Is your child's chronic cough a sign that he has asthma or is he just getting one cold after another in daycare?
Could your toddler have diarrhea for the past month because she has developed a lactose intolerance, does she have a lingering viral infection, or could it be a symptom of an infection with a parasite?
New vs. Chronic SymptomsOne of the most important first steps in evaluating a child with chronic symptoms is first determining if the symptoms have really become chronic. Unfortunately, many children get 6-8 upper respiratory tract infections a year, many of which can last 1-2 weeks, so it can seem like your child is always sick, as he gets over one infection and another quickly starts.
A daily symptom diary can be a good way to record your child's symptoms and determine if his on-again, off-again symptoms are really part of the same illness or not. If your child has had a cough for 2-3 months, but your symptom diary reveals 2-3 weeks of cough free days in between each episode of having a runny nose and cough for a week and no other asthma symptoms, then it may just be that he is getting new colds over and over.
Recurrent SymptomsEven if your child's symptoms do quickly go away each time he gets sick and aren't chronic, it can also be worrisome if they keep coming back. For example, if your child has 'croup' 3-5 times a year and ends up in the emergency room each time, then that could be a sign that he really has asthma instead. Or if your child ends up with a 'stomach virus' with vomiting every month, then maybe he has something like cyclic vomiting syndrome.
Associated Symptoms and InformationIn addition to understanding the pattern of your child's symptoms, it can help your pediatrician figure out what is wrong with your child if you provide as much information as possible at your visit, including things like:
- exposure to other people with similar symptoms
- recent travel in the past few months
- a list of things that make the symptoms better and worse
- other symptoms your child may be having, especially things like weight loss, night sweats, skin rashes, fatigue, etc.
- other recent associated events, such as dietary changes, move to new daycare, tick bite, scratch by a kitten, visit to a petting zoo, or volunteering at a homeless shelter, etc.
- a family history of related problems, like allergies, asthma, inflammatory bowel disease, migraine headaches, etc.
Persistent SymptomsSome of the reasons for children to have some chronic symptoms include, but are not limited to:
- runny nose - allergies, chronic sinus infections, non-allergic or vasomotor rhinitis, enlarged adenoids
- cough - allergies, asthma, cough variant asthma, chronic sinus infections, chronic bronchitis, pertussis (whooping cough), reflux, spasmodic croup, psychogenic cough
- diarrhea - infections, food allergies and intolerances, malabsorption, inflammatory disorders
- vomiting - reflux, intestinal blockages, neurological conditions, metabolic conditions
- fever - infections, juvenile arthritis, oncological conditions, hyperthyroidism
What You Need To Know
- Keep a symptom diary and record your child's symptoms when they seem to linger.
- Remind your pediatrician that your child's symptoms have been lingering and have become chronic if she seems to be treating them as new symptoms at each visit.
- Consider asking for a second opinion from a pediatric specialist if your child's chronic or persistent symptoms don't eventually show some improvement with your pediatrician's plan of care.
- Keep in mind that it can be difficult to diagnose the cause of many of these chronic symptoms, especially a chronic cough. Although you would think it would be easy to diagnose a child with asthma, some children have cough variant asthma and don't wheeze and so are more difficult to recognize. An 'asthma test' is also difficult to do on younger children, although a pediatric pulmonologist may be able to do pulmonary function tests on children under age 5.