Doubts about cystic fibrosis

Question

My son is 5 years old. Since September 2009 he coughs continuously, his stools smell foul. Should I be worried?

Answer

Thanks for your question.

As mentioned this website does not replace the advice from your treating physician. Only if full medical history and clinical exam are performed can a a correct diagnosis follow. We will thus just try to answer some general aspects of this question.

Cough is a frequent complaint in children. Young children are exposed to many viruses and bacteria to which they so far only developed a rather poor immunity. They will thus frequently suffer from infections and these will be mainly infections of the upper airways. Rhinitis and cough are the main problems. Sometimes these symptoms are accompanied by fever, loss of appetite, headache. Less frequently there is involvement of the lower airways with wheeze, shortness of breath, pain on the chest. Every episode will last 1 to 2 weeks followed by a period without symptoms …until the next infection start. Chronic cough during the winter period is thus mostly caused by repeated airway infections. These episodes are then interspersed with short symptom-free periods. At times complications occur such as bacterial sinusitis during which cough and rhinitis are worse and take even longer to clear or only clear with antibiotic treatment.

Changes in aspect and consistency of the stools are also commonly caused by infections or changes in the diet. Rarely there will be prolonged enteral infections or an underlying problem such as poor digestion or chronic inflammation of the intestine. In the latter case there usually are extra symptoms such as abdominal pain, decrease appetite, poor weight gain, little energy…

Chronic cough can of course also be the sign of serious disease. Asthma can present that way, usually the symptoms are associated with wheeze and other allergic type complaints such as eczema, hay fever in the child or the rest of the family. In cystic fibrosis the chronic cough is often associated with signs of maldigestion ( loose stools and poor weight gain). Other more rare conditions associated with chronic cough are for instance diseases of the immune system.

The complaints that you mention in your child could thus be a sign of a chronic disease but they could also be the result of common viral infections. The task of the treating physician is to take a thorough history, examine the child, look for alarm signals (poor weight gain, continuous symptoms without symptom-free periods, abnormalities on physical exam such as abnormal lung auscultation) or detect signs of specific disease (wheeze with asthma, chronic nasal discharge or head ache in case of sinusitis)… If needed the doctor will than plan extra tests to come to the correct diagnosis or to rule out serious underlying disorders. For CF this can be done by means of a sweat test which the doctor will propose in case there is any doubt.

The best you can do is thus to make an appointment with your treating physician so that he can sort out the complaints you mention. If you are worried about a specific condition, that is also a concern you can discuss with him.

Greetings,
Dr. F. Vermeulen

21.04.2010