Coughs are one of the most common symptoms of childhood illness. A cough can sound awful, but it's not usually 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.
But sometimes, a cough calls for a trip to the doctor. Understanding what different types of cough could mean will help you know how to take care of them and when to go to the doctor.
Barky coughs are usually caused by a swelling in the upper part of the airway. Most of the time, a barky cough comes from croup, a swelling of the larynx (voice box) and trachea (windpipe).
Croup usually is due to a virus, but also can come from allergies or a change in temperature at night. 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 (often described as a coarse, musical sound) that happens when the child inhales (breathes in).
Whooping cough is another name for pertussis, 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 of pertussis are a runny nose, sneezing, mild cough, and a low-grade fever.
Although pertussis can happen at any age, it's most severe in infants under 1 year old who did not get the pertussis vaccine. Pertussis is very contagious, so your child should get the pertussis shot at 2 months, 4 months, 6 months, 15 months, and 4-6 years of age. This shot is given as part of the DTaP vaccine (diphtheria, tetanus, acellular pertussis).
The Tdap vaccine (which is similar to DTaP but with lower concentrations of diphtheria and tetanus toxoid for adults) is a booster shot given to children at 11-12 years and once again in adulthood as a part of one of the tetanus boosters. The Tdap vaccine is also recommended for all pregnant women during the second half of each pregnancy, regardless of whether or not they had the vaccine before, or when it was last given.
Adults are encouraged to receive the pertussis vaccine since immunity to pertussis lessens over time. By protecting yourself against pertussis, you are also protecting your kids from getting it.
Pertussis is very contagious, and can spread from person to person through tiny drops of fluid in the air coming from the nose or mouth when people sneeze, cough, or laugh. Others can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.
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.
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.
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.
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 persistent coughs. If the cough lasts for 3 weeks, call your doctor.
When to Call the Doctor
Most childhood coughs are nothing to be worried about. However, call the doctor if your child:
- 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 an infant (3 months old or younger) who 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)
What Your Doctor Will Do
One of the best ways to diagnose a cough is by listening. Knowing what the cough sounds like will help your doctor decide how to treat your child. The treatment for different types of coughs can vary, based on the cause.
Because most coughs are caused by viruses, doctors usually do not give antibiotics for a cough. A cough caused by a virus just needs to run its course. A viral infection can last for as long as 2 weeks.
Unless a cough won't let your child sleep, cough medicines are not needed. They might help a child stop coughing, but do not treat the cause of the cough. If you do choose to 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 children under 6 years old.
Here are some ways to help your child feel better:
- 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.
- 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.
- 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.