Cough is the most common symptom in children and the most common reason for pediatric visits. A child’s cough can be a very distressing thing for many parents. In fact, coughing, like fever, is a defensive reflex of the body and has a protective effect.
The coughing action is essentially a violent and powerful inhalation, followed by the closing of the vocal chambers, followed by a vigorous contraction of the intercostal muscles and the diaphragm, followed by a sudden opening of the vocal chambers and a rapid and forceful contraction of the diaphragm, causing the gas in the lungs to rush out of the respiratory tract at a high rate and ejecting the material adhering to the mucous membrane of the respiratory tract, resulting in coughing and coughing up sputum.
When inflammation occurs in the respiratory tract (e.g. upper respiratory tract infection, bronchitis, pneumonia, etc.), inflammatory exudates, bacteria, viruses and destroyed leukocytes are mixed together and sent to the airways by cilia like garbage, and the accumulation of more can stimulate nerves and cause coughing, and by coughing, this garbage is eliminated. Therefore, as long as the inflammation does not completely subside, the coughing action of eliminating the “garbage” will continue.
If you try to stop the coughing with medication, more and more of this “garbage” will accumulate, which will aggravate the infection and even block the airway. This is why doctors especially encourage weak, elderly and thoracic and abdominal surgery patients to cough to get rid of the “garbage” in their airways so that it does not cause problems in their lungs.
As you can see, coughing can be both harmful and beneficial. Some parents are particularly nervous when they hear a cough, but this is not necessary. As long as your child coughs no more than 10 times a day, it can be considered normal and does not require treatment.
I. Causes and characteristics of coughing
A cough is just a symptom of a disease, and many diseases can cause a cough. Although there are many causes of coughing, the most common causes are mainly colds, infections, postnasal drip syndrome, and allergies. Each of these most common causes of cough has different clinical features.
(A) Cold and cough
The onset of cough is very rapid and is accompanied by cold symptoms, such as drowsiness, runny nose, sneezing, nasal congestion, watery eyes, sometimes accompanied by fever, poor spirits, loss of appetite, and sweating. The cough continues for 3 to 5 days after the cold symptoms disappear. This is the most common cause of acute cough.
(ii) Post-infectious cough
Also known as post-cold cough, it is a cough that remains prolonged after the cold symptoms disappear and can last up to 3 weeks or more. The disease starts with clear symptoms of upper respiratory tract infection, such as runny nose, sneezing, lacrimation, sore throat, and cough. After the cold symptoms subside, the cough remains unresolved, mostly as an irritating dry cough or a small amount of white mucus sputum, and usually lasts for 3 to 8 weeks. It is the most common cause of subacute cough.
(C) Postnasal drip syndrome
This is a type of disease in which secretions flow backwards into the postnasal area and throat due to nasal diseases, or even backflow into the trachea, causing a cough as the main manifestation. The common cold, various rhinitis and sinusitis can produce secretions that flow into the pharynx and cause coughing, which is the most common cause of chronic cough. Cough, hoarseness and pharyngeal discomfort are caused by increased secretions due to nasal and sinus diseases.
In most people, nasal discharge flows from the front nostrils, while in patients suffering from postnasal drip syndrome, nasal discharge flows from the posterior nasal passage to the pharynx as well as the vocal cords, so patients clear their throat before speaking, which is a typical manifestation of postnasal drip syndrome.
(iv) Allergic cough
Cough characteristics: recurrent, violent and paroxysmal coughing; recurrent coughing episodes, usually for more than one month, characterized by nocturnal and morning coughing episodes, aggravated by movement or crying, especially after inhalation of cold air, with a predominantly dry cough and no symptoms other than coughing; coughing often occurs during the alternation of hot and cold or the alternation of seasons, or in spring when there is more pollen in the spring; Children have a tendency to rub their eyes, nose or scalp; they are particularly sweaty and unfaithful when they sleep, and prefer to sleep curled up instead of lying flat.
II. Classification of cough
If coughs are classified according to their duration, they are usually divided into 3 types.
