P: I was just bringing my son and he's just had cough for the last couple of days. I thought about a day and a half ago, it doesn't feel like a cold. He hasn't been too sick, but I was a little bit worried and I wanted to get him seen to see if there's anything we could do.

D: Yeah, for sure. It's a good thing that you brought him in. So the cough, is it consistent? Or does it come and go?

P: It seems to be a little bit worse at night. He'll have this cough during the day. Sometimes I'll notice when he's playing. He's had these coughing fits that last for up to a minute but usually recovers from. He hasn't been too active to be honest. He's been a little bit slowed down these last couple of days, but in regards to consistency, I'd say it's a little bit worse at night.

D: OK, any other triggers like dust or the cold air? Anything like that?

P: I haven't really noticed anything. We've been mainly keeping inside due to covid, right? I think my wife left a window open the other night, and maybe the cough was a little bit better. I'm not sure. It's kind of hard to tell when we sleep.

D: Yeah, have you tried anything for it, like have you given him any over the counter cough medications?

P: No, we're a little scared to give him anything. He's so young. He's 2 1/2. We haven't been really giving him any medications to be honest.

D: OK, good. And if you were to describe the quality of this cough, would you say it's barky? Is it harsh?

P: Barky might be a good word to describe it, like he's had colds before his coughs were quiet but this sounds harsh. It sounds like he's really trying to cough hard there. Very violent sometimes. 

D: OK OK. And has he ever had a cough like this in the past? 

P: No, never.

D: OK, and then in terms of the timeline, is it getting worse? His cough?

P: I think it has been to be honest. He was a little ill like he had a runny nose a couple of days ago, maybe two days ago and then the cough started but it only really started getting noticeably different about the night of the first day, about two days ago so. Now it's been more present I suppose,than it was when he just first had it.

D: OK, and is it a dry cough or does he bring up sputum?

P: Sputum like phlegm,no he doesn't bring anything up really, so dry.

D: OK so no blood as well right?

P: No blood. 

D: OK,  does he have any shortness of breath with his cough?

P: I feel like when he has the coughing fits, he's winded. He's weak after them. Sometimes he cries after them or before the middle can be a trigger for it, but just resting normally, he doesn't seem that out of breath, no.

D: OK any wheeziness?

P: No, not really. He's able to breathe. I can't really hear him breathing that much. Sometimes at night after a bad cough he'll be really winded. And yeah, it does sound like a little different when he's breathing, but just right now he sounds normal.

D: OK, and any reason for you to think he has chest pain?

P:  He hasn't any sort of chest pain. He says his throat hurts, but I don't think it's his chest. 

D: Has he had any fevers? 

P No.  

D: Any change in his hair, nails or skin like rashes?

P: No, no rashes. 

D: How about weight loss?

P: No weight loss, he's a fairly healthy kid.

D:  And his vision and hearing are normal?

P: You know, I haven't gotten him formally assessed yet, but seems to be able to read pretty well from a distance. He's not in school yet, but I haven't noticed anything, and he can hear fine. I think he responds when I call. 

D: OK, has he had a stuffy or runny nose?

P: Yeah yeah, that's kind of how it first started three days ago. Maybe had a runny nose. OK, yeah.

D: Does he still have a runny nose?

P: Umm, a little bit less now. No, not as much now.

D: OK. And his taste, any reason to believe there are any changes there?

P: Well, we've been kind of spoiling him a bit, just giving him ice cream. His throat hurts a little bit and he seems to still like it, so it's hard to tell.

D: OK, so he has a little bit of a sore throat as well?

P: Yeah. 

D: OK OK, and then any dizziness or fainting spells that you've noticed?

P: No fainting or dizzy spells, but he's really gassed after he has like a coughing fit and he doesn't want to stand up, he'll just be sitting down or he wants to be held. 

D: OK, is he more irritable than usual?

P: Yeah after he has a bad coughing fit, he wants to be soothed and he'll be crying, but it's just more of because he's worn out, I believe he's tired.

D: Yeah, OK, and then any confusion or memory loss? 

P: No.

D: OK, and then in terms of his bowel movements, have things been normal from that standpoint?

P: Oh yeah, process of potty training him, but no, no real changes.

D: OK, so no diarrhea, no constipation, no blood in the stool?

P: No. 

D:  OK and he's passing gas?

P: OK yeah I'd say so.

D: Any nausea or vomiting?

P: No. We haven't been really feeding him solid meals, it's because he's been sick, we've been trying to give him soup and liquids for the most part because his throat hurts, but he's able to keep them down. So no, no nausea, no vomiting.

