" - those
lasting less than four weeks vs. "chronic" - those lasting longer than four weeks.
What are the common causes of acute cough in children?
Since children's cough may be associated with a broad array of situations, it
is helpful to consider possible causes under various categories. These
The number one cause of cough
in children would the
common cold (URI -
upper respiratory infection).
Generally this cough is secondary to drainage of mucous down the back of the
throat, thus stimulating the cough reflex center. Most children less than eight
years of age cannot "cough up" this material efficiently. Generally their
cough pushes the drainage from one area of the back of the throat to another.
Children commonly will swallow the mucous after coughing and during
Children have been known to cough with such force that they may
previously swallowed mucoid material.
Irritation and swelling of the vocal
cord region caused by a viral infection may produce a characteristic "barky"
cough (sounding similar to that of a seal) and is termed
infection is generally a complication of a URI and may be associated with
consistent thick and purulent (green or yellow) nasal drainage either onto the
facial region or down the back of the throat. This drainage will also
stimulate the cough center as described above.
Lower airway infections
(i.e. those inside the chest cavity) include viral illnesses (pneumonia,
bronchitis, etc.) or bacterial causes (pneumonia, pertussis
The amount of watery nasal drainage
produced as a consequence of nasal allergy may be considerable. The
material may commonly drain down the back of the throat ("post nasal drainage")
and trigger the cough center in the rear of the throat.
Any object that does not pass from the back
of the mouth into the esophagus runs the risk of aspiration into the windpipe
(trachea). This is most common in young toddlers due to their infatuation
with smaller objects and their intense oral fixation. Any object that can
pass through the opening of a vertically oriented toilet paper cardboard tube is
considered a risk object. Older children or adults who incompletely chew
food prior to swallowing may also aspirate material. Effective emergency
treatment of such a situation may be learned in CPR classes commonly taught by
either the Red Cross or your local hospital.
Narrowing the functional diameter of the
smaller airways make it difficult to breath (exhalation worse than inhalation)
and can cause a characteristic sound during respiration. Wheezing is a
consequence of two phenomena - narrowing the airway secondary to tightening of the
muscles that wrap around this lung region, as well as thickening of the lining of
the airway as a consequence of inflammation. In children the most common
trigger to produce these reactions is the virus that causes the common cold
(URI). Certain viruses (for example,
respiratory syncytial virus
are notorious in this regard. The environment (grasses, dust,
also trigger such a reaction. In older children intense physical activity
or cold air may also trigger a wheezing episode.
Gastroesophageal reflux disease (GERD)
stomach contents and/or acid may trigger a
reflex cough and should be considered
when the more common causes of cough have been eliminated. This is more
common in infants and young children. These young children and infants may not have obvious
spitting up of liquids or solids during such episodes; however, they become very
irritable during such events.
Benign motor tic
Children may occasionally have
repetitive throat clearing as manifestation of a tic. They do not seem to
be in any distress during these episodes and the child may stop them voluntarily
and they do not occur during sleep. Parents will often describe such cough
as "she has a tickle in her throat".
Various rare causes of cough need to be
considered when the more obvious or routine mechanisms have been eliminated.
A partial listing includes:
congenital heart disease, and heart
failure, congenital malformations of the airway, lungs or major blood vessels of
the chest, etc.
Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are important drugs to use to control fever and pain in children. However, too often they are bundled with combinations of antihistamines, decongestants, and cough suppressants; suggesting an all-in-one cure for the common cold and other
upper respiratory tract infections (URIs). Store shelves are filled with these over-the-counter medications that beckon parents to make life a little easier for their child. Yet, even in adults, these medications are less than helpful, and the side effects can be potentially deadly.