Managing a Child’s Cough and When to Be Concerned

Normal cough vs chronic cough

Cough is a protective reflex to clear secretions and particles from the airways. Coughs affects about 30% of children at any given time with majority occurring due to respiratory tract infections. Children less than 4 years have about 5-8 upper respiratory tract infections per year while children > 10 years of age have 2-5 respiratory tract infections per year. Coughs are expected to resolve in 1-3 weeks following most respiratory illnesses and managing a child’s a cough generally isn’t too difficult. Any cough lasting for > 4 weeks is abnormal and needs further evaluation.

What can cause a chronic cough? 


Allergic conditions such as asthma, hay fever

Inhaled foreign body

Enlarged adenoids and tonsils

Chronic infective lung conditions such as chronic bronchitis, cystic fibrosis, Immune deficiencies etc.

Recurrent aspiration from reflux, neurological causes, airway abnormalities and so on.

Cardiac causes

Irritants, psychogenic cough, medications

Things to look out for:

There is usually no need to panic if your child is coughing more than usual. But there are things to look out for which can help you figure out the causes. It’s also important to pay attention to the type of cough and watch for other symptoms.

Onset, duration

Wet or dry cough

Cough free periods

Barking, wheezing

Breathing or feeding difficulties

Triggers and relievers

Associated symptoms

Disappearance during sleep

Response to treatment

How to manage the cough: 

Managing a child’s cough depends on the type of cough it is, how distressing it is to the child and how concerning other factors seem to you.

For a dry cough; Wait and watch. 70 per cent of dry coughs will resolve on their own.

Avoid irritants. These include strong perfumes and sprays, cigarette smoke, dust and more.

Treat  the underlying cause of the cough, such as hay fever, asthma, sinus infections, reflux, bronchitis and more.

Further investigations and referral are needed when a cough is moist for up to and more than 4 weeks. It’s also needed when the cough stops responding to treatment, or when the child is having feeding difficulties and/or noisy breathing.

This article was written by Dr Ramaa Puvvadi. 

Signs your child could have ADHD

Symptoms of inattention

  • Fails to give close attention to details or makes careless mistakes in schoolwork or other activities.
  • Has difficulty sustaining attention in tasks or play activities.
  • Does not seem to listen when spoken to directly
  • Does not follow through on instructions and fails to finish schoolwork or chores
  • Has difficulty organizing tasks and activities.
  • Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework).
  • Loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools).
  • Easily distracted by noises or other stimuli.
  • Forgetful in daily activities.

Symptoms of Hyperactivity/ Impulsiveness

  • Fidgets with hands or feet or squirms in seat.
  • Leaves seat in classroom or in other situations in which remaining seated is expected.
  • Runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness).
  • Has difficulty playing or engaging in leisure activities quietly.
  • Appears “on the go” or acts as if “driven by a motor.”
  • Talks excessively.
  • Blurts out the answers before the questions have been completed.
  • Has difficulty awaiting turn.
  • Interrupts or intrudes on others (e.g., butts into conversations or games).

Some hyperactive-impulsive or inattentive symptoms are present before age 12.

The symptoms are present in two or more settings (e.g., at school and at home). There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

Symptoms of Inattention/ Hyperactivity/ Impulsivity are not the only challenges children with ADHD face. There are many problems with “executive function” which have a huge impact on day to day function. These include problems with planning, starting and sticking to tasks, problems with working memory and sense of time and difficulties shifting focus and difficulties with self awareness, managing emotions and friendships. Children with ADHD are not setting out to deliberately be difficult or annoying. They need your love and support and understanding. The team around the child – parents, teachers, therapists and doctors can make a real difference so they achieve success and maintain their positive attitude and self esteem..

Post by Dr Betty Wamola from Townsville Paediatrics

10 things to know before your paediatrician appointment.

Visiting a specialist for the first time can be a daunting experience for both parents and their child. The important thing to realize is we are very friendly and want to help. A GP referral is required for the initial consult.

