Wet Cough in Children: When do you need to worry!!

A wet cough is a moist cough indicating a cough from the chest. It indicates that the child has phlegm or sputum inside the airway, the child may or may not be able to bring it out. Older children may bring out phlegm which might be white, yellow or green. Many children with viral infections get a transient period of wet or moist cough which is short lasting for 5-10 days. This wet or moist cough is usually not of concern and improves as the viral infection goes away. On the other hand a long-lasting wet cough can be an indicator of an underlying serious problem. In this article we shall discuss the causes, investigations and treatment of a persistent or a chronic wet cough in children.

Wet Cough in Children: When do you need to worry!!

What are the causes of a persistent or chronic wet cough in children?
The most common cause of persistent or chronic wet cough in children is protracted bacterial bronchitis (PBB). The other common cause of chronic or persistent wet cough is upper airway cough syndrome. Children with upper airway cough syndrome have increased mucus production in the upper airway leading to a post nasal drip causing cough. The common conditions leading to upper airway cough syndrome are allergic rhinitis, adenoiditis and rhinosinusitis. Some children with wet cough have permanent dilatation of the airway also known as bronchiectasis. Children with bronchiectasis can have additional features like shortness of breath (dyspnea), wheezing and coughing up blood (hemoptysis).

What are the investigations required for persistent or chronic wet cough in children?
The need for investigations in children who have a persistent or chronic wet cough depends upon the clinical condition. Careful examination of the upper airway helps to decide whether the cause of wet cough is from the upper airway or from the lower airway. Children with wet cough who don't seem to respond to a two week course of antibiotics or get repeated episodes of wet cough need further investigations. Further investigation which might be helpful in such situations are CT scan of the chest and flexible bronchoscopy. CT scan helps us to evaluate the size of the airways in detail. CT scan chest is considered to be the best investigation for diagnosis of bronchiectasis. Bronchoscopy helps to evaluate the airways in detail and also to collect secretions from the airway or sputum sample, which can later be sent for microbiological analysis to identify bacteria, viruses, tuberculosis, etc.

How do we treat persistent or chronic wet cough in children?
Children with a persistent or chronic wet cough need a two week course of an antibiotic to treat persistent bacterial bronchitis. The most commonly used antibiotic is Amoxicillin-clavulanic acid. Some situations we use 3rd generation cephalosporins such as cefdinir or cefpodoxime. Children with an upper airway cough syndrome require intranasal steroid spray and nasal saline irrigation. Children who are considered to have Bronchiectasis require long term chest physiotherapy to drain mucus from the chest. Children with bronchiectasis also require frequent courses of antibiotics.

In case your child is having a prolonged or persistent moist or wet cough or productive cough, you need to get in touch with the pediatric pulmonologist for further evaluation and treatment.

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