1. Acute cough: The cough lasts less than 3 weeks. The common cold is the most common cause of acute cough. Other causes include bronchitis, acute sinusitis, allergic rhinitis, bronchial asthma, etc.
2. Subacute cough: cough duration of 3 to 8 weeks. The most common causes are post-cold cough (also known as post-infectious cough), bacterial sinusitis, asthma, etc.
3. Chronic cough: cough lasting longer than 8 weeks. Chronic cough has more causes, such as pneumonia, tuberculosis, lung cancer, cough variant asthma (a type of asthma), and postnasal drip syndrome (due to rhinitis and sinusitis causing secretions to flow backwards to the back of the nose and throat, resulting in coughing).
III. Prevention and care of cough
Children with cough should reduce activity, increase rest time, and raise the head and chest slightly while lying in bed to allow for smooth breathing. Ensure adequate water and nutrition supply. Encourage the child to drink more water, if necessary by intravenous supplementation. Give a diet that is easily digestible and nutritious. A liquid or semi-liquid diet is appropriate during fever.
Keep the mouth clean. As the child has fever, cough, sputum and thick sputum, and cough can cause vomiting when it is intense, it is important to keep the oral hygiene to increase comfort, enhance appetite and promote the excretion of toxins. Infants and children can be fed an appropriate amount of boiled water after eating to clean their mouths. Older children should rinse their mouths in the morning, after meals and before bedtime.
Observe the nature of respiratory secretions and whether sputum can be effectively coughed up, and instruct and encourage the child to cough effectively. If the sputum is sticky, raise the humidity of the room appropriately, and maintain the humidity in the room at about 60% to humidify the air and dilute the secretions, or use ultrasonic nebulized inhalation or steam inhalation; for children with weak cough, it is appropriate to change the position frequently and pat the back to make the respiratory secretions easy to discharge and promote the dissipation of inflammation; if there are many secretions that affect breathing, use an attractor to remove the sputum in time to keep the respiratory tract clear. . Those with coughing and wheezing symptoms can be given oxygen inhalation.
Keep indoor air fresh and appropriate temperature, room temperature at 20 ℃ is appropriate, avoid convective wind. Conduct appropriate outdoor activities and physical exercise to enhance the body’s ability to adapt to temperature changes. Increase or decrease clothing according to temperature changes to avoid getting cold or overheating.
During the epidemic of respiratory diseases, do not let children go to public places to avoid cross-infection. Actively prevent malnutrition, rickets, anemia and various infectious diseases, and enhance the body’s immune system by timely vaccination.
If you cough incessantly while sleeping, raise the upper body to lie on its side and use a cushion or pillow on the back of the child’s shoulders. Let your baby sleep alternately on the left and right side, which is good for the discharge of respiratory secretions. Do not lie down to sleep immediately after feeding a coughing baby to prevent spitting up due to coughing and causing mis-aspiration. If you have already choked by mistake, you should immediately change your head to a low position, pat your back, and encourage your baby to cough up the inhalation.
Coughs that require urgent medical attention
When your child has a cough, parents should first stabilize and observe the nature of the cough, any complications and systemic symptoms before deciding whether to seek immediate medical attention. In the following cases, parents should take their child to the doctor immediately.
(a) If the child suddenly coughs very badly and has difficulty breathing, there may be a foreign object blocking the airway. Things that can be easily swallowed by mistake include peanuts, pencil sets, pills, buttons, coins, candies, etc. It is fine if the child is found immediately and first aid measures are taken to remove them, but it is very dangerous if the foreign object is never found to be stuck in the airway.
(B) high fever, coughing, wheezing with breathing difficulties, especially for babies less than 3 months old. They need to be taken to the hospital immediately for emergency treatment.
(c) Infants within two years of age are susceptible to capillary bronchitis, which is a form of pneumonia, when the child looks bad, often with purple lips and increased respiration, and in severe cases, respiratory distress, shoulder-lifting breathing, plus depression of the lower part of the chest wall when inhaling, should also be sent to the hospital promptly for treatment.
