Coughing Toddler.

[Moonrakers]

My 4 year old keeps on coughing.

It has been going on for about 1 1/2 years now on and off. It is a dry cough which sounds quite painful to her and often causes her to vomit.

My wife and I have, of course, taken her to see various doctors only to be given cough medicine, paracetamol and anti-biotics each time which never really seem to have much effect.

She does not have this cough permanently, about 50% of the time but still quite (too) regular which leads me to wonder if she has some sort of condition which would make her sensitive.

I grew up with rhinitis and asthma myself which leads to to wonder if maybe she has a hereditary condition.

We try to explain this to the doctor(s), but each time we are passed of with some sort of cough syrup that does little or nothing. My daughter has also contracted pneumonia in the past.

Asides from the obvious discomfort that this causes my (otherwise healthy) daughter, she is also epileptic and the high fevers that can arise are a trigger for epileptic attacks.

So does anybody have a possible diagnosis, advice on what to suggest to the doctor(s) or even just a point in the right direction? Sheryl?

Thanks in advance.

[Sheryl]

Your daughter needs a thorough evaluation by a specialist in Pediatric Allergy. Should also test for TB at that time.

I don't know where you live but to get what you need, will have to go to Bangkok. I recommend going to the Child Health Institute at Samitivej and consulting Dr. Vichayanond, who is a Professor and head of Pediatrics att the country's best medical school (Mahidol/Siriraj)and a leading expert both in Thailand and internationally on pediatric allergy.

http://www.samitivej.co.th/samitivej_front...09827&Img=1

http://www.nationaljewish.org/pdf/ANL.pdf

I also list beow some other doctors who, while not of his stature, are well qualified and have more frequesnt private hours. Once you get to the bottom of the matter, if it is allergy, you'll weant a doctor that you and your wife are comfortable with and that your daughter responds well to, so inter-personal factors are also important and some trial and error may be needed to find the best doctor for you.

http://www.samitivej.co.th/samitivej_front...20477&Img=1

http://www.samitivej.co.th/samitivej_front...14449&Img=1

http://www.samitivej.co.th/samitivej_front...09827&Img=1

http://www.samitivej.co.th/samitivej_front...20649&Img=1

Be sure to mention your own history of asthma and ask about testing for TB.

It may take time to get to the bottom of this and, if allergies are found, some modification to your daughter's physical environment or possibly diet.

The treatment you report from the past has not been appropriate and in future I would avoid the cough syrups (which don't do much anyhow) and agree to antibiotics only if there are clear signs of a bacterial infection (fever, yellow or green sputum, wet sounds when the doctor listens to the lungs, elevated white blood count, changes on Xray). There is a great tendency to overuse antibiotics here, often in sub-therapeutic courses of treatment, and all it does is encourage the development of resistance and also upset the GI tract.

[FBN]

Agree with Sheryl above.

Search Reactive Airways Disease also. This is increasing nowadays as kids get sensitized to air pollution and then develop a condition similar to asthma. You don't hear any wheezing but the underlying irritation causes a shortness of breath and this leads to chronic coughing.

Underlying TB must be excluded as some of the treatment modalities may include short courses of steroids etc.

Once the diagnosis is confirmed, there is a lot one can do to avoid or limit factors such as house mytes etc that may contribute.

[Moonrakers]

Cheers guys.

Definitely somethings for me to think about as I have been suspecting for a while now that it may be allergy related.

[Comehome]

Agree on what others have said.

Go to a pediatric allergy specialist.

(Very good and information Sheryl, will keep the links. thanks.)

That sounds like some sort of allergic reaction to me, since she doesn't have the cough all the time.

I am not a doctor but I have a 17 months old daughter and this is what my friend have told us regarding colds and allergy. She is currently working as a peditrician in Sweden.

If she has a runny nose, look at the colour of the snot.

If it is green or yellow it is filled with bacteria and that means some sort of infection. Infections with bacteria can be treated with antibiotics.

It the snot is clear and waterly it is most probably allergic.

Do you have pets or is she around pets from time to time?

Perhaps you should ask for an allergy test, to clearly specify what she is reacting to.

It could be mold in the bathroom or fungus spores that comes up every time it rains.

What ever it is I think it is important to take care of it as soon as you can. It it is not treated right it could develope into full asthma, especially if she is constantly exposed to whatever is causing the symtoms.

I hope you will find a good doctor for your daughter, that will listen to your worries.

Take care!

/Comehome

[bina]

and if she's getting meds for her epilepsy (steroids/phenobarbs or whatever she gets) remember to bring them along, and find out ahead of time if u have to do allergy tests, if u have to stop treatment

i also go along with the allergy/asthma group.... genetic susceptability, and 'pneumonia' (which doctors mix up with asthma, and vice versa, repetative pneumonia means u should have been sent to a lung/and/or allergy specialist awhile ago for lung function checks... ) although in israel for instance many pediatric docs wait until after age 7 to do allergy /asthma speicalist checks unless u get to the point of hospitalization, and then they go intensive... (gov't insurance plans here)...

bina

[cathyy]

Yep, get her to an allergy specialist. We have asthma in my family, and it manifests most often as a small, dry cough. People think you have to wheeze to have asthma, but it's not so.

The coughing until she vomits is typical of whooping cough/pertussis, but it seems unlikely she has that as it makes kids extremely ill, and she's probably had her vaccinations against it.

