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Children's Health

Recurring barking cough

12/10/2008

Question:

Hello, I have a 9 year old son who has been battling an unknown problem for a couple of years. Between September and February/March of every year he gets a monthly barking cough that keeps him awake through the night. This comes on suddenly. Usually through the day he gets hoarse and begins to have problem`s breathing. We took him to our emergency room and they did every test available to them with no answer as to what it was. He took an albuterol treatment there which helped a little. Since then we`ve taken him to our family doctor who gave us an inhaler, an ENT who said he didn`t have asthma and told us to throw the inhaler away, he referred us to another ENT who did a bronchial scope at a children`s hospital and he said he had acid reflux. Our son doesn`t usually have problems in the summer but he misses a lot school with a fever (99-102 degrees) he has a barky cough about every 30 seconds or so, fever, headaches and stomach aches as well. He also gets dark rings under his eyes. These attacks last for 2-3 days usually, this time we`re on day 5 and he still has a fever,cough,headache,stomach pain. Please help us. We`re not sure where to go from here. A total of 5 doctors haven`t been able to give us anything to go on. We give him albuterol treatments at home still (seems to help a little) and treat headaches with childrens tylenol but we`re at our wits end. Thanks

Answer:

Thank you very much for the question.  It sound like a very frustrating situation for you and your family.  While I cannot make a diagnosis of your son's condition over the internet, I do have some thoughts about your son's situation. 

It sounds like one of your physician's is concerned about airway bronchoconstriction and started your son on albuterol.  It is probably worthwhile getting pulmonary function tests to confirm the diagnosis of asthma.

If your child indeed has gastroesophageal reflux, then a trial of a medicine, such as an H2 blocker may be warranted.  Untreated acid reflux could worsen brochial-constriction and lead to increased albulterol utilization. 

Lastly,a barky cough is often associated with upper respiratory airway infections particularly in the fall and winter.  If your son has a problem with his upper airway this could predispose him to more severe bouts of croup.  Indeed, if he does have uncontrolled asthma and acid reflux, these could make his cough worse.  I suggest that you contact your pediatrician to see if he/she would evaluate your son for the conditions mentioned above.  Thanks again for your assistance.

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Response by:

Stephen E Wilson, MD, MSc Stephen E Wilson, MD, MSc
Assistant Professor of Clinical Medicine
College of Medicine
University of Cincinnati