Once you have the date and time booked in start to prepare any information you have to bring along including results of any investigations, a list of current medications and any reports from Speech Therapists, Occupational Therapists or Psychologist assessments that your child has already seen.

Write down a list of questions you may have as you might not remember them all on the day.

Don’t Forget to bring your child’s Personal Health Record (Red book) which contains information regarding their growth and immunisations.

The appointment will last anything from 30-60 minutes depending on the nature of your concerns. There can be a short waiting time before the appointment depending on how busy the clinic is so bring some distractions, toys or snacks to keep your child busy.

The first visit is a chance to get to know your child. We ask questions about your pregnancy and birth history. We ask about early developmental milestones and growth. We ask about eating habits, sleep routines and of course “poos and wees” toileting habits.

Please bring along a recent report card or letter from your child’s teacher/school/daycare if you have any concerns regarding behavioural or learning issues.

We ask about progress at school and social activities such as sports, clubs and hobbies. If appropriate the child may want to share their favourite things to do and what their likes and dislikes are.

A Physical examination will include a weight and height. For infants it’s helpful to dress them in clothing that can be easily removed and bring an extra nappy just in case. We try and tailor the examination to the age of the child so for younger children it might be easier to examine them on their parent’s knee and distract them with play with a toy.

Be as honest as you can about the nature of the visit and prepare the child. We are going to spend a bit of time talking and then examine them and most visits will not entail any painful procedures so you can reassure them. Talk about the visit a couple of days before.

After the consult we will discuss the plan with you and make arrangements for follow up.

Post by Dr Betty Wamola from Townsville Paediatrics


Dear Dr Betty, why do some kids need ADHD medication?

Non-medication strategies are always tried first, including modification of the classroom environment, additional learning support, strategies to help with organisation and behaviour management strategies.

Medications aim for efficient function in day to day tasks, mainly at school. Stimulants are the most commonly used medication and your paediatrician may start at a low dose, and titrate it to get the most beneficial effect. There are non-stimulant medications also available.

In children who are having significant difficulties in day to day life even after implementing behaviour management strategies, medication is
a useful, safe and effective tool.

Call us at Townsville Paediatrics for an appointment on (07) 4427 5817

Tips for parents whose child has just been diagnosed with ADHD

Life with a child or teen with attention deficit hyperactivity disorder (ADHD) can be frustrating, even overwhelming. But as a parent you can help your child overcome daily challenges, channel their energy into positive arenas, and bring greater calm to your family. And the earlier and more consistently you address your child’s problems, the greater chance they have for success in life.

Children that have been diagnosed with ADHD have some deficits in the ability to think and plan ahead, organise, control impulses, and complete tasks. That means you need to take over as the executive, providing extra guidance while your child gradually acquires executive skills of their own.

Although the symptoms of ADHD can be nothing short of exasperating, it’s important to remember that the child who is ignoring, annoying, or embarrassing you is not acting willfully. Kids with ADHD want to sit quietly; they want to make their rooms tidy and organized; they want to do everything their parent says to do—but they don’t know how to make these things happen.

If you keep in mind that having ADHD is just as frustrating for your child, it will be a lot easier to respond in positive, supportive ways. With patience, compassion, and plenty of support, you can manage childhood ADHD while enjoying a stable, happy home.

ADHD and your family

Before you can successfully parent a child with ADHD, it’s essential to understand the impact of your child’s symptoms on the family as a whole. Children with ADHD exhibit a number of behaviours that can disrupt family life. They often don’t “hear” parental instructions, so they don’t obey them. They’re disorganized and easily distracted, keeping other family members waiting. Or they start projects and forget to finish them—let alone clean up after them. Children with impulsivity issues often interrupt conversations, demand attention at inappropriate times, and speak before they think, saying tactless or embarrassing things. It’s often difficult to get them to bed and to sleep. Hyperactive children may tear around the house or even put themselves in physical danger.

