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Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
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My almost 7 month old daughter has had a wet cough, mainly

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My almost 7 month old daughter has had a wet cough, mainly at night, and wheezing sounds upon listening to her chest since July 3rd. She has been under the care of our primary care pediatrician, but I'm wondering if we should be seeking a second opinion or if you have any insight into what may be happening. She started with a wet cough that we watched for almost a week without improvement, but she had no fever or other symptoms. Upon exam and a video of her coughing the dr heard a wheeze on exhale and an ear infection. Prescribed albuterol and amoxicillin. Returned for recheck and still coughing but ear was clear and wheezing sounded better. Coughing still present a week later, returned to find out wheeze present again. Still no fever or other symptoms. Albuterol again for 5 more day. Last week she had her normal 6 month visit for well check and vaccines and again still coughing mainly at night and wheeze present again on exam. More albuterol. But 2 days later the cough was worse and I could hear the wheeze on exhale and daycare noted her feet turning purple when on her tummy. Rushed her back in and she had another ear infection and still wheezing. Albuterol, budesonide, and azithromycin prescribed. Are we doing everything or should we have a second opinion? I asked about a chest xray at our last visit and pediatrician said no.

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

I can understand your frustration with such a long course of coughing. The question neither you nor I can answer is what her lungs sound like vs. how much of what you are hearing is upper airway noise due to drainage and/or bronchitis. I see lots of kids whose parents are sure their child is wheezing when actually they have a lot of noise that transmits into the chest which you can both hear and feel.

Dr. A. Clark :

The reason I have doubts about wheezing is that she has not responded to albuterol and budesonide, which usually will help true small airway disease causing wheezing.

Dr. A. Clark :

Amoxicillin is rarely going to help in this type of illness and zithromax is appropriate for some bronchitis (Mycoplasma) but with this long history of congestion I suspect she has bronchitis and may need something a bit stronger, such as Omnicef or Suprax and perhaps even an oral steroid to help knock out the inflammatory reaction going on in her airway.

Dr. A. Clark :

Oral steroids, just for 5-7 days will also help if she has wheezing, asthma, etc but again, I suspect she has bronchitis.

Customer: Could the pediatrician be mistaking the wheeze he hears for upper airway? And we haven't rechecked since starting te budesonide. We go back tomorrow. Although her cough seems slightly better I don't know about wheeze at this point until he listens to her again. I'm worried we are throwin meds at her without further explanation as to why she is having the recurig wheeze.
Dr. A. Clark :

There have been several articles published in pediatric journals recently about the failure to diagnose chronic bronchitis in children, all of whom have a course similar to hers.

Dr. A. Clark :

Regarding her doctor, yes and I see this all the time, especially with inexperienced pediatricians, family docs, and ER docs since I work in pediatric urgent care now and we see other doctor's patients who come to us because they want another opinion.

Dr. A. Clark :

I would ask for an oxygen saturation (pulse oximetry) to be done (a sensor on her foot or hand) and it might be worthwhile to do a chest xray just to be sure she doesn't have anything going on in her lungs (pneumonia, foreign body or object she inhaled or swallowed).

Dr. A. Clark :

If she has only upper airway noise then she has bronchitis or sinusitis/bronchitis and needs a stronger antibiotic as well as perhaps an oral steroid.

Customer: Thank you. I will ask tomorrow. I was concerned about offending him if I asked for certain diagnostics or a second opinion becuse I am just a mom with no medical background.
Dr. A. Clark :

Don't ever apologize for being a concerned parent and if your doctor's ego is too big or feel threatened to listen to your questions then you need another pediatrician for sure!

Customer: Thank you, XXXXX XXXXX feel more confident now.
Dr. A. Clark :

You are quite welcome and good luck.

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