Article: Coughs

Reviewed by: Aaron S. Chidekel, MD

Date reviewed: October 2005

Originally reviewed by: Steven Dowshen, MD

Coughs are one of the most frequent symptoms of childhood illness, and although they can sound awful at times, they usually are not a symptom of a serious condition. In fact, coughing is a healthy and important reflex that helps clear the airways in the throat and chest.

Occasionally, though, your child’s cough is going to warrant a visit to the doctor. Recognizing certain types of coughs will help you know how to handle them and when to seek medical help.

Types of Coughs and What They Typically Mean

Here’s some guidance on different types of coughs and the kinds of conditions they’re typically associated with. If you’re concerned that your child’s cough is an indication of a larger illness, or have any questions about your child’s symptoms, call your child’s doctor.

“Barky” Cough

Barky coughs are usually caused by an inflammation or swelling in the upper part of the airway. Most often barky coughs are caused by croup, an inflammation of the larynx (voice box) and trachea (windpipe).

Croup can be brought on by allergies, change in temperature at night or, most commonly, a viral upper respiratory infection. When a young child’s airway becomes inflamed, it may swell near, or just below, the vocal cords, making it harder to breathe. Children younger than 3 years of age tend to get croup because their windpipes are narrow.

Croup can come on suddenly, and in the middle of the night, when your child is at rest. Often it’s accompanied by stridor, a noisy, harsh breathing (some doctors describe it as a coarse, musical sound) that occurs when a child inhales (breathes in).

“Whooping” Cough

Whooping cough is another name used to refer to the illness pertussis, an infection of the respiratory tract that’s caused by a type of bacteria called bordetella pertussis. The illness is marked by severe coughing spells that end in a “whooping” sound when a child breathes in. Other symptoms of pertussis include a runny nose, sneezing, mild cough, and a low-grade fever.

Although pertussis can occur at any age, it’s most severe in infants under 1 year old who aren’t immunized. The pertussis vaccine, which is part of the DTaP (diphtheria, tetanus, acellular pertussis) immunization, is routinely given in five doses before a child’s sixth birthday. It’s important to follow the immunization schedule that your child’s doctor provides.

Pertussis is highly contagious. The bacteria can spread from person to person through tiny drops of fluid in the air from an infected person’s nose or mouth, which get propelled by sneezes, coughs, or laughs. Other people can become infected by inhaling the drops or getting the drops on their hands and then touching their mouths or noses.

Cough With Wheezing

When coughing is accompanied by a wheezing sound as your child exhales, it may be a sign that your child’s lower airway is inflamed. There is also the possibility, particularly in a younger child, that the lower airway is being blocked by a foreign object or mucus from a respiratory infection.

Nighttime Cough

Lots of coughs get worse at night because the congestion in a child’s nose and sinuses drains down the throat and causes irritation while the child lies in bed. This is only a problem if your child is unable to sleep. Asthma can also trigger nighttime coughs because the airways tend to be more sensitive and become more irritable at night.

Daytime Cough

Allergies, asthma, colds, and other respiratory infections are the usual culprits of daytime coughs. Cold air or activity can make these coughs worse, and they often subside at night or when the child is resting. It’s a good idea 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

If your child has a cough, mild fever, and runny nose, chances are that he or she has a common cold. But coughs with a fever of 102 degrees Fahrenheit (39 degrees Celsius) or higher can mean pneumonia, particularly if your child is listless and breathing fast. In this case, call your child’s doctor immediately.

Cough With Vomiting

Children often cough so much that it triggers their gag reflex, making them throw up. Usually, this is not cause for alarm unless the vomiting persists. Also, if your child has a cough with a cold or an asthma flare-up, he or she may throw up if lots of mucus drains into the stomach and causes nausea.

Persistent Cough

Coughs caused by colds can last weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or breathing passages might also be responsible for these persistent coughs. If the cough lasts for 3 weeks, notify your child’s doctor.

When to Call Your Child’s Doctor

Most childhood coughs are nothing to be concerned about. However, consult a doctor if your child:

  • has trouble breathing or is working hard to breathe
  • is breathing more quickly than usual
  • has a blue or dusky color to the lips, face, or tongue
  • has a high fever (particularly in a young infant or in the absence of congestion or a runny nose; contact your child’s doctor for any fever in an infant younger than 3 months)
  • is an infant (3 months old or younger) who has been coughing for more than a few hours
  • makes a “whooping” sound when she breathes after coughing
  • is coughing up blood
  • has stridor when inhaling
  • has wheezing when exhaling (unless you already have home asthma management instructions from your child’s doctor)
  • is listless or cranky

Professional Treatment

One of the best ways to diagnose a cough is by listening. Your child’s doctor will determine how to treat your child based in part on what the cough sounds like.

Because the majority of respiratory illnesses are caused by viruses, doctors typically do not prescribe antibiotics for coughs. If your doctor suspects some kind of bacterial infection, he or she will probably prescribe antibiotics. Some coughing-related illnesses just need to run their course.

Unless your child’s cough is preventing sleep, cough medicines are usually unnecessary (and even for sleep purposes are not proven to work). If you do choose to use an over-the-counter (OTC) cough suppressant, consult the doctor to be sure that the dose is correct since all medications can have side effects and, in some cases, can even be dangerous for infants and young children.

Home Treatment

Home treatments should never take the place of consulting your child’s doctor for any of the conditions listed above, but there are several things you can do at home to make your child more comfortable.

  • If your child has asthma, make sure you have received asthma-management instructions from your child’s doctor. Monitor your child’s progress carefully during a flare-up and give asthma medicines according to the doctor’s instructions.
  • If your child wakes up with a “barky” or “croupy” cough in the middle of the night, take him or her into the bathroom, close the door, and let the shower run on hot for several minutes. After the room steams up, 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 keep your child occupied.
  • A cool-mist humidifier in your child’s room might help him or her sleep through the night.
  • Cool beverages like juice can be soothing; avoid carbonated or citrus drinks, however, because carbonation and citric acid can be painful on raw areas.
  • You should not give your child (especially a baby or toddler) OTC cough medicine, as there may be potential side effects from the medication with little or no relief of the cough.
  • Cough drops, which are fine for older children, are a choking hazard for young children. It’s best to avoid them unless your child’s doctor says that they are safe to provide to your child.


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