Because of these behaviors, siblings of children with ADHD face a number of challenges. Their needs often get less attention than those of the child with ADHD. They may be rebuked more sharply when they error, and their successes may be less celebrated or taken for granted. They may be enlisted as assistant parents—and blamed if the sibling with ADHD misbehaves under their supervision. As a result, siblings may find their love for a brother or sister with ADHD mixed with jealousy and resentment.

The demands of monitoring a child with ADHD can be physically and mentally exhausting. Your child’s inability to “listen” can lead to frustration and that frustration to anger—followed by guilt about being angry at your child. Your child’s behavior can make you anxious and stressed. If there’s a basic difference between your personality and that of your child with ADHD, their behaviour can be especially difficult to accept.

In order to meet the challenges of raising a child with ADHD, you must to be able to master a combination of compassion and consistency. Living in a home that provides both love and structure is the best thing for a child or teenager who is learning to manage ADHD.

Create structure

Make a routine for your child and stick to it every day. Establish rituals around meals, homework, playtime, and bedtime. Simple daily tasks, such as having your child lay out his or her clothes for the next day, can provide essential structure.

Break tasks into manageable pieces

Try using a large wall calendar to help remind a child of their duties. Color coding chores and homework can keep your child from becoming overwhelmed with everyday tasks and school assignments. Even morning routines should be broken down into discrete tasks.

Simplify and organise your child’s life

Create a special, quiet space for your child to read, do homework, and take a break from the chaos of everyday life. Keep your home neat and organized so that your child knows where everything goes. This helps reduce unnecessary distractions.

Limit distractions

Children with ADHD welcome easily accessible distractions. Television, video games, and the computer encourage impulsive behavior and should be regulated. By decreasing time with electronics and increasing time doing engaging activities outside the home, your child will have an outlet for built-up energy.

Encourage exercise

Physical activity burns excess energy in healthy ways. It also helps a child focus their attention on specific movements. This may decrease impulsivity. Exercise may also help to improve concentration, decrease the risk for depression and anxiety, and stimulate the brain in healthy ways. Many professional athletes have ADHD. Experts believe that athletics can help a child with ADHD find a constructive way to focus their passion, attention, and energy.

Regulate sleep patterns

Bedtime may be an especially difficult for children suffering from ADHD. Lack of sleep exacerbates inattention, hyperactivity, and recklessness. Helping your child get better sleep is important. To help them get better rest, eliminate stimulants like sugar and caffeine, and decrease television time. Establish a healthy, calming bedtime ritual.

Encourage out-loud thinking

Children with ADHD can lack self-control. This causes them to speak and act before thinking. Ask your child to verbalize their thoughts and reasoning when the urge to act out arises. It’s important to understand your child’s thought process in order to help him or her curb impulsive behaviors.

Promote wait time

Another way to control the impulse to speak before thinking is to teach your child how to pause a moment before talking or replying. Encourage more thoughtful responses by helping your child with homework assignments and asking interactive questions about a favorite television show or book.

Believe in your child

Your child likely doesn’t realize the stress that their condition can cause. It’s important to remain positive and encouraging. Praise your child’s good behavior so they know when something was done right. Your child may struggle with ADHD now, but it won’t last forever. Have confidence in your child and be positive about their future.

Find individualised counseling

You can’t do it all. Your child needs your encouragement, but they also need professional help. Find a therapist to work with your child and provide another outlet for them. Don’t be afraid to seek assistance if you need it. Many parents are so focused on their children that they neglect their own mental needs. A therapist can help manage your stress and anxiety as well as your child’s. Local support groups may also be a helpful outlet for parents.

