My 8-year-old daughter has been coughing up blood. Otherwise, she seems fine.
How worried should I be about this?
Coughing up blood (called hemoptysis by doctors) should always be taken seriously.
It is an unusual symptom in childhood. When it does occur, it may be a sign of a lung disease that requires treatment.
Before listing some of the most common causes of hemoptysis during childhood, we want to point out that it is not always easy to tell whether the blood is coming from the lungs or the stomach, but both are important.
If your child produces blood from the mouth, and you do not know with assurance that it is coming from nosebleed, the expected shedding of a tooth or a trivial cut, call your doctor right away.
Very rarely, a child coughs up a dangerous amount of blood. This is extremely unusual for a child who has no chronic heart or lung disease.
However, if your child starts coughing up large amounts of blood, you should treat the situation as an emergency.
Lung infection (pneumonia) is the most common cause of hemoptysis, although most children with pneumonia do not cough up blood.
Occasionally, garden variety pneumonia in a normal child can lead to blood-streaked sputum, but children with underlying diseases like cystic fibrosis or immune deficiencies that predispose them to repeated lung infection are most likely to have the kinds of pneumonia that result in lung bleeding.
Sometimes coughing itself appears to lead to a bit of bleeding.
Sometimes a foreign body, for example, a coin or a small toy a child has choked on, lodges in the lung and causes irritation and bleeding.
Trauma to the chest or neck, which might occur in a car crash, can cause the lung or airway to bleed.
Rarely, heart or blood vessel malformations lead to hemoptysis, but in most cases, the diagnosis will already be known from earlier signs.
A number of other causes of hemoptysis, such as tumors, drug reactions, connective tissue disorders and blood clots that travel from deep blood vessels in the leg to the lung, are so unusual that we are almost reluctant to mention them.
About 15 percent of the time, no cause is ever found, and the hemoptysis disappears.
Suffice it to say, however, that hemoptysis is one of those possibly serious symptoms that we believe obligates prompt contact with a doctor.
Wilson is director of general pediatrics at Johns Hopkins Children's Center; Joffe is director of adolescent medicine.
Pub Date: 2/11/97