Coughing

What Are Coughs?

Coughs are one of the most common symptoms of childhood illness. A cough can sound awful, but usually isn't a sign of a serious condition. In fact, coughing is a healthy and important reflex that helps protect the airways in the throat and chest.

What Are the Different Types of Coughs?

Sometimes, though, a cough needs a doctor's care. Understanding the different types of cough can help you know when to handle them at home and when to call your doctor.

The most common types of coughs are:

• "barky" cough
• whooping cough
• cough with wheezing
• nighttime cough
• daytime cough
• cough with a fever
• cough with vomiting
• persistent cough

"Barky" Cough

Barky coughs are usually caused by swelling in the upper airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe). Younger children have smaller airways that, if swollen, can make it hard to breathe. Kids younger than 3 are most at risk for croup because their airways are so narrow.

A cough from croup can start suddenly, often in the middle of the night. Most kids with croup will also have stridor, which is a noisy, harsh breathing that happens when the child inhales (breathes in).

Whooping Cough

Whooping cough (pertussis) is an infection of the airways caused by the bacteria Bordetella pertussis. Kids with pertussis will have spells of back-to-back coughs without breathing in between. At the end of the coughing, they'll take a deep breath in that makes a "whooping" sound. Other symptoms are a runny nose, sneezing, mild cough, and a low-grade fever.

Whooping cough can happen at any age, but is most severe in infants under 1 year old who did not get the pertussis vaccine, which is part of the DTaP vaccine (diphtheria, tetanus, acellular pertussis). It's very contagious, so all kids should get the pertussis shot at 2 months, 4 months, 6 months, 15 months, and 4–6 years of age.

Cough With Wheezing

If your child makes a wheezing (whistling) sound when breathing out (exhaling), this could mean that the lower airways in the lungs are swollen. This can happen with asthma or with the viral infection bronchiolitis. Wheezing also can happen if the lower airway is blocked by a foreign object. A child who starts to cough after inhaling something such as food or a small toy should see a doctor.

Nighttime Cough

Lots of coughs get worse at night. When your child has a cold, the mucus from the nose and sinuses can drain down the throat and trigger a cough during sleep. This is only a problem if the cough won't let your child sleep.

Asthma also can trigger nighttime coughs because the airways tend to be more sensitive and irritable at night.

Daytime Cough

Cold air or activity can make coughs worse during the daytime. Try to make sure that nothing in your house — like air freshener, pets, or smoke (especially tobacco smoke) — is making your child cough.

Cough With a Fever

A child who has a cough, mild fever, and runny nose probably has a common cold. But coughs with a fever of 102°F (39°C) or higher can sometimes be due to pneumonia, especially if a child is weak and breathing fast. In this case, call your doctor immediately.

Cough With Vomiting

Kids often cough so much that it triggers their gag reflex, making them throw up. Also, a child who has a cough with a cold or an asthma flare-up might vomit if lots of mucus drains into the stomach and causes nausea. Usually, this is not cause for alarm unless the vomiting doesn't stop.

Persistent Cough

Coughs caused by colds due to viruses can last weeks, especially if a child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or airways also might cause lasting coughs. If your child still has a cough after 3 weeks, call your doctor.

How Are Types of Coughs Diagnosed?

If you're concerned about your child's cough, call your doctor. Depending on the type of cough, other symptoms, and how long it's lasting, the doctor might want to see your child.

Many health care providers now offer telehealth visits, which can save parents a trip to the office (especially for a nighttime cough). "Video chatting" lets doctors see and hear a child cough, and often this is enough to make a diagnosis or rule out a serious problem. Hearing the cough will help the doctor decide whether (and how) to treat it.

How Are Coughs Treated?

Most coughs are caused by viruses and have to just run their course. Sometimes, this can take up to 2 weeks. Doctors usually don't prescribe antibiotics because these only work against bacteria.

Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but they don't treat the cause of the cough. If you do use an over-the-counter (OTC) cough medicine, call the doctor to be sure of the correct dose and to make sure it's safe for your child.

Do not use OTC combination medicines (like "Tylenol Cold") — they have more than one medicine in them, and kids can have more side effects than adults and are more likely to get an overdose of the medicine.

Cough medicines are not recommended for any children under 6 years old.

How Can I Help My Child Feel Better?

To help your coughing child feel better:

• For a "barky" or "croupy" cough, turn on the hot water in the shower in your bathroom and close the door so the room will steam up. Then, sit in the bathroom with your child for about 20 minutes. The steam should help your child breathe more easily. Try reading a book together to pass the time.
• A cool-mist humidifier in your child's bedroom might help with sleep.
• Sometimes, brief exposure to cool air outdoors can relieve the cough. Make sure to dress your child appropriately for the outdoor weather and try this for 10–15 minutes.
• Cool beverages like juice can be soothing and it is important to keep your child hydrated. But do not give soda or orange juice, as these can hurt a throat that is sore from coughing.
• You should not give your child (especially a baby or toddler) OTC cough medicine without first checking with your doctor.
• If your child has asthma, make sure you have an asthma action plan from your doctor. The plan should help you choose the right asthma medicines to give.
• Cough drops are OK for older kids, but kids younger than 3 years old can choke on them. It's better to avoid cough drops unless your doctor says that they're safe for your child.

When Should I Call the Doctor?

Always call your doctor if your child is coughing and:

• has trouble breathing or is working hard to breathe
• is breathing faster than usual
• has a blue or dusky color to the lips, face, or tongue
• has a high fever (especially if your child is coughing but does NOT have a runny or stuffy nose)
• has any fever and is younger than 3 months old
• is younger than 3 months old and has been coughing for more than a few hours
• makes a "whooping" sound when breathing in after coughing
• is coughing up blood
• has stridor (a noisy or musical sound) when breathing in
• has wheezing when breathing out (unless your doctor already gave you an asthma action plan)
• is weak, cranky, or irritable
• is dehydrated; signs include dizziness, drowsiness, a dry or sticky mouth, sunken eyes, crying with little or no tears, or peeing less often (or having fewer wet diapers)