Take breaks

You can’t be supportive 100 percent of the time. It’s normal to become overwhelmed or frustrated with yourself or your child. Just as your child will need to take breaks while studying, you’ll need your own breaks as well. Scheduling alone time is important for any parent. Consider hiring a babysitter. Good break options include:

going for a walk
going to the gym
taking a relaxing bath
Calm yourself

You can’t help an impulsive child if you yourself are aggravated. Children mimic the behaviors they see around them, so if you remain composed and controlled during an outburst, it will help your child to do the same. Take time to breathe, relax, and collect your thoughts before attempting to pacify your child. The calmer you are, the calmer your child will become.

“Don’ts” for dealing with an ADHD child

Don’t sweat the small stuff

Be willing to make some compromises with your child. If your child has accomplished two of the three chores you assigned, consider being flexible with the third, uncompleted task. It’s a learning process and even small steps count.

Don’t get overwhelmed and lash out

Remember that your child’s behavior is caused by a disorder. ADHD may not be visible on the outside, but it’s a disability and should be treated as such. When you begin to feel angry or frustrated, remember that your child can’t “snap out of it” or “just be normal.”

Don’t be negative

It sounds simplistic, but take things one day at a time and remember to keep it all in perspective. What is stressful or embarrassing today will fade away tomorrow.

Don’t let your child or the disorder take control

Remember that you are the parent and, ultimately, you establish the rules for acceptable behavior in your home. Be patient and nurturing, but don’t allow yourself to be bullied or intimidated by your child’s behaviors.

Can your 6 month old do this?

Your baby at six months old.
At 6 months old, they’re half way through their first year and baby development at 6 months typically have few things in common.

This is an exciting time for your baby. They imagination is starting to come alive. They are also better at remembering things, like favourite people, toys and books.

Your baby’s emotions keep developing. Baby will let you know when they are happy and sad and can also tell how you’re feeling by your tone of voice and the look on your face.

Your baby might show signs of strong attachment to family members or carers, and even prefer some toys and books to others. At the same time, you might see signs of separation anxiety or stranger anxiety. It might help you to know that separation anxiety and stranger anxiety are a normal part of a child’s development.

You might hear a lot of babbling from your baby. They might respond to their own name and stop when they hear you say ‘no’. They might also communicate with you using gestures – for example, they might put their arms up when they want you to lift them up.

You might have started feeding your baby solids. Your baby will let you know when they have had enough to eat – often by waving their hand or turning their head away. When you’re feeding them, you might see the first signs of teeth.

Around this age your baby can roll both ways and might start to move around the house by commando crawling. They might even crawl using their hands and knees. If you hold them, they might be able to stand and bounce up and down.

Your baby is learning all the time, often by putting things in their mouth or looking closely at what’s in their hand. He’ll bang and shake toys and try to grab blocks. When they can’t reach objects they want, they will look to you for help.

At this age your baby might also:

sit up without help, sometimes using their arms for balance
pick up smaller objects and use their fingers to drag things towards themselves
pat their own image in the mirror
look for (and find!) partly hidden objects
listen to music.

Helping your Baby’s development at 6 months.

1). Babies of this age absolutely love animal noises and they are beginning to understand that different creatures make different sounds. Show him pictures of animals in a book and make all the noises, one by one. He will love it (as will the neighbours)

2). Your baby needs plenty of stimulation but don’t think you have to be madly waving toys and making realistic animal noises all day long. They also need quieter periods – a few minutes at a time – when they can play on their own with no prompts. It’s great practice for later if they can learn now to amuse themselves a bit

3). Your baby may also like repeating one syllable, such as “ba”, “ma”, “ga”, or other consonant-vowel combinations, over and over. He may even add another syllable or two, making their sounds more complex
Stacking blocks and cups are going to have a bit of a moment now. Developing hand-to-eye coordination is one of the biggest challenges for your baby, and these are a great way to learn

4). Touch and feel. Collect some items of different textures – a silky scarf, a square of fine sandpaper, a velvety toy and a hard wooden block – and encourage them to feel each one in turn.

Please note all children are all different on developmental milestones: it’s really true – all babies are different and although we can encourage them, they will do things at their own pace and in their own time.

