The Rhythm of the Cough (Pedcast)

32 years of practice, 4 years of residency and fellowship…I know the rhythm of a cough. Respiratory illness (that is a fancy word for cough), runny nose, sore-throat-type-illness, it usually follows a predictable pattern. And it does this for a reason that we are about to discuss. So, put on those listening ears and learn the Why and How of a respiratory illness in your children.

News Flash! The germ theory is past the theory stage…it is fact. Almost all childhood illness is caused by viruses, those sub microscopic little pieces of genetic material wrapped up in a little box called a capsule that have proven to be so incredibly effective at using us as their hosts. Remember the swine flu a few years ago? Despite our best efforts, that newly discovered virus made its way to every continent within two weeks of emergence, to a large degree because of children. Kids are virus magnets because their hands seem to be everywhere and are almost always dirty and in their mouths or noses. Those little hyperactive, never-sit-still machines you call your children seem to touch everything in just milliseconds, infecting every surface they get near with their spit and nasal secretions. Two days later, the victims of these germs begin to realize they are sick. If the germ is put in the nose, runny nose will most likely be first symptom. If it goes in the throat, that awful sore throat will kick things off. And don’t forget about the eyes…they are part of the respiratory tract as well. Your child might herald a full blown viral illness with a red, watery eye. So much fun.

Now here is what I want you to learn and remember today about respiratory illness in children: it follows a predictable pattern of localization such as upper, middle, and lower infections. We’ve talked about that before (, but also the pattern of how your child felt and how his or her symptoms progressed. Think about one of the many respiratory illnesses your children have undoubtedly had in their lives. It probably went something like this:

Day 1- Your child began to feel poorly and had fairly localized symptoms such as a stuffy/runny nose or a sore throat. Fever may have started because the virus was rapidly replicating and growing in numbers. Your child’s body didn’t like that.

Day 2- Your child probably felt worse and had even more symptoms: more sore throat, more cough, more stuffy/runny nose and maybe even more fever. Remember, these are infections of the surface cells of their nose, throat, and bronchioles. The virus is literally creeping its way down and up your child’s respiratory system infecting these surface cells.

Day 3- Most likely, your child’s symptoms had now maxed out and they now had lots of cough, runny nose, and maybe you even lost some of their voice…but by some miracle, your child was starting to actually FEEL better but sound worse.Why, you ask? Because the quantity of virus was going down since they have run out of surface cells to grow in. Remember, viruses grow inside cells, and this virus was running out of new cells to infect in its host, your child’s respiratory tract. In addition, your little one’s immune system had turned on and was fighting back, neutralizing the viruses ability to spread. Thank goodness. This virus has done its damage and probably moved onto another person’s nose and throat.

So, this is what I call the rhythm of a cough. Learn this pattern and see if your kids (and yourself) don’t follow it in their next respiratory viral infection.  If they don’t start feeling better by the end of day three, or at any point you get worried, GET THEM SEEN by their pediatrician. One word of caution as you try to implement this way of watching illness. This is a mistake I see parents make all the time: getting sick on Tuesday night and still getting worse on Thursday morning doesn’t count as 3 days. That’s only 36 hours, not 72 hours. Let me repeat this important point: if it has really been 72 hours and your child is not FEELING better, take them to get checked by all means or if, at anytime you feel they are very sick, take them to the pediatrician.  That is what they are there for. I’m sure they will help.  So now you hopefully know a little more about the rhythm of a cough. When I see sick children in the office, I am thinking, “Where in the rhythm of the cough are they?” If the child doesn’t follow this predictable pattern, my radar is up on high alert trying to detect complications like pneumonia or other invasive diseases.  DocSmo pearl: For most children, a tincture of time takes care of even the meanest virus, because your child’s immune system is a germ-killing machine, tuned and sharpened by lots of practice.

I hope this pedcast added to your knowledge with portable practical pediatrics. For more podcasts out of the DocSmo mold, explore my website. You will find literally hundreds of pedcasts and articles to explore. As always, your comments are welcome at my blog, This is Dr. Paul Smolen, hoping that  knowing a little more about your child’s cough will have its pay off.  Until next time.