My Doctor Online The Permanente Medical Group

Coughs in Children

Overview

Coughs occur when your child's throat, windpipe (trachea), or passages in the lungs get infected or irritated. Coughing is a reflex. It is the body's normal way of clearing mucus out of the airway.

Since a cough is a symptom and not a disease, it is generally a sign that something is irritating or inflaming your child's respiratory system.

Often, a cough occurs together with other symptoms, such as when your child has a cold or the flu. Coughs range from minor to more serious. Many coughs go away over time, but some do require treatment. 

Diagnosing and treating your child's cough depends on several factors:

• The type of cough
• How long your child has been sick
• Symptoms that indicate an infection
• Degree of your child's discomfort

Causes

Since a cough is a symptom and not a disease, it is generally a sign that something is irritating or inflaming your child's respiratory system.

Often your child will develop a cough when sick with another respiratory infection, such as a cold or flu. For example, a cough with a sore throat, headache, or runny nose without a fever is likely a sign of a common cold.

Common causes of coughs

• Viral infections. Colds, flu, bronchiolitis, croup, and respiratory syncytial virus (RSV) can all cause coughing.
• Bacterial infections. Pneumonia, sinus infections, and whooping cough (pertussis) can cause serious coughs.
• Asthma. A cough can also be a sign of poorly controlled asthma.
• Allergies/postnasal drip. If your child has nasal allergies, dripping mucus can irritate the throat and cause a lingering cough.
• Irritants. Breathing in smoke, dust, or chemicals can irritate the lining of the airway and trigger coughing.
• Aspiration. When food or a foreign object partially blocks the airway, it can cause choking and coughing.
• Acid reflux. When stomach acid backs up into the esophagus, it can irritate the opening to the airway and cause a persistent cough. 

Types

Dry cough

Coughs that do not produce much mucus are considered "dry" coughs. This type of cough can sometimes accompany a viral illness, such as a common cold or the flu. Cold, dry air tends to make these coughs worse.

Moist cough

These coughs are sometimes called "productive" because they produce mucus or phlegm. Be aware that it's normal for a child to have yellow or green mucus with a cough; it does not necessarily mean that a bacterial infection is present.

Barking cough

These kinds of coughs are often caused by swelling in the upper airway (larynx or trachea). Croup is the most common cause of barking coughs in young children, since their airways are narrow. 

Croup causes a hoarse cough that sounds like a seal's bark as well as noisy breathing when your child breathes in. Croup often comes on suddenly, usually in the middle of the night. This can be frightening for you and your child, but it usually clears up with home treatment.

Whooping cough

Whooping cough (also called pertussis) is a contagious disease that can be spread easily from person to person through coughing.

Pertussis often starts with a runny nose just like a cold, but soon a severe cough develops. 

Whooping cough causes a loud "crowing" or "whooping" noise when a child breathes in. These long coughing spasms can last several minutes and can be frightening.

Pertussis is preventable but can be very serious, especially for babies. Since outbreaks are on the rise, it's important to be sure that you and your child have received all of the recommended immunizations and booster shots.

Wheezing cough

Children who cough with wheezing (whistling sounds) sometimes have a more serious underlying illness. Some possibilities include:

Asthma

Children with asthma often wheeze and/or have a dry cough. In this condition, the bronchial tubes in the lungs get inflamed and irritated, causing a child’s airways to narrow. The muscles around the tubes constrict, which makes it difficult to draw a deep breath. 

Asthma is a persistent (ongoing) condition that children can develop at any time, but most children with asthma are diagnosed before age 5.

Pneumonia

Pneumonia occurs when bacteria or viruses enter the lungs and cause an infection and inflammation. Children who have pneumonia almost always have the following symptoms: a productive cough, a fever, faster breathing than normal, and sounds within the lungs. Some cases of pneumonia are mild and resolve on their own, but others are more serious and require treatment.

Respiratory syncytial virus (RSV)

RSV is a viral illness that causes symptoms like those of a bad cold. It is most common in babies, during the fall and winter months. Lots of rest and plenty of fluids can help your child get well. It may take your child 10 to 14 days to feel better.

Home Treatment

General information

Most coughs can be managed at home. In general, if your child is alert, eating well, drinking enough fluids, able to breathe and cough normally, and able to sleep, home treatment without medicine is probably all that is needed.