(d) There is also a special kind of cough that sounds like a dog barking and makes a “hollow” sound, called a barking cough, which is a characteristic symptom of acute laryngitis. If the cough is stifled and bruised, the larynx is severely edematous, which can cause asphyxia and threaten the child’s life, so the child should be taken to the hospital for treatment.
V. Treatment of cough
(a) Western medical treatment
1. Reasonable choice of cough medicine
When it comes to the treatment of cough, many parents immediately think of using cough medicine and ask around about the kind of cough medicine that works well. So, let’s first talk about how to apply cough medicine.
It is not necessary to stop coughing as soon as you see it, unless it is a violent cough that affects work or rest. A child’s cough of no more than 10 coughs per day can be considered normal. Cough suppressants should only be used when there is a lot of phlegm. If you blindly stop the cough, it may lead to poor expulsion of phlegm and germs, causing misaspiration or aggravating the infection.
The treatment of general cough should be based on expectoration and the use of cough suppressants is not suitable, especially not central cough suppressants such as codeine, cough suppressant, cough mephentermine, etc. Cough suppressants should only be used for a short period of time if the cough is frequent and severe, or if there are frequent episodes of irritating dry cough with little sputum, which affects the patient’s rest and sleep, and to prevent the cough from causing complications (e.g. pulmonary vascular rupture, emphysema, bronchiectasis, hemoptysis). For cough with a lot of sputum, it should be combined with expectorants (e.g. ammonium chloride, bromoxynil, acetylcysteine) to facilitate the expulsion of sputum and to strengthen the cough suppressant effect. For wet coughs with particularly high sputum, such as lung abscess, the drug should be given judiciously to avoid obstruction of sputum discharge and retention in the respiratory tract or aggravation of infection.
2. Treatment for the cause
As can be seen from the classification of coughs, common coughs are not caused by infection, except for cold cough caused by bacterial infection and some rhinitis and sinusitis in postnasal drip syndrome. Therefore, most do not require antibiotic treatment.
Coughs caused by colds and post-infection coughs are usually self-limiting diseases that can be relieved naturally and generally do not require special treatment. In case of heavy cough, some cough suppressants may be added.
Postnasal drip syndrome, treatment should be taken based on its possible diseases. For those caused by common cold, non-allergic rhinitis, etc., 1st generation antihistamines (e.g. paracetamol) and nasal decongestants (pseudoephedrine hydrochloride) are preferred. For postnasal drip syndrome caused by allergic rhinitis, 2nd generation antihistamines without sedative effects (e.g. loratadine or asmizole) are preferred.
Nasal inhalation hormones are also the drug of choice for allergic rhinitis. The main treatment for acute bacterial sinusitis is the application of antibacterial drugs, and nasal inhalation hormones and decongestants can be used to reduce inflammation when the effect is poor or when there is a lot of secretion. Treatment of chronic sinusitis: antibacterial drugs combined with antihistamines, drugs to reduce nasal congestion and inhaled hormones. Negative pressure drainage, puncture drainage or surgery are feasible when internal treatment is not effective.
For allergic cough, anti-allergic drugs such as paracetamol, loratadine and ketotifol are mainly used, and bronchodilators such as salbutamol and aminophylline can also be used.
(II) Traditional Chinese medicine treatment
1.Discriminative use of medicine
Chinese medicine believes that children’s internal organs are not fully developed, and the lungs are especially delicate, so it is particularly easy to cause external evil to attack the body. Viruses or bacteria are particularly likely to invade small children, so they are prone to coughing. Depending on the cause of the cough, it can be divided into two categories: external coughs and internal coughs. External coughs occur when children feel an external evil in the presence of climate change and poor self-regulation.
Most acute and subacute coughs are classified as external coughs. Internal coughs are caused by weakness of the internal organs or long-term imbalance in lifestyle habits such as diet, mood, labor, and smoking, which impair the function of the internal organs and eventually affect the lungs. Internal injury coughs are distinguished by spleen deficiency, lung deficiency, and kidney deficiency, and are characterized by slow onset, long duration, and recurrent attacks. Chronic coughs are internal injury coughs.