[bina]

catthhy,

my daughter had pertussis when 12 yrs old; the only reason we id'd it was cause she was hospitalized in bad shape with asthma that her inhalation meds didnt seem to help after being sick on and off with 'flue' for two months, thanx to our stupid kibbutz family doctor misdiagnosing her as 'just a cold' (no longer working here, brilliant liver specialist horrible family doctor) thinking i was an hysterical mother (not and never have been) but when duaghter was blue around the lips i ran with her to the ER (with out the proper paperwork, but that is an other story ) and she was id'd (blood checks) as having pertussis and also had chlymidia (not the bird or goat kind, the general human kind that is called 'walking pneumonia). the vaccine apparently wears off at around age 12 and i was told that in the states the samething happened the same year. i was told that many kids had it w/o anything other then a cough that didnt seem to go away.

slightly off topic just thought it would be interesting to folks.

bina

[chiangmaibruce]

Global

You don't mention if the times she cough are at particular times of the year (e.g. the burning season) and/or at a particular time of the day (e.g. only in the evenings)

We have a 3 yo with a similar problem which I posted about some time ago here:

http://www.thaivisa.com/forum/Seeking-Good...ion+kids+doctor

We have tried a few doctors from two hospitals (Special Medical Service and McCormick) and been quite disatified with the diagnosis/treatment. This was initially infection of some sort, then allergy related to air/pollution, then asmtha, then infection again. He has had a chest x-ray. Too much strong anti-biotics (3 different types) then anti-allergy drugs then asthma inhalants (2 types). He is OK now but on the last occasion he was in McCormick hospital for 3 nights - taken in with high fever and coughing and they claimed infection, but only treatment with asmtha meds (???) Next stop might have to be this fellow in BKK that Sheryl recommends.

His cough is primarily in the evenings, only clear mucus, no wheezing, somtimes it has been associated with fever but usually not. No sneezing or obvious allergy-related symptoms. We are in Chiang Mai so of course I am wondering if we should clear out - at least during late Jan to March period.

- CB

[cathyy]

Thanks, Bina, for the bit about the pertussis. I knew it usually presented as a cold that got better except for a small dry cough, that lasted for weeks/months beyond the cold, before the kid got seriously ill. It's worth knowing that the obviously ill part may be missing!

ChiangmaiBruce, the pattern of a cold/upper respiratory infection which rapidly turns into bronchitis/pneumonia is typical of people with asthma. It's also common for asthma that is normally "under control" to worsen at the end of a cold/upper respiratory infection. This could be what's happening to your child. Also, hospitals routinely give people with pneumonia breathing treatments with the same meds used for asthma. So the treatment with asthma meds makes sense. It really sounds like your child needs to be seen by a good doc who knows asthma and how to treat it. The cough in the evenings, the clear mucus, the no wheezing all fit right in with that diagnosis.

It might be worth a try at making his bedroom a "clean room." If allergy testing shows sensitivity to dust or dust mites, then it's a must. National Allergy Supply It can make a real difference. Getting allergy tests to see what triggers the asthma is a great help. Then you can avoid it. I'm allergic to everything: dust mites, dust, pollen, mold & mildew, cat dander, sunlight, and most scented things like detergent and cleansers. My husband is allergic to cats, dogs and any scent that doesn't bother me. Oh, and we both have asthma.

[bina]

catthy, that is pretty similar to us: my duaghter is a 'happy wheezer' i.e. even in really bad attacks (far and few between usually caused by cold/flue which she gets often) she still manages to function as if she is getting 100% air. when checked for blood gasses (the thingy they check in the finger) she often has 90% or 85%!!! any body else would have been on the floor,passed out with that... my son is a chronic minor wheezer even with treatment but both are sports oriented. we are all allergic to perfumes, scents of certain sorts, and cleaning liquids of the various sorts. my husband, thai, is asthmatic but never been tested or treated, allergic to cats and perfume...

whatever, ....

bina

israel

[Comehome]

Globalj:

How is it going?

Is she getting better?

I don't know where you are living but I if you have rainy season at the moment, is it making the cough better or worse?

I hope you get the best treatment for your daughter.

Please let us know how it is going. It is good for other parents (like myself) to learn from your experience.

Take care!

/Comehome

[Moonrakers]

Globalj:

How is it going?

Is she getting better?

I don't know where you are living but I if you have rainy season at the moment, is it making the cough better or worse?

I hope you get the best treatment for your daughter.

Please let us know how it is going. It is good for other parents (like myself) to learn from your experience.

Take care!

/Comehome

She seems better today. But then it seems to come and go with no recognisable pattern and the weather does not appear to be a factor.

We shall be taking her to an allergy specialist next week as recommended, we just have to wait for pay day first.

I shall keep you updated.

[Comehome]

Globalj:

Sounds great!

Will keep my fingers crossed for her that she gets the help she needs and a nice doctor!

Take care

comehome

[thaibkk]

is it just me or are all thai doctors retarted?

for every couch, throat infection , vomit .... they prescribe antibiotics

western doctors know this is bad for health & should be avoided

but when my daughter goes to a doctor, she always gets antibiotics prescribed for the smallest of things, every time

[Comehome]

I agree with you.

A friend in europe who is a pediatric nurse, was very surprised when she came to Thailand on holiday and needed medical help for her children.

She wasn't very happy with how easily they prescribed antibiotics to young children without a blink. Sometimes even two cures in a row if the first one didn't give the result they wanted.

Also the nurses do not always wash their hands with antibacterial solution between treating different patients.