Managing Cough and Phlegm in Children: A Guide for Parents

My younger brother has phlegm in his lungs! How should we handle this?

Hello Dr.
Hsiao,
My younger brother suddenly developed a fever of 39.8 degrees Celsius around 1 AM last Saturday.
He was taken to Chang Gung Memorial Hospital's emergency department, where the doctor diagnosed him with pharyngitis and prescribed anti-inflammatory fever-reducing medication, allowing us to go home.
However, on April 2, he had another fever reaching 38.5 degrees Celsius and was taken to the emergency room again.
The emergency physician noted that he had phlegm accumulation in his lungs and that the pharyngitis was still present, but blood test results were normal.
He was prescribed cough suppressants and expectorants, and we were advised to perform chest percussion at least four times a day to help clear the phlegm.

I have a few questions:
1.
How many days can we expect the fever from phlegm accumulation in the lungs to last? It has been five days since the fever started (tonight he recorded a temperature of 38 degrees Celsius), is this normal?
2.
Can a fever from phlegm accumulation in the lungs persist until all the phlegm is completely cleared?
3.
I heard that pharyngitis is caused by a virus, but since my brother had blood tests, why was no virus detected? (The blood test was conducted due to the phlegm accumulation in his lungs.)
4.
Four days before the fever started, my brother received the measles, mumps, and rubella (MMR) vaccine.
Could this be the reason for his prolonged fever? Normally, it is said that fever and cold symptoms can occur 5 to 26 days after receiving the MMR vaccine, but I would like to know the maximum duration of fever in such cases.

Zhuang Tai Tai, 20~29 year old female. Ask Date: 2013/04/03

Dr. Xiao Kaiwen reply Pediatrics

1.
Viral infections can cause fever for 2-3 days, but in some cases, it may last up to a week.
Generally, if a fever persists for more than 3-4 days, physicians will conduct tests (such as blood tests, X-rays, or urinalysis) to check for possible bacterial infections.
If the fever lasts until the fifth day, but the intervals between fevers are lengthening, the peak temperature is starting to decrease, the patient remains active during the fever resolution, and there are no signs of respiratory distress, then observation may be appropriate.

2.
The presence of phlegm does not necessarily correlate with fever, and persistent fever does not always indicate the presence of phlegm; there is no definitive relationship between the two.
Fever indicates that an "infection" is still ongoing.
3.
The virus responsible for viral pharyngitis can be identified through a throat swab for viral culture, or in some cases, blood tests for antibodies may be referenced.
However, such detailed testing is generally not performed in routine situations.
4.
Fever resulting from vaccination typically does not exceed 24 hours, and it certainly does not last longer than 48 hours.

Reply Date: 2013/04/03

More Info

Managing cough and phlegm in children can be a challenging experience for parents, especially when the child is dealing with conditions like pharyngitis and bronchitis. Your concerns about your brother's health are valid, and it's important to understand the nature of his symptoms and the appropriate care measures.

1. Duration of Fever with Phlegm Accumulation: The duration of fever in children with respiratory infections can vary widely. In general, a fever associated with a viral infection can last anywhere from a few days to a week. If your brother has been experiencing fever for five days, it is not uncommon, especially if he has a concurrent infection like pharyngitis. However, if the fever persists beyond a week or is accompanied by worsening symptoms, it is crucial to follow up with a healthcare provider to rule out any complications or secondary infections.

2. Fever and Phlegm Resolution: It is possible for a child to have a fever until the phlegm in the lungs is resolved. The body’s immune response to infection often includes fever as a mechanism to fight off pathogens. As the phlegm clears and the underlying infection resolves, the fever should subside. However, if the fever does not improve or if it spikes again, further evaluation may be necessary to ensure there are no other underlying issues, such as bacterial infections that may require antibiotics.

3. Viral Infections and Blood Tests: Pharyngitis can indeed be caused by viruses, and not all viral infections will show up in blood tests. Common viral infections may not produce specific markers detectable in routine blood tests. The absence of findings in blood tests does not rule out a viral infection. If your brother has been diagnosed with pharyngitis, it is likely that the physician is treating the symptoms while allowing the body to fight off the virus.

4. Vaccination and Fever: Vaccination can sometimes cause mild fever as a side effect, typically occurring within a few days of receiving the vaccine. The vaccines for measles, mumps, and rubella (MMR) can cause fever, but this is usually a mild and self-limiting reaction. The fever associated with vaccination typically resolves within a few days. If your brother's fever persists longer than expected after vaccination, it is essential to consult with a healthcare provider to determine if it is related to the vaccine or another underlying condition.

Additional Care Tips for Managing Cough and Phlegm in Children:
- Hydration: Ensure your brother stays well-hydrated. Fluids can help thin mucus, making it easier to expel. Warm liquids, such as broth or herbal teas, can be soothing.

- Humidification: Using a humidifier in his room can help keep the air moist, which may ease coughing and help loosen phlegm.

- Positioning: Encourage him to sleep with his head elevated. This can help reduce coughing at night and facilitate easier breathing.

- Coughing Techniques: Gentle chest percussion (patting on the back) can help loosen phlegm. However, this should be done carefully and ideally under the guidance of a healthcare professional.

- Medications: Follow the physician's advice regarding cough suppressants and expectorants. These can help manage symptoms but should be used as directed.

- Monitoring Symptoms: Keep a close eye on his symptoms. If he develops difficulty breathing, persistent high fever, or if the cough worsens, seek medical attention promptly.

In conclusion, managing cough and phlegm in children requires a combination of supportive care, monitoring, and sometimes medical intervention. It’s essential to maintain open communication with healthcare providers and to follow their recommendations closely. Your proactive approach in seeking information and care for your brother is commendable, and I hope he feels better soon.

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