Coughing Infant

Dear Lisa,

My 6-month old baby is teething, but for the last, she had a running nose. This morning when she woke up, she had a very bad cough. We don't have a medical aid, but she has to see a doctor. Can you please give me some advice?

God bless.

“Worried Mom”

Dear “Worried Mom”,

Babies that are teething tend to have a runny nose and drool a lot. Other signs of teething include waking at night, bulging gums, bleeding gums, fussiness, irritability, putting objects or fists in the mouth, biting and gnawing.(1) These symptoms seem to intensify a few days before a tooth actually erupts. Babies may also experience diarrhea, a diaper rash, low grade fever and cough right before they “break a tooth”.

It is normal for a baby that is teething to cough a few times per day. Coughing is a natural protective mechanism that clears the secretions from the baby’s airway. If the frequency of the cough is more than a few times per day or if the quality of the cough is deep or harsh, it may be due to another condition.

Constantly putting hands and teething rings in the mouth increases an infant’s exposure to germs that cause Upper Respiratory Infections. It is common for a baby to develop a virus or an Upper Respiratory Tract infection while teething. Therefore, the development of a cough in a teething infant can be a sign of a respiratory infection. Signs of an Upper Respiratory Tract infection include; nasal discharge, sneezing, fussiness, decreased appetite and cough.(2)

Many times it is difficult to differentiate a baby who is teething from one with an Upper Respiratory Tract infection. Therefore it is a good idea to have a baby with a cough or signs of a respiratory infection evaluated by a health care professional. In addition, infants are at risk for developing complications from an upper respiratory infection. These complications may include Otitis Media (Middle Ear Infection), Bronchiolitis or Pneumonia.

Otitis Media is the infection of the middle ear cavity. It is commonly referred to as a Middle Ear Infection. A Middle Ear infection is a common childhood ailment which accounts for 20% of all visits to the doctor during the first five years of life.(3) The symptoms include earache, sensation of “blockage” of ears, rubbing or pulling ears, hearing loss, fever, irritability, upper respiratory symptoms, vomiting or diarrhea.(3)

Bronchiolitis is one of the most common and serious viral infection that affects the lower respiratory tract in young children.(4) Almost 85% of cases are caused by the RSV virus. Other potential pathogens include Parainfluenza Virus, Adenovirus, Influenza Virus and Rhinovirus. The symptoms of Bronchiolitis include a several day history of clear nasal discharge and nasal congestion followed by cough, fever, wheezing, retractions, poor feeding and in some cases respiratory distress.(5) Signs and symptoms of Bronchiolitis last for 10 to 14 days with the most intense symptoms occurring by the fifth day.(5)

Bronchiolitis is usually a mild and self limiting disorder, but in some cases it can become quite serious. It happens to be the most common cause of hospitalization among infants. Those children at risk for developing severe disease include the very young, premature and those who are chronically ill.(5) All young children with symptoms consistent with Bronchiolitis should be evaluated and closely followed by a health care professional.

Signs of Pneumonia in an infant include fever, fast breathing and irritability. (6) In some cases an Atypical Pneumonia may occur which presents with different symptoms. Signs of Atypical Pneumonia include; cough, fast breathing or wheezing. A fever is typically not present in a child with Atypical Pneumonia. (6)

The diagnosis of Pneumonia is made from a physical examination, bloodwork and X-rays. Many times X-ray results will "lag behind" the clinical presentation of Pneumonia. In other words, an initial X-ray will show normal results, but a follow-up X-ray performed at a later date demonstrates signs of Pneumonia. (6) Sputum analysis is routinely not performed on children because of the difficulty of obtaining a suitable specimen. (6)

It is a good sign that your daughter is not experiencing difficulty with feeding, irritability, fast breathing or fever. It is important to watch for these signs because they can represent a condition more serious than teething. Concerning signs include a baby who will not drink, fever over 100 degrees Fahrenheit, increased respiratory rate, increased work of breathing, nasal flaring, retractions (chest wall sucks in between the ribs with breathing), wheezing, pale or blue color and a baby that cannot be consoled. If your baby is experiencing any of these symptoms an evaluation by a Physician should be performed without delay.

I hope your baby is feeling better soon.

If you are interested in reading other Pediatric Advice Stories covering topics discussed:

Teething

Baby with Cold Symptoms

Otitis Media

Treatment for Cough

Chronic Cough

Bronchiolitis

Pneumonia

References:
(1)Grassia T. Talking teething: Start god oral hygiene early. Infectious Diseases in Children. 2006. August:44.
(2) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 707-708.
(3)Alper B, Fox G. Acute Otitis Media. The Clinical Advisor. 2005. April:78-86.
(4)Linzer JF, Guthrie CG. Managing a winter season risk: bronchiolitis in Children. Pediat Emerg Med Rep. 2003.8:13—24.
(5)Bradin SA. Croup and Bronchiolitis: Classic Childhood Maladies Still Pack a Punch. Consultant for Pediatricians. 2006. Jan:23-30.
(6)Nield L, Mahajan P, Kamat D. Pneumonia: Update on Causes-and Treatment Options. Consultant for Pediatricians. 2005. Sept:365-370.


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

Pediatric Advice For Parents