(1) Wind-cold cough
The body feels the evil of wind-cold, which is manifested by coughing with peripheral muscle aches, fear of cold, sore throat, no sweating, spitting white sputum, accompanied by headache, runny nose and fever, with a light red tongue and thin white tongue coating. Chinese herbal medicine should be Jin Bo Cao Cao San, Chinese patent medicine can be used for children’s lung clearing oral liquid, apricot sophora cough syrup, relief muscle and cough pill, etc. Chinese herbs: Jin Bo Cao Cao 9 grams, Qian Hu 9 grams, Almond 6 grams, Thornbush 12 grams, Hossein 6 grams, Semen 6 grams, Poria 9 grams, Ginger 3 slices, Licorice 3 grams.
(2) Wind-heat cough
The body feels the evil of wind-heat, manifesting as cough with fever, dry mouth, nasal congestion, spitting yellow sputum and unpleasant sputum, sore throat, red tongue and yellow tongue coating. Chinese herbal medicine can be used, such as mulberry chrysanthemum drink, Chinese patent medicine can be used, such as compound fresh bamboo leek oral liquid, snake bile and Sichuan shellfish liquid, mulberry chrysanthemum and silver fork powder, and silver yellow oral liquid. Chinese herbs: Mulberry leaf 6g, chrysanthemum 3g, almond 6g, forsythia 5g, peppermint 3g, orris 6g, licorice 3g, rhizome 6g.
(3) Phlegm-damp cough
Characterized by cough with sputum, clear and thin sputum, heavy cough in the morning and evening, often accompanied by loss of appetite and more saliva. Treatment is to dry dampness and resolve phlegm. Chinese herbal medicines can be used such as Orange Red Pills and Orange Red Phlegm Cough Liquid. Chinese herbal medicine: 10 grams of Semen, 10 grams of tangerine red, 9 grams of white poria, 5 grams of roasted licorice.
(4) Qi deficiency cough
Characterized by prolonged cough, weak cough, thin sputum, white face and sweating, etc. The treatment is to strengthen the spleen, benefit the qi, and nourish the lung to stop coughing. Chinese herbal medicines can be used, such as children’s health care and Sijunzi. Chinese herbs: Ginseng 9g, Atractylodes Macrocephala 9g, Poria 9g, Radix et Rhizoma Glycyrrhizae 6g, Pericarpium Citri Reticulatae 3g, Radix et Rhizoma Paeoniae 5g.
(5) Yin deficiency cough
Characterized by dry cough with little phlegm, coughing for a long time, often accompanied by physical wasting, dry mouth and throat, heat in the hands and feet, etc. Treatment is to nourish Yin and moisten the lung to stop coughing. Chinese herbal medicines can be used to nourish Yin and clear lung pills, Niancian Chuanbei Loquat Paste, etc. Chinese herbal medicine: 10 grams of northern ginseng, 10 grams of yucca, 10 grams of maitake, 15 grams of smallpox powder, 10 grams of lentil, 6 grams of mulberry leaf, 3 grams of raw licorice.
2. Diet therapy
Wind-cold cough should eat some warm, phlegm-relieving foods to relieve cough. Wind-heat should eat foods that clear the lungs, resolve phlegm and stop coughing. Internal cough should pay attention to foods that regulate the spleen and stomach, tonify the kidneys and replenish lung qi for children. The specific methods are as follows.
(1) Ginger and garlic brown sugar water
If your child also has a cough, you can add 2 to 3 cloves of garlic to the ginger and brown sugar water and cook it for 10 minutes on low heat.
(2) Roasted oranges
Bake oranges directly on a low fire and keep turning them until the skin is black and hot air comes out of them.
Orange is warm and has the effect of reducing phlegm and cough, especially the outer red part of the orange peel is stronger, also called orange red, wind-cold cough and more phlegm, is white thin sticky phlegm, eat roasted orange, the amount of phlegm will be significantly reduced, cough suppressing effect is very obvious, and children are willing to eat.
(3) pepper and rock sugar pear
One pear, dig out the middle core, put 20 peppercorns, 2 grains of rock sugar, put the upper part of the pear into a bowl, put it into a pot and steam for about half an hour, one pear can be finished in two times. Suitable for wind-cold cough.