It is common for coughs to be worse in the evening and at night. Try some of the following tips to keep your child more comfortable:

• Offer extra fluids. Give your child extra water or diluted juices to help loosen mucus and soothe a sore throat. 
• Give a spoonful of honey to children older than 1 year. If your child’s cough is dry or hacking, you can put a spoonful of honey into warm water, herbal tea, or lemon juice, about 30 minutes before bedtime. However, do not give honey if your child is less than 1 year old. It can make your baby very sick.
• Encourage rest. It may not be necessary to keep your child in bed, but do encourage quiet activities if your child feels sick or if activity makes your child's cough worse.
• Add moisture to the air. If you own one, use a humidifier (which makes steam) or a cold water vaporizer (which makes a cool mist) in your child's room. Use distilled water and make sure to change it frequently. Do not add any medication to the water in the humidifier. You can also encourage your child to take a warm bath or shower to breathe in the moist air.
• Elevate the head of the bed. Raise the head of your child's bed slightly to make it easier to breathe.
• For older children. Cough drops, lozenges, or hard candy can also soothe irritated throats and dry, tickling coughs.
• Protect your child from smoke. Do not smoke or allow anyone to smoke around your child or in your home.
• Manage pain and reduce fever. If your child is uncomfortable, you can give acetaminophen or ibuprofen for fever, pain, or fussiness. Read and follow all instructions on the label. Do not give aspirin to anyone younger than 20. It has been linked to Reye's syndrome, a serious illness.

Be aware that over-the-counter cough medicines do not cure the cough or shorten the time your child will be sick. Keep in mind that cough and cold medicines have not been proven to be effective in children of any age, and they may be harmful for children if inappropriately used.

Do not give any cough or cold products if your child is less than 4 years old. These medicines are not safe for young children. There have been reports of accidental overdoses and even death in young children who have been given too much medicine.

In older children, if the cough is keeping your child awake at night and you are considering giving a cough medicine, make sure to follow the directions on the package label exactly. These products come in many different strengths. Too much medicine can have serious side effects.

Duration

Coughs usually stop when the illness that is causing the cough goes away. Coughs caused by common respiratory viruses will often last up to 3 weeks. More persistent coughs may be an indication of allergies or asthma.

Prevention

The following tips can help keep you and your family healthy:

• Do not smoke or allow anyone to smoke around your child. If you smoke and are thinking of quitting, we can help.
• Handwashing. Teach your child to wash his or her hands often and use alcohol-based hand sanitizer gel. Also, teach children to cough into the crook of their elbows and keep hands away from their nose, eyes, and mouth.
• If your child has allergies or asthma, take special care to manage these conditions. Keep up with any regular prescription medications and prevent flare-ups by avoiding triggers such as pollen, smoke, dust, pet hair, cockroaches, stress, cold air, or anything that makes your child's symptoms worse.
• Practice healthy living. Help your child eat a healthy diet low in fat, with at least five helpings of fruits and vegetables each day.
• Encourage your child to be active for at least 30 to 60 minutes a day.

Immunizations

Keep up with all your child's recommended immunizations: If your child does need shots, we can discuss it at your next well-check visit. Check your child's immunization record with our personalized online Preventive Services. The following are diseases that can cause serious coughing:

Pertussis (Whooping cough)

Whooping cough (also called pertussis) is a contagious disease that can be spread easily from person to person through coughing. It can be very serious in babies.

If you have a baby, or spend time around infants, protect them by getting yourself vaccinated or by getting a booster shot.

Flu

All children ages 6 months to 18 years need an annual seasonal flu shot. Note: If your child is less than 9 years old and is getting a flu shot for the first time, he or she will need 2 doses, given a month apart. 

Pneumococcal conjugate vaccine (Prevnar)

The Pneumococcus bacteria is the most common cause of pneumonia in babies and young children. This vaccine is recommended for all young children under age 5.

When to Call Us

Watch closely for changes in your child’s health and call us right away if your child is:

Less than 1 year old and:

• Has a cough and is acting sick (eating poorly, irritable, less active or alert than usual).
• Seems tired from too much coughing.
• Has not been fully immunized against pertussis (whooping cough).

Less than 2 years old and:

• Has a cough with a fever over 101.4ºF for more than 3 days.

Age 2 and older and:

• Has repeated episodes of choking, gagging, vomiting, or turning blue from coughing.
• Has trouble breathing:
  • Chest caves in between the ribs.
  • Is using belly muscles to breathe.
  • Has a grunting, whooping, or wheezing sound with breathing.
  • Nostrils flare while trying to breathe.
• Has a cough with a fever over 101.4º F for more than 5 days.
• Has shaking chills along with cough and fever.
• Has been coughing for 2 to 3 weeks  without improvement.
• Has coughing that continuously disturbs sleep.
• Develops new symptoms, such as an earache or  rash.

Call 911 or other emergency services immediately if you observe:

• Signs of moderate to severe difficulty breathing.
• Difficulty speaking, struggling to breathe, or making a whistling sound when breathing in.
• Lips or fingernails are blue.
• Loses consciousness after a coughing spasm.

Related Health Tools:

If you have an emergency medical condition, call 911 or go to the nearest hospital. An emergency medical condition is any of the following: (1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.

This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.