Conditions
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Conditions and Symptoms
Dry and Wet Cough
A cough lasting longer than 8 weeks is regarded as a prolonged cough. This is because a cough from an infection like a cold or flu will usually resolve after 2 weeks. Coughing in children can be very distressing and can interfere with daily activities.
Causes of prolonged cough
There are many causes of a prolonged cough, depending on the nature, duration and age of the child. A dry cough at night with exercise could be due to asthma. A persistent wet cough could be due to more serious conditions such as cystic fibrosis. Other causes include post nasal drip, gastro-oesophageal reflux and autoimmune diseases.
Treatment
Your doctor may need to do special tests to determine the cause of cough – a lung function/blowing test, allergy and blood tests, or a chest x-ray. The treatment will then be aimed at treating the underlying cause.
Conditions and Symptoms
Wheeze
Wheezing occurs when the small airways of the lungs become narrow or constricted. This makes it difficult to breathe, and can cause a whistling sound when breathing out. Wheezing can be a symptom of asthma where a combination of swelling, mucus and muscles tightening can cause narrowing of the airways. However, asthma is not the only cause of wheezing. For example, wheezing can also be a symptom of other breathing conditions such as bronchiolitis which is inflammation of the lungs caused by a virus. In addition, other viral infections of the airways such as Respiratory Syncytial Virus (RSV) can lead to excess mucus production that can build up and clog the airways. This is particularly likely in a child born with narrow or abnormally shaped airways. It is therefore important to remember that when narrowing of the small lower airways occurs, it can be caused by different things depending on the condition or problem that your child might have.
Causes
There are many causes of wheezing. In young children under five, the most common cause is a viral infection. Other common causes include asthma and reflux. Less commonly wheeze may be due to an inhaled foreign object, bronchitis, narrowing of the airways from birth, cystic fibrosis and heart problems.
Treatment
The treatment depends on the cause of the wheeze. Most pre-school children who wheeze will outgrow their symptoms by the time they are six. During this time, asthma treatment may be necessary to control symptoms if no other cause is found. Speak to your doctor about the cause of your child’s wheeze and the best treatment.
Conditions and Symptoms
ASTHMA
Asthma is a disease of the airways, the small tubes which carry air in and out of the lungs. Children with asthma have sensitive or “twitchy” airways. When exposed to certain asthma triggers (such as cold air, exercise, pollen and viruses) the sensitive airways react. They can become red and swollen (inflamed) which causes the airways muscles to tighten and produce excess mucus (phlegm). This makes the airways narrow and difficult for a person to breathe. Common asthma symptoms include shortness of breath, wheezing, coughing, and a feeling of tightness in the chest. Asthma is a manageable health condition. Although at the moment there is no cure, with good asthma management and education, children with asthma can lead normal, active lives.
Features of an Asthma Attack
Asthma typically causes symptoms such as coughing, wheezing, shortness of breath and/or chest tightness during an asthma attack. For many asthma is a minor nuisance, but for others, this respiratory condition can interfere with daily activities. Severe asthma attacks can be life-threatening, and it is thus important to see Dr Mothilal for a comprehensive diagnosis and to pinpoint what triggers attacks. Once you know the triggers, your lung specialist may assist you in how best to manage flares and what emergency treatment may involve.
Treatment of Asthma
Treatment will involve long-term control medications to reduce the inflammation in your airways, preventing an asthma attack. In cases of an asthma attack, quick-relief inhalers (bronchodilators) may be used to open the inflamed airways. In some cases, if triggers are allergens, allergy medications may be necessary. Because asthma often changes over time, many may only have bad asthma symptoms as a child, and once their lungs have grown, the symptoms go away. In most cases, asthma is present for the rest of their lives, but symptoms will come and go.
Conditions and Symptoms
Allergic Rhinitis
Allergic rhinitis is inflammation or swelling of the lining of the nose. It may be intermittent or seasonal, or it may persist throughout the year. It results in nose symptoms such as a blocked, sneezy, runny and itchy nose. In severe cases it causes snoring, frequent ear infections, poor sleep and may interfere with daily activities.
Causes
Allergic rhinitis tends to run in families and so your child is more likely to have it, if a parent or a sibling also suffers from allergic rhinitis. Allergic rhinitis is usually triggered by an allergy to something in the environment eg. House dust mites, pets, mould or grass. In some cases, no allergen is identified, but symptoms are still present.
Diagnosis
Your doctor will take a detailed history of your symptoms, and examine the inside of your nose. Usually the nasal passages are seen to be narrowed due to the swelling, together with a post nasal drip. Children with allergic rhinitis often have tired faces with dark circles under their eyes. This is from the congestion in the nose and sinuses.
If allergic rhinitis is suspected, allergy tests to aero-allergens (allergens in the environment) will be done. The cheapest and most accurate test is a skin prick test (see information on skin prick tests).
What is the treatment
Avoidance
If an allergen is identified, avoidance is the most important part of management. Sometimes certain allergens are very difficult to avoid because they are everywhere, like Grass and house dust mites. Your doctor will explain avoidance measures that you can try in these scenarios.
Drug Treatment
Nose sprays with steroids form the most important drug treatment in controlling and managing the symptoms. They work by reducing the inflammation and swelling in the nose. Your doctor may also prescribe oral antihistamines if predominant symptoms include a itchiness or a runny nose. Allergic rhinitis can be managed but not cured, so it is very important to take the treatment regularly. Once discontinued, the symptoms recur.
Allergen Immunotherapy
In severe cases where avoidance measures and drug treatment do not help, immunotherapy may be considered. This is a vaccine containing the allergen, which builds up a natural immunity to the allergen. It is usually given orally (under the tongue), or by injection, for a period of three to five years.
