Respiratory illness

A word or two about winter respiratory illnesses.  Parents bring their children to see me because of coughing more than any other symptom.  Coughing can be as simple as a cold with dripping down your throat or as complex as a deep pneumonia (which means infection in the substance of the lung).  Coughing is often associated with other problems.

Croup:  This is usually a self-limited respiratory virus where the inflammation centers in the larynx (or voice box) and to a lesser extent in the trachea and bronchi which are the tubes traveling toward the lungs.  The cough is dry and barky like a seal, worse at night and better during the day.  This is best treated with good hydration and a humidifier or vaporizer.  Sometimes a steamy shower will help or even a walk in cool night air.  If there is true difficulty in breathing you should seek medical attention.

Bronchitis:  This is a non-specific term meaning that there is some inflammation in the air tubes on the way to the lung.  Again it can be very mild to quite severe.  Hydration and humidification can be helpful. Some children with bronchitis may make a wheezing sound, especially as they breathe out.  This may be a sign of asthma which might point toward other types of treatment, such as inhaled medicine or even nebulized medicine (a nebulizer is a machine that puts medicine into a vapor to breathe in).  Most bronchitis is caused by viruses, but if associated with other problems (sinusitis, otitis media), antibiotics may be of help.  Antibiotics are not helpful if an infection is mainly viral.

Pneumonia:  Every so often a child with a bad cough turns out to have pneumonia, or infection in the substance of the lung.  That doesn’t necessarily mean they are worse off than a simple case of bronchitis, but a child with pneumonia typically is sicker, usually with fever, bad cough, and sometimes shortness of breath.  Clearly this needs medical evaluation and treatment.

Otitis Media:  An infant with a persistent cold and cough may have an ear infection or otitis media.  This is the most common infection I treat in children.  Otitis media is an infection in the space behind the ear drum.  That space connects to the back of you throat through the Eustachian tube, the tube which opens and closes when you go up or down in altitude.  An ear infection occurs when germs travel up the Eustachian tube and grow in that middle ear compartment.  Treatment is usually a course of antibiotics.  Ear infections are not dangerous and generally not an emergency.  If your child has significant ear pain he should come see me.  Ear pain itself is best treated with an appropriate dose of Tylenol or Ibuprofen (Motrin, Advil).  Just as often a child with an ear infection comes in because of persistent and worsening cold and cough, often unaware that they have an ear infection.