Why Do Babies Cry?

Dear Dr Siva, why do babies cry?

Babies are dependent on parents for all their needs which include food and comfort. Most often, babies communicate by crying and they cry for various reasons.

The most common reason is hunger. The other causes are discomfort, wet or soiled nappy, tiredness and feeling cold or hot. Sometimes they cry for no specific reason. Most often they settle with feeds, cuddles, comforting or swaddle. Sometimes they cry inconsolably and it may be hard to find a reason.

Babies also cry when they are sick or developing an infection. In that case they usually have other associated symptoms like fever, rash, lethargy, poor feeding. If any of these symptoms are present, seek immediate medical attention.

Some other causes of inconsolable crying and irritability are reflux or food intolerance. They are often associated with recurrent vomiting, constipation, blood or mucous in the stools. Seeing your doctor and addressing the underlying cause may help to settle your baby.

Looking for a family friendly Paediatrician? Speak to the team at Townsville Paediatrics today!

4427 5817

Why is it a good idea to take notes when your child hits milestones?

Dr Betty answers your question.

Why is it a good idea to take notes when your child hits and important milestone?

A good way of keeping track of your child’s milestones is to use the Personal Health Record (Red book) to record your child’s milestones at from 6 months to 4.5 years. The Parents’ Evaluation of Development Status (PEDS) is included in the red book provided to the parents of every newborn in Queensland, and is designed to pick up developmental and behavioural issues in children aged from birth, six months, 12 months, 18 months, 2.5 years to 3.5 years, and four to five years.

Parents and carers know their child better than anyone else and may notice things that no one else does. In fact, your observations of your child are the most important part of the PEDS process. It only takes a few minutes to go through the questions.

The PEDS questions are as follows.

  1. Please list any concerns about your child’s learning, development and behaviour.
  2. Do you have any concerns about how your child talks and makes speech sounds?
  3. Do you have any concerns about how your child understands what you say?
  4. Do you have any concerns about how your child uses his or her hands and fingers to do things?
  5. Do you have any concerns about how your child uses his or her arms and legs?
  6. Do you have any concerns about how your child behaves?
  7. Do you have any concerns about how your child gets along with others?
  8. Do you have any concerns about how your child is learning to do things for himself/herself?
  9. Do you have any concerns about how your child is learning preschool or school skills?

You can also download the Red Book here 

we got the link from

Early identification means children can be referred to services that will help ensure they reach their full potential.


Why your child might see a Paediatrician?

Your child might see a paediatrician if your GP wants a specialist opinion about your child’s health and development, or thinks your child needs specialised care and treatment.

For example, your GP might refer your child to a paediatrician for further assessment and treatment of:

A paediatrician might also see your baby immediately after birth, to make sure everything is OK.

To see a paediatrician, you’ll need a referral from your GP. Your GP is always a good place to start if you’re worried about your child’s health or development. Your GP can help you decide about seeing a paediatrician and help you find someone who’s right for your child.

Before going to a paediatrician

If your GP refers your child to a paediatrician, it’s a good idea to talk with your GP about the following things:

  • Why you’re going to the paediatrician: talk with your GP about why your child needs a referral to a paediatrician.
  • Waiting list: how long before you can get an appointment to see the paediatrician?
  • Is there anything you can do while you’re waiting to get an appointment?
  • Making an appointment: it might take you more than one phone call to make an appointment.
  • Cost: how much will the appointment with the paediatrician cost? It’s a good idea to check whether you can get money back from Medicare or whether you can get some other kind of financial help.
  • Location: find out where you have to go to see the paediatrician – for example, a public or private hospital, community health centre or consulting rooms. You might have to travel further than you expect, depending on your child’s needs.

You could also ask about these things when you make the appointment with the paediatrician’s clinic. It’s a good idea to write down your questions, so you don’t forget.

What do paediatricians help with?

