Q: My son has cough for the past 4 months. It comes mainly when he is lying down, especially at night. We showed him to a paediatrician who ruled out any infection and prescribed cough syrup. However, he never got back to normal and the cough kept recurring. After two months we showed him to another doctor who prescribed Montair, Momentasone nasal spray and Cetirizine 5 ml. But his condition continues to remain the same after 3 weeks. Although the cough seems to reduce in between, he always has a lot of mucus in his throat. What should we do? Is it safe to give him Salbutamol inhaler when his cough gets bad? How long will it take for this to clear?

A:I understand your distress. Persistent cough in a three year old will certainly be a cause of great concern to all of us. First you have to rule out any chronic infection. Never mind the previous tests. Kindly request your doctor to repeat the chest x-ray, Mantoux and the blood counts. With these simple tests, you will know whether there is any tuberculous infection, other bronchitis and allergy. Occasionally, childhood asthma presents with marked cough and very little wheezing. That is probably why Salbutamol had been prescribed. It is a safe drug. But first we have to try and get a proper diagnosis. The quest in your baby boys illness will be to rule out other causes. Once that is done, it will be worthwhile to stop the cough syrups; most of them dry up the throat and the dryness leads to cough. Thus, we end up with something quite opposite to what we wanted. Another possibility is an illness called Gastro Esophageal Reflux Disease (GERD). This is a condition in which the acidic contents of the stomach regurgitate on lying down. the resultant irritation leads to cough. Simple measures like avoiding a full stomach (not going to bed immediately after a meal), avoiding fatty foods in the nights just before going to bed, staying up for one to two hours after any meal will bring great relief. With all this information, kindly remember that two important things to rule out are 1. any infection in the lungs and 2. asthmatic wheeze