20 month old - cough that has lasted for about 7 months

[StarExpat]

This past winter, DS had pneumonia, then several episodes of tonsillitis. Throughout all of it, he has had this chesty cough, sometimes a barking cough. It's definitely phlegm-y sounding and sometimes (sorry TMI) I can tell he's coughed something up as he chews/sucks in the back of his mouth, then swallows it back down.

Anyway, when he was ill, he'd cough a lot. Now, he only coughs at night, after (sometimes during) his nap, and when he's first up in the morning. It sounds really horrible. He also coughs when he's been running around a lot outside. People always give an odd look at him when he coughs because it sounds really awful.

Mothers often ask me if he's ill or say "aww, poor little lad" or similar... when actually, he's perfectly fine other than the cough. he'll cough several times in a row and it's really chesty so it does sound bad.

I have asthma (had it as a child and it's not bad now at all, but was when I was smaller). I know that 20 months is too young to tell, but I'm hoping this isn't it.

He did seem to have hayfever. We controlled that with Piriton.

What else could this be? I don't want him to have this cough forever. Do you think it's something more sinister?

My mother (non-smoker all her life) died of lung caner at the age of 40, so this is probably what is worrying me most of all I know that is an over reaction, I just have this feeling that something is not right. And I want my little boy to be ok Anyone else with a cough like this or know what it might be?
Sorry it's so long.

Just a v brief reply i'm afraid -DD1 & 2 on my knee- but wondered what your GP thinks? I would push to get your DS seen by a specialist to check for asthma?
Also, not to scare you, but was he checked for cystic fibrosis with the newborn heel prick test? is his weight gain ok?
Really feel for you-definitely push the health professionals for more investigation. Good luck x

Thank you for your reply, jumpingjellyfish
I've been to the gp so many times. I tend to go for every small thing pfb, 1st time mother...etc. Every time we went for tonsillitis I'd ask about it. Then I'd get an appointment in between the tonsillitis episodes (only 1-2 weeks) and they would say he was "fine". How would I know if he had the cystic fibrosis test? Is it in his red book?

Re: Weight gain, he's a really solid, heavy little boy. He was born at 5lbs 15oz, and was a bit less when he came home, but then quickly gained and was only on the 2nd percentile line for a couple of months. Then, despite being breastfed, he shot up in weight and was definitely putting on the lbs without any difficulty. He's thinning out a bit now, but is still definitely not struggling in the weight area. Is that a good sign? I don't htink he's overweight, btw. Sorry I'm rambling again

oh goodness I should have mentioned I get quite nervous and paranoid about things very easily. Now very worried about cystic fibrosis. This probably isn't what it is, right? Should I just ask my GP? they will just laugh at me and say he's fine. Scared now.

StarExpat, why don't you ask your gp for a referral to an asthma specialist? After having recurrent chest infections over the last 2 years (ds born with very slight breathing problems and very prone to get chest infections - every time he has a cold, really!), I've now asked for a referral.

He has inhalers to use every day and is a happy and overall healthy boy, but, like you, I would just like confirmation that all is ok.

I don't think you have to worry about cystic fibrosis unnecessarily though. Sometimes they just have weak lungs, and often grow out of it as young teenagers.

Ok, I'm going to ask the gp for a referral. Thanks Will they just refer me, just like that? They usually brush me off (in a nice way of course). Did you do it privately? Maybe I should do that instead.

Ah yes, I'm doing it privately, sorry, should have said. The reason why I'm going private is because the inhalers doesn't seem to work much lately, so I'd prefer it checked out urgently. Still, I have to wait one month to get an appointment at the specialist my gp recommended (he's very good).

If you're not in as big a rush, just be honest with gp, say that you'd like reassurance because of the length of time he's been coughing and your family history of asthma. Be warned though, it would very likely be a couple of months at least.

However, as they are unlikely to be able to "fix" it anyway, the waiting not necessarily bad.

Do insist though that the referral (if gp is willing to give) is to an asthma/allergy specialist and not just to a general paediatrician.

If you have private medical insurance, I'd recommend that btw, as it gives you more flexibility as to who you can choose and which appointments you prefer. Obviously it doesn't make a difference to the quality of doctor - all private specialists we've seen before were also working in the NHS.