(4)White radish water
Cut 4-5 thin slices of white radish, put it into a small pot, then add half a bowl of water, put it on the fire and boil it, then change the fire and boil it for 5 minutes, you can add appropriate amount of rock sugar or honey, drink it 2-3 times a day. Suitable for wind-heat cough
(5) Er Chen Er Ren Congee
9 grams of Chen Pi, 6 grams of Semen, 12 grams of Poria, 15 grams of Job’s Tear, 15 grams of Dong Gua Ren, and 100 grams of round-grained rice. Decoct the first five ingredients in water, boil for about 10 minutes, remove the dregs and extract the juice. Add round-grained rice and an appropriate amount of water, cook with for porridge. It is suitable for cough with phlegm and dampness.
(6) Boiled yam porridge
Take a piece of yam, add half a bowl of water, process it into a thin paste, pour it into a small pot, put it on the fire and stir it while boiling to prevent the bottom of the pot from getting gummed up, when the yam boils and bubbles, turn off the fire. The finished bowl of yam porridge can be fed to your child in 2 to 3 servings. Yam strengthens the stomach, tonifies lung qi, benefits kidney essence, nourishes and strengthens, and is suitable for coughing and asthma due to deficiency of spleen and stomach qi and deficiency of lung and kidney.
(7) Steamed pear with Sichuan scallop and rock sugar
After digging out the middle core of the pear, put in 2~3 grains of rock sugar, 5~6 grains of Chuanbei, Chuanbei should be cracked into the end, put the upper part of the pear together well, steam it on the pot for about 30 minutes, and give it to the child in 2 times. Suitable for Yin deficiency cough.
3.Tui Na massage
(1) Basic operation.
The face of the child first in the head and face for the usual techniques, that is, open Tianmen 30 times, divided head yin and Yang 30 times, rub the sun 30 times; then in the chest part of the push Tanzhong 100 times, rub the side of the breast, breast root 30 times each; and then for the hand transport within the Bagua 200 times, 300 times to clear the lung meridian, lung meridian 500 times; finally press and knead the double lower limbs Fenglong and foot Sanli points respectively, each point for 1 minute.
With the child lying prone on the treatment bed or the doctor sitting facing the back of the child, press and rub the Fengmen and Lung Yu points respectively for 1 minute each; push the shoulder swollen bone 100 times and apply the rubbing method to the back of the child’s Yu point, to the extent of heat.
(2) Add and subtract with evidence.
For cough with external wind-cold sensation, add 30 times of rubbing the outer labyrinth, 300 times of pushing the upper three gates, 5-10 times of taking the hegu and 10 times of taking the fengchi; for cough with external wind-heat sensation, add 500 times of clearing the lung meridian, 500 times of retreating the lower six internal organs and 100 times of pushing the tianzhu bone; for cough with internal injury, add 500 times of tonic spleen meridian, 300 times of tonic kidney meridian, 200 times of rubbing the middle yard, 2 minutes of rubbing the dantian, and then press and rub the spleen, stomach and kidney yu, each point for 1 for 1 minute each.
4.Moxibustion
Acupuncture points for cough in children: Dazhi point, Fengmen and Lung Yu.
Dazhi point: It belongs to the Governor’s meridian and can regulate the rise of Yang energy in the body. It is located in the depression below the spinous process of the seventh cervical vertebra. It mainly treats fever, cough, asthma, bone steaming and night sweating, epilepsy, headache and strong neck, shoulder and back pain, strong pain in the lumbar spine and rubella. Moxibustion of the Dazhi point should not be less than 10 minutes.
Fengmen: 1.5 inches below the second thoracic vertebrae spine on the back, treating cough and nasal congestion and excessive snot.
Lung Yu point: 1.5 inches below the spinous process of the third thoracic vertebra, treating cough, asthma, hot flashes, night sweats and nasal congestion.
Fengmen and Lung Yu are close to each other, so you can move moxibustion around them. Do not combine these two acupoints for less than 10 minutes.