Keiki Health Guide: Decode Your Child's Cough

by Sandra Gordon

It's always distressing to hear your little one cough, especially in the middle of the night. It's helpful to know that it often sounds worse than it really is. “Coughing is the body's way of clearing and protecting the airways from irritating mucous and other secretions,” says Charles Shubin, M.D., director of pediatrics at Mercy Family Care in Baltimore, MD. Coughs also provide valuable clues about your child's illness. Follow our guide to figure out what's worrisome and what's not, and help your child feel better fast.   

Cough Clues: A distinctive, shrill, dry, seallike bark, which frequently starts in the middle of the night. “The sound is unlike any cough you’ve ever heard before,” says pediatrician Mark Widome, M.D., author of Ask Dr. Mark.  

Other symptoms: Your child’s illness follows a circadian rhythm: better during the day, worse at night. He or she may have a slight fever. In severe cases, your child may develop stridor, a harsh, high-pitched sound every time he or she inhales—similar to the noise kids make after a long crying jag.

Likely culprit: CROUP, a contagious, viral infection that causes the throat and windpipe to swell and narrow. It typically affects kids between 6 months and 3 years. (Adults and older children have wider windpipes, so swelling is less likely to affect breathing.)

What to do: Sit with your child in a steamy bathroom for five minutes; the humidity will help move mucus from the lungs and calm his or her cough. After that, bundle up your child and open the freezer in the kitchen and have your child breathe in the frigid air, says Bonnie Kvistad, M.D., a pediatrician in Fargo, N.D. The combination of steam and cool air can help reduce airway inflammation.  At bedtime, run a cool-mist humidifier in your child’s room; the cold, moist air may reduce airway swelling as well. Call your doctor right away if your child is less than 2 to 3 months old, his or her cough worsens or he or she is having trouble breathing. Medicine may be needed to reduce inflammation. Otherwise, croup often runs its course in three to four days.

Cough Clues: A wet or dry, hacking cough without wheezing or fast breathing, day or night.

Other symptoms: Sneezing, a runny nose, watery eyes and a mild fever (usually less than 101.5 degrees F).

Likely culprit: COMMON COLD, a viral infection of the nose, sinuses, throat and large airways of the lungs. Coughing usually lasts the entire length of the cold (about seven to 10 days), but can linger twice as long, with mild improvement each day.

What to do: Keep nasal passages as clear as possible; congestion and postnasal drip worsen the cough. Using a cool-mist humidifier in your child’s bedroom will help moisten airways to reduce the coughing caused by postnasal drip. For babies and toddlers who can’t blow their noses yet, use nasal saline drops and a bulb aspirator to suction runny noses. Children’s Tylenol or Ibuprofen can keep them comfortable if they have fevers. If your child’s cough and stuffy nose persist for more than 10 days without improving, see your doctor. Your little one could have asthma, allergies or even enlarged adenoids, which inhibit breathing. Older kids could have sinusitis (a bacterial infection that’s often brought on by a cold).

Cough Clues: Dry, hacking coughing fits—as many as 25 coughs in a single breath. When your child inhales sharply to catch his or her breath, it causes a high-pitched, whooping sound.

Other symptoms: Before the cough starts, your child has a week of coldlike symptoms but no fever. In infants, the illness can be severe and cause mucus to bubble from the nostrils. It can also lead to convulsions and make a baby stop breathing if he or she gets tired.

Likely culprit: Whooping Cough (also known as

pertussis), a highly contagious bacterial infection of the throat, windpipe and lungs. Children who haven't received their full immunizations are most vulnerable. Babies routinely get their shots at 2, 4 and 6 months, an additional booster at 15 months, and another between 4 and 6 years. Immunity wanes as we get older. Therefore, adults may carry pertussis but get only a mild cough. It is now recommended that adults close to children get immunized, as well, as they can pass the infection on to children.

