Cough is rough on muscles caught in middle


My 10-year old developed a bad cold with fever and a hard cough last week. In general, he seems better, but he is still coughing. Now he says his chest hurts. Should I be worried?

If your son's chest hurts only when he coughs, the pain is probably due to sore chest and abdominal muscles. Coughing is hard work. It can put extra strain on muscles not used to working so hard, just as starting a new sport or exercise program might.

Make yourself cough as you read this, and feel how much more deeply you inhale and how much more forcefully your chest and abdominal muscles move in than they do during a normal breath. Of course, exercise is voluntary and you can back off when you feel the soreness. Coughing is not. Another lesson from the comparison with exercise soreness might be helpful. You can partially relieve muscles sore from coughing by giving simple pain medicine like acetaminophen or ibuprofen.

Sore muscles are not the only possibility to explain cough and chest pain. Cough is one of the cardinal symptoms of infection in the lungs (pneumonia) that can cause chest pain, too, especially if the infection reaches all the way to the lung covering, called the pleura, which contains many nerve endings. Pain often results when the inflamed pleura rubs against the inside of the chest wall. This kind of pain, called pleurodynia, is exacerbated by deep breathing. Pneumonia is usually accompanied by fever. Your son's doctor would probably want to hear from you, if you are worried that your son's pain best fits this description.

If your son has sore muscles as the cause of his chest pain, he should feel a little better each day as his cough resolves. If he does not or you believe he is actually getting worse, you should call his doctor. There are a number of other more remote explanations for the combination of cough and chest pain your doctor may want to explore.

Dr. Wilson is director of general pediatrics at the Johns Hopkins Children's Center; Dr. Joffe is director of adolescent medicine.

Pub Date: 3/18/97

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