Decoding Your Child’s Cough

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When your child comes down with a cough, there could be many possibilities as to the cause. Here are some tips on what to look for and what to do.

When a child develops a cough, it’s up to you to decipher the symptoms and decide what to do. We asked parents on Facebook how they determine whether or not a child goes to school. Desiree David says she asks herself a series of questions, “How is the child acting? Run down? Is the cough dry or productive?” Mom Anita Hammann worries, “Coughs can be a lot more of something in a child compared to an adult.”

However, different coughs have specific markers for severity and concern that can help guide you in making decisions for your child.

Productive Cough

When a child has mucus, you can hear it. It’s usually caused by a virus and most times it’s cleared from the airways with a hearty cough and then swallowed or spit out. Sometimes, in infants, you can hear it rattle when they breathe, but it won’t necessarily prompt them to cough until it interferes with taking a breath. Ronna Schneider, M.D., of Suburban Pediatrics says, “So many medications are not appropriate for little ones, so it’s just about helping them deal with the symptoms as their little bodies work through it.” Babies younger than 2 may not want to eat or breastfeed because a plugged nose makes it difficult to latch on or drink from a sippy cup or bottle. Schneider says, “Try to flush him out as best as you can so he can breathe more comfortably.” Use saline before suctioning and keep a cool mist humidifier going. Also, prop up his crib mattress (not the baby) for more comfortable sleeping.

If your child’s cough is accompanied by a fever, that’s more concerning. Schneider says, “Under the age of 2, we’re much more concerned about things like bronchiolitis.” Bronchiolitis is inflammation of the smallest air passages of the lungs and is most common for this age.

In older children (7 – 10 years), Schneider says there’s concern with a cough that lasts for a while before a fever develops. This could point to reactive airway disease, a general diagnosis used to describe coughing, wheezing or shortness of breath that’s triggered by infection. It could also be asthma.

Staying hydrated is extremely important. Not only will the hydration keep the mucus thinned for easier clearing but Leah Zemany, A.P.R.N., F.N.P.C.), for The Little Clinic says, “In children, fluids are especially important because they tend to dehydrate more quickly than adults.” Zemany adds, “A common myth is that yellow sputum is a sign of bacterial infection, when actually, it’s just a sign that your immune system is working to fight off the virus.” If your child’s mucus appears rusty or tinged with blood coughing up from the lungs, then it could mean things are advancing toward pneumonia. Call the doctor.

Zemany says cough medications aren’t typically recommended for children under the age of 12 because they’re not very effective. The best thing for coughs, she says, “Is hydration, warm fluids, honey (if child is 1 year of age or older) and lozenges.”

Dry and Raspy

Post-nasal drip (drainage) typically occurs in upper respiratory viral infections along with a sore throat that’s also caused by the drainage. Zemany says, “The drainage irritates the cough center and makes you feel like you need to cough or clear your throat.” That’s why it’s dry. The urge is coming from the nose and not the lungs. The cough is usually the last thing to go away.

Influenza (the flu) is a viral infection that also causes a dry, unproductive cough. The flu’s true marker is a high fever, but chills and body aches are also common. If this is the case with your child, call the doctor. Zemeny says, “If caught within the first 48 hours, Tamiflu can be prescribed to help shorten the duration of the illness.” She stresses that, “fluids are especially important.” Also, get your flu vaccine yearly. It’s still possible to catch the flu even after receiving the vaccine, but symptoms are usually milder.

Home treatment is the same as for a wet, productive cough. A dry cough can also be from an irritant or allergen like dust, pollen or smoke. If this is the case avoidance of the irritant is best.

Sounds Like a Barking Seal or Dog

“People often think of croup (laryngotracheitis) and it’s trademark ‘barky’ cough,” says Zemany. She says this is true for younger children, but older children experience hoarseness. Croup may sound awful, but Zemeny says, “It’s typically viral in nature, mild and a self limited illness.”

The barking sound is made because the upper airways are constricted and inflamed. It helps to sit with your child in a steamy bathroom for 15 – 20 minutes, or go outside in the fresh air if it’s cool (not cold). However, if the symptoms are quick to set in — less than 12 hours of being sick with significant airway compromise — or your child has experienced previous episodes of croup, seek medical attention.

Accompanied by Stridor or Wheezing

Stridor is a high-pitched sound kids make when they inhale; it’s shrill and harsh sounding. It signals an upper airway problem. Schneider says, “Stridor is more common with croup. If that’s the case, call the doctor immediately.” Zemany adds, “It is most common between ages 6 – 36 months and rare beyond the age of 6 years.”

Wheezing is a noise that happens on an exhale and is more of a whistling sound. It’s also common with asthma. For a child who has asthma, the symptoms may worsen when he has a cold. Zemeny says, “With most viral upper respiratory infections you can have a degree of wheezing as well.” Wheezing by itself is not too alarming but Zemeny says, “You want to look out for signs that your child is having difficulty breathing.” She says to look for increased respirations, short quick breaths and difficulty speaking.

“If your child is still able to talk in complete sentences, they’re usually is no acute distress,” she says. In little ones, sudden onset of wheezing can mean they’ve inhaled a foreign body that needs to be removed. Children with chronic wheezing should be monitored for possible asthma.

A Severe Coughing Followed by a WHOOP

According to the Northern Kentucky Health Department there has been an increase in whooping cough, or pertussis. Their website reports that,  “Most of these cases have been in school age youth aged between 10 and 17.” Whooping cough is serious and can result in hospitalization or death. It means the infected child is literally coughing all of the air out of his lungs and then struggling on the inhale, thus creating the whoop sound.

When it comes to warning signs of whooping cough, Schneider says,  “It’s kind of scary because it starts out as really just a cold.” She says a week after the initial cough your child will develop a fever. “Then the ‘whooping’ will start to happen,” she says, “and then it’s a chronic, constant, cough that is dangerous — particularly for babies.” Vaccination is extremely important, starting with Mom receiving a booster in her third trimester of pregnancy to help protect her infant.

When to Keep Kids Home From School

“It’s really not necessary to keep kids home from school when they have a cold,” Zemeny says. That may sound counter intuitive to moms like Hammann who worry because her child has asthma and as she says, “a simple cough” can become life threatening. Unfortunately, Zemany says, “a person is most contagious in the 24 – 48 hours before symptom onset.” This is the incubation period. Children should stay home when they have a fever and in accordance to school protocol.

Bonnie Jean Feldkamp is a writer, wife, and mom of three kids whose ages span two decades. Her work has appeared in the New York Times; Brain, Child Magazine; Scary Mommy and more. Her Cincinnati Family mom blog earned Best Overall Blog in the 2017 Ohio Society of Professional Journalists Awards. Find her on Facebook, Twitter, and Instagram @WriterBonnie or on her website at

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