Parent’s Cheat Sheet: Describing coughs (and other noises) to the doctor

Describing Cough to DoctorWhen children come down with respiratory illnesses, they make lots of noises. The words parents use to describe these noises don’t always agree with how the doctors use the terms. Here’s the lowdown on the noises kids make when they have a cold or the flu.

  1. Congestion. This occurs with a stuffy nose and sinuses. When a child is congested, he will sound nasal because less air is passing through his nostrils when he talks. Which nostril is clogged varies throughout the day.
  2. Postnasal drip. If a child has a cold, mucus not only drips out of his nose, but some will also drip down the back of his throat. This can make his voice hoarse or raspy.
  3. Garbled voice. If a child has enlarged tonsils, he will often sound like he has “marbles” in the back of his throat.
  4. Chest rattle. Babies and young children don’t do a good job clearing mucus from their nose and throats when they have a cold. As a result, they often produce a rattle-like sound when they breathe. Parents not only hear this noise coming from the baby’s throat, but they may also feel it in the baby’s chest when he’s being held. A chest rattle is not usually a sign of pneumonia.
  5. Dry cough. This refers to a cough that has a rough, staccato quality.
  6. Wet cough. This refers to a cough that has a moist quality. It usually happens if a child has postnasal drip or bronchitis. Contrary to what many people believe, bronchitis in children is usually a viral disease and does not require antibiotics.
  7. Croupy cough. If a child has croup, his trachea becomes swollen below the vocal cords. This creates a hoarse voice and a barky, seal-like cough.
  8. Stridor. This sound is made during inspiration. It’s a brassy sound associated with a sense of difficulty getting air into the lungs. This is most commonly heard in children with croup: they “bark” when they cough and have stridor when they breathe in.
  9. Whoop. A classic whoop is heard with pertussis (whooping cough). The whoop is dramatic and occurs after a child has had a prolonged coughing fit. Nowadays, pertussis is more likely to be seen in older children or adolescents rather than babies or toddlers. An older child is more likely to “gasp” than whoop when he takes a breath after a prolonged coughing spell.
  10. Wheezing. This sound is made primarily during expiration. It’s a medium to high-pitched noise that sounds like the word. It is produced when a child’s bronchial tubes are tight (asthma) or narrowed with mucus (bronchitis, asthma). If a wheezing child is having respiratory distress (difficulty breathing), you may notice certain things when he breathes in: (1) his nostrils flare and (2) the spaces between his ribs pull in (“retract”).
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Young children don’t know what the expression “sore throat” means

Next to colds, throat infections are the most common reason children see the doctor. It is important to realize, however, that young children do not know what it means when someone asks them if they have a sore throat. Therefore, if you are inquiring about this symptom, ask your child if it hurts when he swallows. You would be surprised how many children will say yes to this question even if they just told you they do not have a “sore throat.”

Stuffy babies usually do not have colds

In the first few months of life, babies are obligate nose breathers. This means that they have to breathe through their noses. By the time babies are three to six months of age, they are able to breath through their mouths, but most still prefer nasal breathing. Because babies breath through their noses, they make all sorts of noise—snurgles, snorts, and other sounds that mimic a cold. If a baby truly has a cold, he will have a runny nose and a cough.

The reason this distinction is important is because many parents feel the need to clean their baby’s noses if they are stuffy. As long as your baby can feed easily, you do not need to (a) put saline drops in his nose or (b) clean his nose with a nasal aspirator. If your baby is so stuffy that she cannot feed properly, you should discuss this with your doctor.

Bronchitis is usually a viral infection

Most episodes of bronchitis do not require antibiotics because they are caused by viral infections. Parents become understandably concerned if their children are coughing and often notice a chesty “rattle” when their kids cough. Although this may be due to mucus that is produced in the bronchial tubes, i.e., bronchitis, in many cases this sound is generated because young children are inefficient at clearing mucus from their throats when they have a cold. (You feel the “rattle” when they breathe through mucus in the back of the throat.) So the next time your doctor diagnoses bronchitis, ask whether you can take care of the infection without antibiotics.