Decode your child’s cough

It’s always distressing to hear your little one cough, especially in the middle of the night. Still, as common as this wintertime symptom is, 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 Dr. Charles Shubin. Coughs also provide valuable clues about your child’s illness.

Follow our guide to figure out what’s worrisome and what’s not — and how to help your child feel better — fast.


A contagious wintertime 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.)

Cough clues: A distinctive, shrill, dry, seal-like bark, which frequently starts in the middle of the night.

“The sound is unlike any cough you’ve ever heard before,” says Dr. Mark Widome, a pediatrician and author of “Ask Dr. Mark.”

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

What to do: Sit with your child in a steamy bathroom for five minutes; the humidity will help move mucus from her lungs and calm her cough.

“After that, bundle her up in warm pajamas and take her out into the cool night air for a few minutes or open the freezer in the kitchen and have your child breathe in the frigid air,” says Dr. Bonnie Kvistad, a pediatrician.

The combination of steam then cool air can help reduce airway inflammation. At bedtime, run a cool-mist humidifier in the 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, her cough worsens, or she’s having trouble breathing. She may need medicine to reduce inflammation. Otherwise, croup often runs its course in three to four days.

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.

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).

What to do: Keep nasal passages as clear as possible; congestion and postnasal drip worsen this cough. Using a cool-mist humidifier in your child’s bedroom will help moisten airways to reduce the coughing caused by post-nasal drip.

For babies and toddlers who can’t blow their nose yet, use nasal saline drops and a nasal aspirator to suction a runny nose.

Children’s Tylenol or Ibuprofen can keep him comfortable if he has a fever, but check with your doctor for the right dose if your child is under age 2.

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 often brought on by a cold.

Whooping cough

Also known as pertussis, it’s a highly contagious bacterial infection of the throat, windpipe, and lungs. Babies routinely get their shots at 2, 4, and 6 months of age, and additional booster at 15 months and again between 4 and 6 years. Children who haven’t received their full immunizations are most vulnerable. All adults, especially those in close contact with infants younger than 12 months, get the Tdap (tetanus, diphtheria, and pertussis) vaccine and a booster every 10 years. Immunity wanes as we get older. Therefore, adults may carry pertussis but get only a mild cough.

Cough clues: Dry, hacking coughing fits — as many as 25 coughs in a single breath. When your child inhales sharply to catch her breath, she makes a high-pitched whooping sound.

Other symptoms: Before the cough starts, your child has a week of cold-like 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 she gets tired.

What to do: Call your doctor if your child’s cough worsens — instead of improving — after a week. Babies usually need to be hospitalized to control the cough and have mucus suctioned from their throat. The illness is treated with antibiotics, although 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 pediatrician. “They may be given prophylactic antibiotics,” Dr. Kvistad says.

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.

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

Other symptoms: She 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.

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


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 Dr. Widome.

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.

What to do: In mild asthma cases, a chronic cough may be the only symptom, Dr. 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.


A viral respiratory illness that’s most common from November through April.

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 throat is scratchy and sore, his head hurts, and the muscles in his back and legs ache. He may also have a runny nose, fever, and nausea.

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 clear congestion in his airways. Also, to ward off future bouts of the flu, ask your pediatrician about getting your child an annual flu shot; it’s recommended for children 6 months of age and older. It’s not expected to protect against the swine flu (H1N1), which has similar symptoms to seasonal flu. But a separate swine flu vaccine is currently being developed. Ask your pediatrician for more information.


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.

“Respiratory syncytial virus is different than the common cold, but it’s not pneumonia. Almost all kids will get a bout of it by age 2,” says Dr. Paul Checchia, a respiratory syncytial virus specialist. It typically runs its course in five to seven days.

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 up to 103 degrees F. He’s lethargic and makes a wheezing sound when he exhales.

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), blow his nose for him with a nasal aspirator or help him blow his nose, put a cool-mist humidifier in his room to help loosen mucus in his lungs, and make sure he drinks plenty of fluids. Kids can get respiratory syncytial virus year after year, because the body doesn’t build immunity to the virus. The virus can stay alive on surfaces for hours.

“You can’t put your child in a bubble, so the best you can do to avoid infection is wash your hands often,” Dr. Checchia says.

Sandra Gordon is an award-winning freelance writer who delivers expert advice and the latest developments in health, nutrition, parenting and consumer issues.w