Paediatricians play a vital role in the community but there are many people who don’t know who they are, or what their duties entail.

Paediatricians are doctors who have completed specialists training in medical conditions that affect the wellbeing of children. In Australia a general paediatrician would have completed at least another six years of training to complete the specialisation process. Some subspecialist would then continue further training in a sub-speciality field of their interest.

General paediatricians care for all children, from the day your beautiful baby arrives in this world, until your still beautiful (but maybe a bit grumpy) teenager finishes school. Paediatricians co-ordinate the healthcare of children to ensure they have access to support where needed. Here are the five most common reasons children are referred to a paediatrician.


Paediatricians often attends the delivery of newborn babies. Not all deliveries require the presence of a paediatrician but if any complications are anticipated a paediatrician will be called to the delivery. Fortunately most babies do not need much help and the paediatrician are there “just in case.” If a paediatrician is at the delivery, they will examine the baby to make sure that it is healthy. Occasionally a baby might have some difficulties at birth and might need some support, for example, to start breathing properly. In the days that follow the paediatrician would normally do a few more checks to ensure everyone is adjusting well and then do a check before the baby is discharged home.


Unfortunately babies sometimes arrive earlier than expected, are born with medical conditions that affect them at birth or suffer from birth complications. The baby will then likely be admitted to a neonatal unit. In not so serious circumstances, this will be in a nursery or special care baby unit. If the baby is very unwell admission to a neonatal intensive care unit might be needed. General paediatricians often look after babies admitted to nurseries. If the baby is admitted to a NICU then paediatricians who have specialised in neonatal care will take over care of the baby.


Common reasons young children are referred to a paediatrician are about concerns with the growth or development of a young child. Paediatricians have been trained to assess growth and development of children. Sometimes the problem might be fairly simple and just need a bit of reassurance and advice. Sometimes the paediatrician will ask an allied health provider to have a more detailed look at the child’s difficulties and provide advice to optimise the child’s development. Occasionally concerns can point to a more serious endocrine, neurological or developmental conditions and paediatricians will then decide whether further tests, such as blood tests or scans, are necessary to find the reason for the child’s difficulties.


Behavioural difficulties are one of the most common reasons parents will request a referral to a paediatrician. For younger children, this could be sleeping, eating or toileting difficulties. Older pre-school or school aged children are often referred for ADHD type assessments because they are extremely busy, unable to sit still or have difficulties concentrating. These concerns sometimes cause difficulties at school and the child might fall behind in their academic work or the child’s behaviour could wreak havoc within the family. Paediatricians also frequently see concerns about possible autistic features, especially if the child behaves in an unusual way, struggle making friends or come across as very different from their peers. These types of consultations are often more complex and it can take time to get to the bottom of the child’s difficulties.


Children are often referred with a range of common illnesses, such as asthma and other respiratory conditions, eczema and skin lesions, allergies, gastro-intestinal conditions, especially constipation and soiling, urinary tract conditions and neurological problems, to name a few. Most of these conditions are common and relatively easily managed by a general paediatrician in an outpatient setting. Some conditions, such as epilepsy or other neurological conditions are a bit more complex and would likely involve more intensive longer-term care.

The above are probably the most common reasons children are referred to a general paediatrician’s rooms but is by no means an exhaustive list of what a paediatrician does. Many paediatricians work in hospital settings and will look after children when they are unwell with, for example, infective illnesses, heart conditions, respiratory problems, cancers or in the rehabilitation process after they have been in accidents.

Paediatricians also often work behind the scenes to advocate for the health and wellbeing of children, this can be with the child protection system or working in non-profit organisations to develop access to services for children who are marginalised in society or who live in poorer parts of the world.

If you have any concerns about the development or health of your child, feel free to ask your GP for a referral to see a paediatrician.

We have three fantastic paediatrician’s on staff Dr.S.Siva, Dr B.Wamola and Dr A.Heyer for more information check out our team page.