I do have private medical insurance. I'll look into that. thanks so much

Ok, will visit that thread tonight - thanks, pixie

I will also arrange an appointment with my GP and my private GP and look into costs and see what is affordable at the moment. I don't think it's too urgent as he's not really poorly, just the cough - we do have a blue inhaler, which was given to him when he had his first chest infection and that does help if a coughing fit is too long. I really hope it's not asthma I remember being younger and having an asthma attack and having that feeling that I just could not catch a breath. So scary I don't want ds to ever feel that!

It does sounds like he has asthma - a night cough, coughing in the morning and exercise-induced cough are all pretty indicative of asthma in children.

Children with asthma produce sticky mucus, a side effect of the inflammation going on, but it is usually clear and not infective - the child will be otherwise well (ie no fever).

It sounds like he needs to try a month of an inhaled steroid (a brown inhaler) and if it helps then it probably is asthma - if you had asthma as a child there can be a family history.

In the meantime give him his blue inhaler whenever he's coughing and try and see the GP when you can, or if your practice has an asthma nurse see her/him. Don't panic if it is asthma, treatment has come a long way in the last 10-15 years so he may not have as bad a time of it as you did!

Thanks so much for your replies. As much as I don't want it to be asthma, it sounds so much better than CF.

I know night coughing is associated with asthma, but I also know they will probably not formally diagnose before the age of two.

Excellent - then I'll get my name on a waiting list. As he's 20 months now, and I'll probably wait 4 months, he'll be 2 by then Will they do a proper test for asthma or just go by symptoms?
I remember having to blow into this tube several times after doing a variety of tasks. I'm from the US, so things might be done differently... not sure what to expect.

My DS was diagnosed with whooping cough, despite having had all his vaccinations, after he had months of coughing, especially at night. GP prescribed an antibiotic, (I think?) and something to ease the irritation of his coughing. She said it would take a month to go, and it did, but he has been fine ever since. GP said whooping cough in children is the most underdiagnosed cause of coughing in the UK. Everyone forgets about it because of vaccine.

Don't panic, it by no means has to be CF. Asthma, or even a viral of bacterial infection seem equally plausible. I would just see your GP. Good Luck

Thanks sparkle and pixie

Pixie - do you know when they would do an actual test to check if it is, indeed, asthma?
I find that method to be a bit odd... sort of like giving symptoms of lung cancer, then assessing that it's in your family, so it's probably that. That would never happen. So, why with asthma? Why not just give the definitive breathing tests? I'm not trying to be mean or pushy, I know it's sounding that way I just don't understand how that can be a proper diagnosis of a chronic condition.

The only way to definitively diagnose asthma is through lung function tests, such as spirometry or peak flow diurnal variation.

The problem is that young children can't effectively do these tests, so not giving accurate results. Also we don't want to confuse them with taking their inhalers (breathing in) with doing peak flows/spirometry (blowing out).

We won't start the 'proper' diagnostic pathways until around 6, depending on the child. Before then we have to go on symptomology and history/clinical assessment/trial of therapy. The way that asthma develops and presents is generally fairly standard and so we can assume fairly safely that if the child responds to x then they probably have y. But that's also why we don't usually mark their medical records as having asthma until definitive tests have been done when they are older.

Thanks so much for that, sidge! That makes a lot more sense to me now
Just one more question for you then, if I can bother you... what if, at age 6, it turns out that he doesn't have asthma, but has been taking inhalers for asthmatics with steroids...etc. until then because he was treated with them? Could this be harmful? Or is this safe? Sorry, I just really want to do the right thing.

Has he been tested for Mycoplasma pneumoniae?

oh goodness, we can't afford for him to have stunted growth as we're not very tall!

Thank you - you did a great job explaining that! That makes me feel better about letting him have it.

Rollmops - shall I google that?? He had pneumonia once then several episodes of tonsillitis which was caught before they became chest infections. He's really healthy right now. Just the cough.

What Pixie said re inhaled steroids!

They are a very safe drug, delivered directly to the lungs to reduce inflammation so have very little systemic effect.

Also if a child doesn't have asthma then inhaled steroids are unlikely to have much of an effect, so the child wouldn't be on them for a great length of time anyway. We usually give a steroid inhaler, review after 4-6 weeks and if absolutely no relief with symptoms at all then we stop it or try something else.