Cough and Sore Throat

Dear Lisa,

Hello, I wanted to know my 3 in a half year old had a temperature of 101.2 last night, I gave her children's Tylenol. This morning her temperature went down, but she had a coarse cough. When she tries to cry its like she struggles to cry aloud, I'm guessing she has a sore throat. She coughs a lot in small periods of the time. What should I do to soothe her? Should I take her to the doctor, she not running a fever. She still seems happy she tries to laugh, talk, and giggle throughout the day.

“Daughter with a cough and sore throat”

Dear “Daughter with a cough and sore throat’,

Symptoms including a low grade fever, sore throat and cough in a 3½ year old who otherwise is playful, eating well and acting normal most likely represent a virus. One of the viruses that can cause such symptoms is Adenovirus.

There is an increased incidence of respiratory infections from Adenovirus during the late winter, early spring and summer months. The symptoms of Adenovirus include pharyngitis(throat infection), cough, respiratory symptoms and conjunctivitis. In some cases Croup, Pertussis-like syndrome, Bronchiolitis and Pneumonia may develop.(1,2) Laryngitis or the inflammation of the voice box which causes a child to have a haorse "voice" may also occur. Severe Pneumonia can develop in younger infants and less commonly in older children and adolescents. The disease is often more severe in immunocompromised children.

Adenovirus is spread through respiratory secretions, from person to person contact, or from contact with surfaces harboring the germ. Adenovirus can also cause Gastroenteritis symptoms such as vomiting and diarrhea. The strain that causes gastrointestinal symptoms is transmitted via the fecal oral route. Good hand washing after toileting and proper disposal of diapers is necessary in order to prevent the spread of this type of infection.

The incubation period (the time a takes a person to catch the disease) for respiratory infections due to Adenovirus varies from 2 to 14 days. The incubation period for Gastroenteritis caused by Adenovirus is 3 to 10 days. Adenovirus infections are most communicable during the first few days of acute illness but persistent shedding of the germ for longer periods does frequently occur.(1)

Other viruses that can cause a sore throat, cough and fever include the Parainfluenza virus, Respiratory syncytial virus(RSV), Influenza and the Measles virus. Children who have been immunized with the MMR vaccine are not likely to have the Measles.

Since your daughter no longer has a fever, she seems happy and is giggling throughout the day it is unlikely that her condition warrants an urgent evaluation. Supportive care and monitoring of her symptoms are measures that are necessary at this time.

Giving your daughter a lot of fluid to drink not only can help soothe her throat, but will liquefy her respiratory secretions and prevent her from becoming dehydrated. Children with a sore throat can benefit from drinking chilled fluids or ice pops. The coldness of the fluid will numb the area and relieve pain. Sugar and lemon drinks can also be given and can help soothe the throat. (3)

To help your daughter with her cough you can use a Menthol chest rub. Menthol rubs are appropriate for a 3 ½ year old child with a cough. Menthol has shown some ability to reduce cough sensitivity in laboratory studies. (3) If your daughter continues to cough, develops shortness of breath, increased work of breathing, wheezing, fast breathing or difficulty breathing you should bring her to the doctor for an evaluation.

Other concerning symptoms include the return of a temperature, disinterest in eating, vomiting with coughing, drooling, lethargy, irritability or a persistent sore throat. These symptoms may represent worsening of her condition or a different condition and should be evaluated by a Physician or Nurse Practitioner.

If your daughter has a history of a chronic condition such as Asthma, Diabetes, cardiac defect, immunodeficiency or musculoskeletal disease it is important to have her evaluated by her Physician. Viruses and illnesses can exacerbate underlying chronic medical conditions and lead to complications.

If you are interested in reading other Pediatric Advice stories covering these topics:

Cough

Sore Throat

Gastroenteritis

Temperature Reading

References:
(1)American Academy of Pediatrics. Adenovirus Infections. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:130-131.
(2) Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:1214.
(3)Chang AB, Glomb WB. Guidelines for evaluating chronic cough in pediatrics. ACCP evidence-based clinical practice guidelines. Chest. 2006. 129:260S-283S.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

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