Conditions and Symptoms
Obstructive Sleep Apnea
Obstructive sleep apnoea (OSA) is a common sleep disorder and respiratory condition in which the walls of the throat relax and narrow during sleep, causing interruptions in breathing. Breathing is interrupted by repeated episodes of apnoea and hypopnoea throughout the night, in which apnoea refers to a total blockage of the airway by the muscles and soft tissues in the throat and hypopnoea refers to a partial blockage of the airway. Each of these types of breathing interruptions lasts for 10 seconds or more, causing a lack of oxygen which triggers the brain to wake the individual from slumber to a lighter sleep or to wakefulness to gasp for air, causing interrupted sleep.
Causes
The main risk factors for OSA in children are enlargement of the tonsils and adenoids. Any condition that reduces the size of the airway can also case OSA. Examples include, obesity, neuromuscular weakness from Down syndrome or Cerebral Palsy, facial abnormalities, and neurological conditions such as Muscular dystrophy.
Symptoms of OSA
Habitual snoring is the most common symptom of OSA. However a history is not sufficient to diagnose OSA as not all children who snore have OSA. Parents of children with OSA may also notice periods of cessation of breathing while asleep. Other symptoms of OSA include, daytime tiredness, concentration problems and morning headaches.
Diagnosis of OSA
Your doctor will take a detailed history and examine your child. Although most children with OSA have a normal examination, some display the cause of the obstruction, like enlarged tonsils. If OSA is suspected, an overnight polysomnogram (sleep study) will be done.
Treatment
If the tonsils and adenoids are enlarged, they can be removed. The operation is usually curative. In some instances where surgery is not possible or has failed, wearing a mask while sleeping at night may be needed. This mask is connected to a machine which pumps a small amount of air into the nose which keeps the airway open. This continuous positive airway pressure machine (CPAP) prevents blockage or airflow.
Conditions and Symptoms
Cystic Fibrosis
Cystic fibrosis or CF is a disease that mainly affects the lungs and digestive system. Although CF can be treated and CF patients can usually lead fairly normal lives, there is no cure for CF. With good medical care the majority of children is surviving to adulthood.
Causes
Children are born with CF. CF is a genetic disease, meaning it is passed from parents to their children. About 1 in every 25 people carry the gene that can cause CF. A gene is a section of DNA that gives an instruction to a cell. Most of the time, the instruction is a “recipe” for making a protein. CF is caused by a recessive gene. This means that a person needs to have 2 copies of the gene to develop CF. If a person has only 1 copy of the gene, they will not have CF, but they may pass the gene on to their children. People with only 1 copy of a recessive gene are called “carriers” of the gene. Most parents do not know they carry the CF gene because they have only 1 copy, so they do not have symptoms. To develop CF, a child must inherit 2 copies of the gene, 1 from each parent. Two parents with the CF gene may have many children with CF or none at all. The risk of having a child with CF is the same with each pregnancy. CF is not contagious. You cannot catch it from someone else.
Diagnosis of CS
If your doctor suspects cystic fibrosis, your child will have a sweat test. Sweat is collected on a filter paper or gauze. The salt level is measured. If it is high, your doctor will request a blood sample to test for the abnormal gene. Most children who have a sweat test do not have cystic fibrosis. It is a simple and easy test, and important in excluding cystic fibrosis. If there is any further doubt about the diagnosis of cystic fibrosis, a blood test can be done to look for the genetic mutation.
Treatment
Cystic fibrosis or CF is a disease that mainly affects the lungs and digestive system. Although CF can be treated and CF patients can usually lead fairly normal lives, there is no cure for CF. With good medical care the majority of children is surviving to adulthood.
Physiotherapy
Regular chest physiotherapy is the cornerstone of cystic fibrosis management. This clears the lungs of thick mucus and thus prevents infections and permanent damage to the lungs. A physiotherapist usually trains parents on how to perform physiotherapy. This should be done twice a day at home, or more frequently when sick.
Antibiotics
Regular courses of antibiotics may be necessary to treat lung infections. Sometimes hospital admission is required, if the infection does not respond well.
Other Treatments
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Dornase is a medicine given by a nebulizer. It helps to break down the thick mucus so that it can be cleared from the lungs easier.
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Enzyme supplements (for example, Creon) are often needed with meals to help digest food.
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Nutritional advice is important because children with cystic fibrosis need more energy than other children.
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Other medications may be needed to treat reflux, liver disease and diabetes.
Prognosis
Cystic fibrosis is a life long condition. With early diagnosis and effective treatment, patients are living longer and healthier lives than before.
Conditions and Symptoms
Gastro Oesophagal Reflux
GER is when the contents of the stomach enters the oesophagus (food pipe). GER is very common and occurs in up to two thirds of otherwise healthy babies. GER also occurs in association with other conditions such as neurological problems, lung diseases, obesity and prematurity.
Symptoms
The symptoms of GER depends on the age of the child. Babies with GER most commonly present with vomiting or spitting up, irritability, crying, arching, wheeze and poor weight gain. Symptoms in older children may include abdominal pain, vomiting, chronic cough and asthma. Adolescents may complain of heart burn and nausea.
Diagnosis of GER
In most cases the diagnosis can be made by taking a history and doing a physical examination. If your doctor is still unsure, there are specialised x-rays that can help to make the diagnosis. There is no single test that can reliably make the diagnosis. Often your doctor will try a trial of anti-reflux therapy to see if there is an improvement in symptoms.
Treatment
Conservative measures that are helpful in treating GER in babies include keeping babies upright after feeding and reducing the feed volumes while increasing the frequency of feeds. In some cases where this is unhelpful and in older children, medication may be tried. These decrease the acid in the stomach and thus causes less irritation of the oesophagus.
Conditions and Symptoms
Child Friendly Specialist Health Care