A Parent's Guide to Coughs

No mom enjoys hearing her child cough, even though pediatricians often remind parents that coughing is actually a good thing: It’s the body’s way of keeping the lungs clear and preventing pneumonia. But that doesn’t make the problem any easier for you or your child, especially when your little one can’t get a good night’s sleep because of a nagging cough.

Figuring out the cause of your child’s cough can be tricky, says Roy Benaroch, M.D., assistant clinical professor of pediatrics at Emory University in Atlanta. “The description of the cough is really just a starting point because different people hear slightly different things,” says Benaroch. “You really need to look at the cough in context of the other symptoms.”

The first question you need to ask yourself is, “How sick is my child?” says Benaroch. For instance, if your child is sucking in her ribs with every breath, breathing fast or having trouble speaking in complete sentences, these are all signs of breathing difficulties that require prompt medical attention either in the physician’s office or in the emergency room, he says.

Below is a guide to deciphering and treating the most common types of cough symptoms in young children.

Cough symptom: Wet and productive, or dry and hacking

• What it probably means: It’s likely a cold or another upper respiratory infection, which are the most common causes of coughs in children, according to Benaroch. He adds that while the child’s cough may sound productive, it usually isn’t; young children generally don’t cough up phlegm.
• How to treat it: Plenty of fluids and a vaporizer, which adds moisture to dry air, effectively ease coughs due to colds. Parents can also administer appropriate over-the-counter cough and cold medicine based on the age of their children. If the cough is accompanied by a high fever (more than 103 F), take your child to a pediatrician to rule out pneumonia. “If the fever comes on in the middle of the night, you don’t need to rush to the ER right then,” says Benaroch. “In this case, it’s usually OK to wait until the next morning.”

Cough symptom: Wheezy

• What it probably means: This is the classic chronic cough that often accompanies asthma symptoms. Oftentimes, the cough is triggered by cold air or exercise.
• How to treat it: If you notice that your child is wheezing, call your doctor right away, as it might be a sign of a first asthma attack. If the wheezing is severe and your child has difficulty breathing (struggles for each breath, makes grunting noises with each breath, or cannot speak or cry due to difficulty breathing), call 911 immediately. Depending on the severity and frequency of asthma symptoms, your child may need to take asthma drugs to control the disease, treat the symptoms or do both.

Cough symptom: Dry and tickling

• What it probably means: A cough that’s caused by environmental allergies, such as mold or ragweed, often originates in the upper airways, says Benaroch. “By the time kids are about 6 or so, I’ll often ask them to show me where the cough is coming from. With allergy-related coughs, they’ll usually point to the upper chest,” he says. Other symptoms that accompany the cough include an itchy nose and frequent sneezing.
• How to treat it: The best solution for managing allergies is to try to minimize exposure to known allergens. However, over-the-counter allergy medicines, such as those that contain the antihistamine loratadine, can also be helpful.

Cough symptom: Bark-like

• What it probably means: If your child wakes up in the middle of the night and her cough sounds like a seal or a small dog barking, the likely culprit is croup. This common childhood infection causes swelling of the larynx and trachea, which is why children also often have a hoarse voice and make a high-pitched, squeaky sound as they inhale. The cough usually lasts three or four days; it often improves during the day and then gets worse again at night.
• How to treat it: “I tell parents it’s important to remain calm so that the child remains calm. As children become more anxious, they tighten their throats and that just makes the cough worse,” says Benaroch. The best remedy for croup is to take your child outside if it’s cold or into a steamy bathroom if the weather’s warm. The cold or steamy air will help reduce swelling and ease the cough. Severe cases may require oral steroid medications. Children under the age of 2 are at a higher risk of developing breathing problems with croup, so be on the lookout for the signs of breathing difficulty listed above.

Cough symptom: Severe, violent and rapid

• What it probably means: It could be whooping cough, a persistent bacterial infection of the lungs that has been increasingly prevalent across the U.S. “In school-age children, the infection can cause very severe bouts of coughing,” says Benaroch. “A child may not be coughing constantly throughout the day, but he’ll periodically have violent spells where he coughs so rapidly that he really doesn’t get a chance to catch his breath.” The name comes from the “whoop” sound that kids make at the end of the cough as they take a big breath to try to get air into the lungs. Although babies generally don’t cough, they’re at the greatest risk of dying if infected with the bacteria. Until the pertussis vaccine became available in the 1950s, whooping cough was a common cause of mortality in newborns, says Benaroch, “and unfortunately it seems to be making a bit of a comeback.” A big cause for the resurgence in cases, he says, is that the pertussis vaccine given to babies doesn’t offer lifelong immunity, and many preteens aren’t getting the recommended pertussis booster recommended at age 11 or 12. A booster is also suggested for adults.
• How to treat it: Antibiotics are essential to stop the spread of the bacteria. However, antibiotics generally don’t ease symptoms or shorten the duration of the illness. If you or a family member has a persistent or severe cough, it’s a good idea to avoid close contact with infants until a doctor has ruled out whooping cough.