D: OK, and then how about changes in his appetite? 

P: Yeah, he's not eating as much but still, we're trying to force food into him to keep his energy up. Most of time he always will be asking for snacks in the afternoon, but now not so much. 

D: OK. Alright and any anything else that I missed that he's been experiencing over the past few days?

P: No, just the cough. 

D: OK, and then he otherwise healthy? Does he have any longstanding medical conditions?

P: No longstanding medical conditions. Yeah, nothing really. We had a little bit of stay in the NICU, just because he was a little bit underweight, but no, nothing really. 

D: OK. And then his mother's pregnancy with him? Any complications at that point?

P: Yeah he's a little pre term. 34 weeks I think. 

D: OK, was he also underweight too?  You mentioned just a little bit.

P: Yeah. 

D: OK, and any complications during the actual delivery?

P: Yeah, not that I remember like she started going to labor early, like earlier than we expected. We thought it was just a regular contraction and that it will just resolve but she wound up proceeding when we showed up at the hospital

D: OK and then in terms of growth, weight and head circumference, has he been hitting all those milestones for the past 2 1/2 years?

P: Yeah, we we bring him to the family doctor every couple of month for his regular checkups and nothing has been brought up to be concerning for his vaccines. He has been doing well.

D: OK and then how about other milestones like speech, movement, fine movement, all of that, like have those been normal? Is he on par with his peers?

P: Yeah, this is our first kid, but compared to his cousins he seems to be doing well. He's speaking, he's got little sentences, now he has good eye contact. He's a good kid.

D: OK, good good. Any hospitalizations or surgeries aside from when he was born?

P: No no.

D: OK good and is he on any medications?

P: No, OK we give him like a flintstone gummy.

D: OK, is he up to date with all his immunizations?

P: Yeah. 

D: Any allergies? 

P: Not that we know of.

D: Any family history of lung conditions?

P: So my grandfather, so his greatgrandfather I suppose passed away from lung cancer. He was a heavy smoker though. On my mom's side there's some breast cancer. No,  nothing really that comes to mind for lungs. 

D: And any heart conditions?

P: No, not that we know of.

D: And how about other cancers?

P: No, not that I know of.

D: OK, how about asthma, eczema or allergies in the family?

P: You know, I think my sister is allergic to peas, but she was never sick from them like go to the hospital.  I don't think there are any allergies in the family.

D: OK, good, has he been in contact with anyone who's been sick recently?

P: You know, like 5 days ago we had a playdate with his cousin. And we kind of thought that that's where he got the cold from. Like the runny nose, but it just turned weird, you know.

D: OK and how's this cousin doing?

P: Last time I talked to Charlotte, Hank seems to be doing well so.

D: Alright, and has he traveled to anywhere recently? Have you any of you traveled anywhere recently?

P: No, with covid and everything, we have just been keeping to ourselves.

D: And with who and where does he live?

P: He lives with me and his mother in a house 

D: OK. Any old carpets or mold or concerns for asbestos? Anything like that at home?

P: I don't know when this house is built. I don't think there's any asbestos in it and it's all hardwood. So no. 

D: OK, good. Anyone at home smoke?

P: No, no. 

D: OK, good. So those were all the questions that I had. Do you have any questions for me?

P: No, no that's it, no.

D: OK, well, from the sounds of it, he most likely has some sort of viral infection. We will do a COVID swap to rule that out because some symptoms do seem to overlap with COVID and we want to make sure to rule that out. So we'll take a swab. Those PCR results should come back in about 24 to 48 hours. In the meantime, he should isolate for 14 days at home and if it's not COVID, it could be another viral infection like parainfluenza, also known as croup. So for that, for any of these viral infections, actually the best treatment is to stay at home and make sure that he's very well hydrated and eating well. If his symptoms persist for three to five days or more, or if his symptoms worsen, especially if he has like a seizure or urological issues, he should go to the ER and if his symptoms do become worse, we can also prescribe him some steroids or epinephrine just to open up his airways. And if it's really, really bad he might be hospitalised as well. So just keep an eye on on that for now. And if you have any 
questions or concerns, just give us a call. How does that sound?

P: A little scary. Sounds good. OK, I'll just keep an eye on him for the next five days. 

D: Give us a call if his symptoms are becoming worse or if they're not resolving and we will try to do an assessment on him. Of course we will do a physical exam today and will let you know how severe his symptoms are. Most children will get over their infection on their own and he likely won't need any additional treatments.

P: OK, sounds good.

D: Alright take care.

P: Thank you.