2 year old coughing for 4 months

[yellokat]

My two year old started coughing in August.  It is now November and he hasn't stoped.  We've seen the general practitioner (GP) (there are no pediatricians available freely in London) 4 times (maybe more), and every time I hear the same thing - viral infection, it will go away.  But it doesn't. It seems to go in cycles: starts of dry, and infrequent, and continues to become wet and he coughs every hour or so.  Then it slows down again, and goes back to being dry.  About two months ago, we've gone to the emergency room where they did an X-ray which was clean.  The GP also does not hear anything when he listens to my son's chest and back.  What do I do?  Is is allergies?  We have no pets, but it is an old house so I am starting to suspect dust mites.  I am frustrated and tired to guessing.  Please advise.  Many thanks in advance.

[National Jewish]

Chronic cough in a two year old is a common, but difficult problem.  This can be from the upper airways, such as sinuses and allergies or from the lower airways, such as asthma and bronchitis.  There are generally 2 approaches taken.  The first is simply to treat the cough.  When the cough subsides in a short period of time, everyone is happy and no one really cares about the cause.  If it persists, as you have described, it is essential to determine the cause to get it under control.  A chest x-ray does not help a lot in the type of cough you are describing.  I would suggest talking with your doctor about a CT scan of the sinuses and an evaluation for possible allergies and asthma as the next steps.

[genwar]

Hi yellokat ~

This comes by way of moral support, since I have little advice to give. Having been in a similar situation, I understand how disconcerting it can be.

Like you, we also live in an older home that we’re making over room by room. Whenever we do some demolition, I’m always unsettled about the old filth and vermin that’s above the ceilings and between the walls … dust, coal soot, mouse nests and droppings, guano, dead bugs and who knows what else? I’m pretty sure these make-over projects have taken a few years off my life.

Our ten-year old daughter has had a problem every year for the past three or four years similar to what you describe with respect to your young son. It usually begins about the time school starts in the fall, lasts several weeks thereafter, then finally goes away.

This year we decided to look into it, mainly because the severe bouts of coughing are alarming or worrisome (contagion) to some people at school and the outside activities she participates in. The only symptom she really had was the coughing spells, which usually occurred late in the day or during the night, usually became rather violent, and sometimes ended with her spitting up something (She’d just say, “I barfed”. What she spit up looked merely like a bunch of saliva.) Otherwise she appeared perfectly healthy … no fever, no shortness of breath, no discomfort of any other kind. We originally suspected an allergy, but to who knows what!?!

The doctor never happened to witness one of her coughing episodes, because she never had one during visits to his office, which were always in the morning. After a couple of visits, he recommended lab testing … asthma testing or allergy testing or both. Because, in our observation, allergy testing can go on forever and is often inconclusive, we arbitrarily chose the asthma tests. The first evaluation was evidently inconclusive. On the second visit a Methacholine Challenge Test (MCT) was performed which, according to the doctor, was “positive” (I didn’t ask for details; opinions differ on what constitutes a “positive” result). On the basis of that, his firm professional opinion was that she most certainly had asthma. The only other support he could give for his diagnosis was his twenty years of experience and knowing asthma when he sees it (which begged the question, “Then why the choice of lab tests?”) He became rather uncomfortable and impatient with my questioning the diagnosis, especially with my assertion that the MCT has limitations, and is not definitive as a diagnostic tool (does a better job of proving one does not have asthma). My other points were that she exhibited none of the other symptoms of asthma, and that her coughing appeared to be strictly a seasonal thing. (I didn’t mention that my wife and I were not at all impressed with the professionalism and probable competence of the technician doing the MCT at the hospital. We weren’t invited to observe the procedure, the results of which can be quite variable, depending upon the technician’s competence, the calibration of the equipment, the patient’s cooperativeness, etc.)

We are not eager to jump aboard an “asthma” diagnosis for a couple of reasons. First, such chronic conditions are stigmatizing to a child. Second, medications almost always have side effects, so we are touchy about using medications when the need has not been clearly established. Finally, in our thirty-year family history, we have suffered the consequences of wrong diagnoses enough times to have learned that we need to become informed and engaged in the process, even if most physicians aren’t comfortable with (or don’t have time for)such “consultations”.

In doing so, we make use of the many wonderful resources now available on the Internet … such as this one. In this particular instance, one of the things I discovered was that whooping cough … also called “the 100-day cough” … is not at all as uncommon as most people, including physicians, think (per www.whoopingcough.net, provided by one of your countrymen … or is it London, Ontario?). It is also not as serious or frightening as it used to be back in the pre-vaccination old days. The symptoms our daughter displayed (she’s over it again now) fit that diagnosis as least as well as asthma. That diagnosis would even be somewhat comforting since by the time the cough appears it’s too late to do anything other than let it take its course and get revaccinated in order to prevent its happening again next year.

So at this point all we know is that her symptoms closely match those described for “the 100-day cough”. Could be whooping cough, asthma, or who knows what? At school, at home and in the environment, kids are exposed to all sorts of things. As usual, whatever it was has disappeared, apparently spontaneously.  So, for the time being at least, all’s well that ends well. I hope by this time your situation has come out the same or soon will, or if not, that you will be lucky enough to discover what the problem really is. The only advice I could offer would be for you to keep doing what you are evidently already doing … plug in as many symptoms as you can think of in your favorite search engine, then follow the links until you have a pretty good idea of what the possibilities and probabilities are.

-=gw=-