Common childhood coughs: how to identify & treatment options

Coughs are never pleasant—a persistent cough can be annoying for a child and unsettling for a parent. Sometimes a cough can be downright scary, especially when it wakes your child in the middle of the night. Generally, coughing occurs when irritants in the throat and airways trigger a reflex that forces air and secretions from the lungs. Everyone coughs from time to time. During the winter months, much of the coughing children experience is due to cold and flu viruses. While most coughs (like the common cold) will resolve without treatment, others can be cause for concern. 

As a general rule, call your child’s health care provider if your child is wheezing or if a cough lasts more than three weeks. Seek emergency care if your child has difficulty breathing or swallowing. And never give over-the-counter cough and cold medicines to children under 4 years of age. Between ages 4 and 6, only give your child cough and cold medicines if your child’s health care provider recommends them.

Here's how you can identify which cough your child may have, and how to treat it.

Croup

Known for its harsh, barking cough, croup is most common in children between the ages of 6 months and 3 years. It is caused by the parainfluenza virus and can begin without warning or develop gradually along with mild cold symptoms. In addition to a cough, which has been likened to the sound of a “seal barking,” symptoms of croup include labored, noisy breathing (called stridor), fever, and hoarseness. Croup is seldom serious and can usually be managed at home. Parents should, however, contact their child’s health care provider or seek immediate medical care if their child makes noisy, high-pitched breathing sounds when inhaling, begins drooling or has trouble swallowing, seems extremely irritable or extremely tired, refuses to eat or drink, struggles to breathe, or develops blue or grayish skin around the nose, mouth, or fingernails. 

If your child has a croupy cough without any of the above symptoms, he will likely feel better if he breathes in moist air. As a result, the American Academy of Pediatrics (AAP) recommends that you sit with your child in a steam-filled bathroom (turn on the hot water in the shower and close the bathroom door so the steam does not escape). Your child’s breathing should improve within 15 to 20 minutes, but the barky cough may take a bit longer. If the warm steam doesn’t provide relief, take your child outside for a few minutes to breathe the cool, moist air. This, too, may help him breathe more freely. There is no evidence to show that warm or cool mist actually improves breathing, but it may temporarily make your child more comfortable. 

There is no vaccine for croup. Like many viruses, it spreads when children come in contact with the virus and then touch their noses, eyes, or mouths. As a result, frequent handwashing is the best way to avoid catching croup.

Dry cough

When your child has a fairly nondescript cough and isn’t coughing up mucus, he likely has what’s called a dry cough. Dry coughs, according to the Centers for Disease Control and Prevention (CDC), are often associated with the flu, cold, or other viruses. In addition to a cough, your child may also complain of a sore throat or sore chest. Setting up a cool-mist humidifier in his room may help the cough and make it easier for him to breathe and sleep. If, however, the cough lasts more than three weeks, you should contact your child’s pediatrician because it could be a sign of something more serious.

Wet cough

A productive or wet cough is one that produces mucus, which can be clear, white, yellowish-gray, or green in color. Most phlegmy coughs, according to the AAP, are caused by viral bronchitis—an inflammation of the large breathing tubes (called bronchi) that results in an increased production of mucus. Bronchitis often develops from the common cold or other viral infections in the upper respiratory tract. As a result, antibiotics are ineffective in treating most cough illnesses/bronchitis in a child who otherwise appears well. For coughing spasms, the AAP recommends treating wet coughs with plenty of fluids, a humidifier, and warm chicken broth or apple juice if your child is older than one year. Mothers are urged to continue breastfeeding. These coughs may linger for weeks, but as long as your child doesn’t have a fever and feels well enough to participate in activities, he may return to school. 

Another common cause of a wet cough is bronchiolitis—a viral illness that causes swelling in the small breathing tubes of the lungs. Bronchiolitis can make it difficult for infants and young children to breathe and can result in them experiencing asthmatic symptoms (wheezing, labored breathing, etc.). If your child has difficulty breathing, seek immediate medical care.

Wheezing

A wheezing cough or wheezing while exhaling is a common sign of asthma in children. It can also be a sign of bronchiolitis, which, as described above, is a respiratory infection common in infants. Asthma symptoms can escalate quickly in babies and young children, so it is important to seek immediate medical care if your child has any difficulty breathing.

Whooping cough

Whooping cough, also known as pertussis, causes severe coughing spells that can leave your child gasping for air. After a coughing spell (or between coughs), a child with whooping cough typically makes the familiar “whooping” sound that gives this disease its name. 

Other symptoms of whooping cough include those associated with the common cold. In fact, someone with pertussis may experience congestion, runny nose, watery eyes, sneezing, or a mild cough and fever for one to two weeks before the severe coughing begins. Eventually, the coughing attacks may bring up thick phlegm, trigger vomiting, result in a red or blue face, or cause extreme fatigue. If your child displays any of these symptoms, you should contact his or her pediatrician immediately. 

Though infants will likely be admitted to the hospital for treatment, older children can typically undergo treatment, which includes antibiotics, at home. While at home, children with Whooping Cough should rest, drink plenty of fluids, and eat small meals to prevent vomiting after coughing. They may also benefit from having a vaporizer in their rooms to assist in loosening mucus in the lungs. If left untreated, whooping cough can lead to pneumonia, seizures, brain damage, or death. 

The bacteria that causes pertussis, Bordetella, spreads through direct contact when a child or adult comes in contact with someone who is infected with the disease. Although it isn’t 100 percent effective, the DTaP vaccine, which protects against pertussis and two other serious bacterial diseases, goes a long way toward preventing pertussis. The CDC recommends that pregnant women receive the vaccine to reduce babies' risk of illness; babies typically receive their first dose of the DTaP vaccine when they are 2 months old, but are not considered well-protected until after their third vaccination at 6 months of age. Preteens, teens, and adults who were vaccinated as children should be re-vaccinated because the vaccine’s protection decreases over time.

Last updated July 11, 2017

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