Yet another coughing thread...

[PseudoBadger]

DS is 23 months and has had a cough for a couple of weeks. Since Tuesday it's got much worse and he's had a fever Wednesday and today. He never gets a temperature. I took him to the gp yesterday and he said that his chest was clear and to carry on with calpol etc.
So he's still got the fever today, has had lots of bad coughing fits and made himself sick coughing at dinner.
He's asleep now propped up on 3 pillows but has woken 3 times already. I think I should go back to the GP tomorrow but will they be interested?

How is his breathing? How high is his fever?

I wouldn't put anything on a GP saying that a chest is clear as it is incredibly difficult to accurately diagnose this. That is why in A&E and that is why respiratory consultants always use chest X-rays.

Breathing is slightly rough (hard to tell as he has a runny nose too), and highest temp today was 38.2.

If he is not in pain I would not give him any calpol or calprofen unless the temperature goes up to 38.5 or even 39. I would then in first instance give calpol and give it 1 hour to work. If temperature hasn't come down to 38.5 I would also give calprofen/other children's ibuprofen. To avoid overdosing you may want to keep a note of when you give how much of each medicine.

Usually a child with a chest infection (which is basically pneumonia) will have a very high temperature which does not respond to medication. Also, breathing will be laboured.

If you are worried about oxygen levels, you can do the nailbed test: you push hard with your finger tip on the nailbed of one of his fingers whilst moving your fingertip to his fingertip. His nail will very briefly go white and should be nice and pink again in a second or so.

You could help his breathing through using saline drops or saline spray (sterimar or others), you can even make a salt solution yourself but may need to ask NHS direct for correct amount of salt to be mixed with cool boiled water. You can do this quite frequent, which also reduces the risk of throat and ear infections.

Ultimately, trust your instincts, if you remain worried, take him back to GP or other GP or OOH or A&E.

Thank you very much :)

Just been through this with my ds.. Started suddenly on Saturday high fever and terrible cough he was in so much pain every time he coughed.. By tues he was up all night choking and coughing took him to GP who said his chest was clear.. Still running a fever and coughing was just awful I was even thinking it could be whooping cough so took him back to the GP who again said chest is clear but gave me antibiotics for him anyway.. Basically to shut me up I think! Anyway within 12 hours his fever had come down and the coughing no where near as severe 24 hours on.. I'm certain he had some kind of infection.

DS's temp has just gone up to 39.1 (was around 38 this morning). So I've given calpol and will check again in an hour. Still nasty cough, he's not verbal enough to tell me how or where he has pain. He's happy watching tv or cuddling on the sofa.

is his cough dry or is it productive? if productive is the phlegm greenish and thick? if it is then that would indicate a bacterial infection which would respond to antibiotics.

if the cough is dry or phlegm is clear then it indicates viral so antibiotics no use.

gp's listening to chests is accurate enough to see if it's clear. if there isn't obstruction or thick mucus breath sounds are easy to hear right down to the bases of the lungs. pneumonia normally blocks these breath sounds down in the lower lobes of the lungs as gravity will settle the mucus there and it's harder to cough up as it is thick.

with both viral and bacterial respiratory problems wheezing is common when listening to chest, so the main difference is the quality of breath sounds and the locations of them. duller sounds or absence of sounds in some areas with bacterial.

treat the pain and the temperature with medication. plenty of fluids to prevent dehydration as this will thicken any mucus secretions and make it more difficult and painful to cough up.

a good regime for medication is to start with a full dose of ibuprofen first, two reasons 1. it is a really effective medication for temperatures, 2. the anti-inflammatory properties help if there is any irritation in the throat. if your son is off his food then cold milk is good enough to protect his stomach. it is also the linger acting medication so can't be given again for 6-8 hours and not more than 3 times in 24 hours.

if in 2-3 hours you notice his temperature is creeping back up then give half a dose of paracetamol. only half a dose so that you still have another dose 2-3 hours later if pain/temperature creeps up again.

you'll then find 2-3 hours after this you can re-dose with ibuprofen and then repeat throughout day to give a really constant release of pain relief instead of peaks and troughs.

example: total

        6am ibuprofen full dose.                          1 full ibuprofen
        8-9am paracetamol half dose.
        11-12 paracetamol half dose.         1 full ibuprofen & 1 full paracetamol
        2-3 full ibuprofen                           2 fill ibuprof.        1 full paracet.
        4-6 half paracetamol
         8-9pm half paracet.                      2 full ibufrof          2 full paracet.

if this works throughout the day it will leave 1 full ibuprofen for during the night or a bedtime dose, and 2 full paracetamol doses to use either in halves or full doses depending on how many time he's waking up. so no chance of overdosing 3 ibuprofen in 24 hours and 4 paracetamol in 24 hours. it is worht keeping a record of times for your doses until you get used to split dose regimes.

sorry if i've waffled/patronised in anyway, just wanted to be clear when it comes to medication. also i've been lazy and not used capitals, please forgive and all the best.

Thank you, unfortunately I can't follow your suggestion as I've already given calpol first! Although it makes perfect sense :)
So I've just taken his temperature again an hour after calpol and it's up to 39.2! I've called the gp (panicking as it's my pfb's first proper fever!) and he's calling back.
Other symptoms are this cough (he's not coughing stuff up but may be swallowing it?), runny nose and a few sneezes and he's just had diarrhoea. I think breathing may be slightly laboured (but not struggling for breath) and he's red in the face. Cold feet (which I hope is just from refusing to keep socks on in a coolish house) but warm hands.

My ds age 3 had cough similar sounding to your ds- temp spiked to nearly 40.
When temp round 38-39 went to gp cos of cough/hacking til sick etc. She gave a soluble one off steroid which he thankfully took ok. She said his airways/ throat inflamed. Still bit of cough but much better.
Hope things improve.