What to do: Call your doctor if your child’s cough worsens instead of getting better after a week. Babies usually need to be hospitalized to control the cough and have mucus suctioned from their throats. The illness is treated with antibiotics, though the cough can last for many weeks or even months. “Whooping cough is very contagious, so children who are not fully immunized who have been in contact with somebody with whooping cough should see their pediatricians. They may be given prophylactic antibiotics,” Kvistad says.

Cough Clues: A wheezy, crackly, persistent cough after your child eats. Coughing episodes typically worsen when she’s lying down.

Other symptoms: Your child may feel a burning sensation or may vomit or belch when swallowing. A baby might be fussy or have been labeled as colicky. Toddlers may develop wheezing and picky eating habits.

Likely culprit: GERD (gastroesophageal reflux disease), caused by a weak or immature band of muscle between the esophagus and stomach that allows acid to flow back up. Sometimes the irritating juices can enter the lungs, causing a chronic cough.

What to do: See your pediatrician if your child’s wheezy cough lasts longer than two weeks. He or she may recommend keeping your baby upright for at least 30 minutes after feedings and elevating the head of his or her mattress while he or she sleeps. Prescription medicine can also control GERD symptoms.

Cough Clues: A persistent cough that’s often whistling or wheezy, lasts longer than 10 days, and worsens at night or after your child exercises or is exposed to pollen, cold air, animal dander, dust mites or smoke.

Other symptoms: Your child is wheezing or has labored, rapid breathing.

Likely culprit: ASTHMA, a chronic condition in which small airways in the lungs  swell, narrow, become clogged with mucous and spasm, making breathing difficult. Common asthma triggers include environmental irritants, viral infections and exercise. “Children with asthma, in essence, have sensitive lungs,” says Widome.

What to do: In mild asthma cases, a chronic cough may be the only symptom, Widome says. See your doctor for an accurate diagnosis. Mention any family history of allergy, asthma or eczema, which can increase your child’s likelihood of the disease.

Cough Clues: A mildly hoarse, throaty cough that comes in frequent spells and can be either wet or dry.

Other symptoms: Your child feels listless and complains that his or her throat is scratchy and sore, his or her head hurts, and the muscles in his or her back and legs ache. There may also be a runny nose, fever and nausea.

Likely culprit: FLU, a viral, respiratory illness that’s most common from November through April.

What to do: Call your doctor if your child has a fever above 101.5 degrees F, is throwing up, has diarrhea, or is uninterested in eating or drinking (your doctor will recommend steps to prevent dehydration). Give your child plenty of fluids, and use a humidifier to ease congestion in his or her airways. Also, to ward off future bouts of the flu, ask your pediatrician about getting your child an annual flu shot; it’s recommend for children 6 months of age and older. It can protect your child against the swine flu (H1N1), which has similar symptoms to seasonal flu, as well as two other flu viruses that research indicates will be prevalent during the upcoming flu season.

Cough Clues: A phlegmy or wheezy cough that’s often accompanied by fast, shallow or difficult breathing.

Other symptoms: Your child starts out with cold symptoms, such as sneezing or a stuffy or runny nose, that last about a week, and may develop a fever of up to 103 degrees F. He or she is lethargic and makes a wheezing sound when he or she exhales.

Likely culprit: Bronchiolitis, an infection of the tiny lower airways in the lungs called bronchioles. It’s usually caused by respiratory syncytial virus (RSV) and most often occurs from late fall to early spring. Not to be confused with bronchitis (a frequent upper-respiratory infection in older kids and adults), bronchiolitis is common among babies and toddlers. “Almost all kids will get a bout of it by age 3,” says Susanna McColley, M.D., division head of pulmonary medicine at Children’s Memorial Hospital, in Chicago, IL.

What to do: Call your pediatrician right away if your little one seems to be struggling to breathe or is too irritable to eat or drink. Infants with bronchiolitis sometimes need to be hospitalized to receive oxygen treatment. If your child’s symptoms are mild (a wheezy cough without breathing trouble), put a cool-mist humidifier in his or her room to help loosen mucus in his or her lungs, and make sure he or she drinks plenty of fluids.