Cough in Children

"Why does my child cough all the time?" "Has this cough gone down to the lungs?" "Could a night-time cough be a sign of asthma?" "Should I give a cough syrup?" "How many days does it have to last before I take my child to the doctor?"

Cough is one of the most common complaints in childhood.

Most of the time it appears during a viral infection such as a common cold and lessens on its own as the illness gets better. However, how long the cough lasts, how it sounds, whether it is dry or productive, and the other signs that come along with it can sometimes give a clue to a different condition.

For this reason, the important question in children is not only "Is there a cough?"

How long has the child been coughing, what does the cough sound like, and what other signs come along with it?

These questions should be evaluated together.

What Is a Cough?

A cough is actually one of the body's defense mechanisms.

When the following reach the airways:

• Secretions
• A foreign substance
• Dust
• Smoke
• Microorganisms

the cough reflex helps to clear the airways.

For this reason it is not right to see every cough as a sign that absolutely must be stopped.

Most of the time the aim is not to silence the cough, but to understand its cause.

Why Does Cough Develop in Children?

A cough in children can have many different causes.

Among the most common causes are:

• Upper respiratory tract infections
• The common cold
• Influenza and other viral infections
• Postnasal drip
• Sinusitis
• Asthma and airway sensitivity
• Croup
• Bronchiolitis
• Pneumonia
• Whooping cough (pertussis)
• Foreign body aspiration

In coughs that last longer, the causes may be different.

For this reason, classifying a child's cough only as "dry" or "productive" is not enough to make a diagnosis.

What Is the Most Common Cause of Cough in Children?

One of the most common causes of acute cough in children is viral upper respiratory tract infections.

A cough that starts along with a runny nose, sneezing, a blocked nose, a sore throat and sometimes fever is mostly related to a viral infection.

Children who go to daycare and school in particular can meet different viruses one after another during the winter months.

The child may meet a new virus before the cough from one infection has fully finished, and may start coughing again.

In this situation it can look to the family as though the child "has not gotten better for two months."

Yet sometimes what is actually happening is a series of different viral infections following one another.

How Many Days Does a Cough Last in Children?

In a simple viral respiratory infection, the cough does not have to stop completely within a few days.

Even though the other signs improve, the cough may continue for a while longer.

A large part of acute coughs lessen on their own within a few weeks.

For this reason, an antibiotic does not need to be started automatically just because a child has been coughing for 7 to 10 days.

What really matters is whether the cough:

• Is lessening
• Is continuing at the same level
• Or is gradually getting worse

When Is a Cough Considered Chronic in Children?

In children, a cough that continues every day and goes beyond 4 weeks is evaluated as a chronic cough.

In a daily cough lasting more than four weeks, instead of thinking only of "a flu that will not go away," the cause needs to be investigated.

The evaluation becomes even more important if findings such as the following come along with it:

• A constantly productive/wet cough
• A cough that increases at night or with exercise
• Failure to gain weight
• Repeated pneumonia
• Shortness of breath
• Wheezing

Why Does a Dry Cough Develop?

In a dry cough there is no noticeable phlegm or secretion brought up.

It can often be seen at the beginning of viral infections or during the recovery period.

Besides this, a dry cough can also be seen in different conditions such as:

• Asthma
• Irritation of the upper airway
• Croup
• Whooping cough (pertussis)

For this reason the cause of the illness cannot be determined only from the information that "the cough is dry."

What Does a Productive or Wet Cough Mean?

Children, especially at young ages, may swallow phlegm instead of spitting it out.

For this reason the family may not always see phlegm.

However, the cough may sound wet or full of secretions.

A temporary wet cough may be seen during acute infections.

A daily wet cough that continues for weeks, on the other hand, calls for a more detailed evaluation.

Why Does a Night-Time Cough Develop?

A night-time cough can be seen in children for different reasons.

For example, the following can increase night-time coughing:

• Upper respiratory tract infections
• Postnasal drip
• Asthma
• Certain airway conditions

However, a night-time cough on its own does not establish a diagnosis of asthma.

An evaluation for asthma may be needed especially if the cough comes together with:

• Wheezing
• Shortness of breath
• Coughing when running
• Repeated episodes

Why Does Coughing Develop When Running or Playing?

A cough that keeps coming back after running and intense physical activity may be a finding that needs to be evaluated in terms of:

• Asthma
• Exercise-related bronchoconstriction (narrowing of the airways)
• Airway sensitivity

It is especially important if the child falls behind friends during play, often needs to stop to catch a breath, or if wheezing comes along with it.

What Is an Asthma Cough Like in Children?

In asthma, the cough:

• May keep coming back
• May increase at night or toward the morning
• May be triggered by running and exercise

It may become more noticeable with cold air or viral infections.

Wheezing and shortness of breath may come along with it.

However, not every long-lasting or night-time cough is asthma.

A diagnosis of asthma is made with the child's history, the examination and, when age-appropriate, an evaluation of lung function.

Does Sinusitis Cause Coughing?

Yes.

In acute bacterial sinusitis in children, the following may be seen:

• Runny nose
• Blocked nose
• Postnasal drip
• Daytime and night-time coughing

An evaluation for sinusitis may be needed especially if the signs of an upper respiratory tract infection are not improving even though more than 10 days have passed, or if the child gets better first and then gets worse again.

However, the presence of a cough alone does not establish a diagnosis of sinusitis.

Why Does a Barking Cough Develop?

If the child's cough makes a hoarse sound resembling a dog's bark or a seal's call, croup may be considered.

In croup, the following may be seen:

• A barking type of cough
• Hoarseness
• A high-pitched sound appearing especially while breathing in
• Difficulty breathing in some children

If the child makes a clear sound while breathing in even when calm, or has difficulty breathing, urgent evaluation is needed.

What Is a Whooping Cough Like?

In whooping cough (pertussis), over time the cough may follow a course with:

• Severe fits coming one after another
• Vomiting after the coughing
• Difficulty breathing

Classically, a deep, noisy intake of breath may be seen after a coughing fit; however, the typical sound may not always be there, especially in small babies.

In babies, more serious findings such as pauses in breathing (apnea) may be seen instead of coughing.

A cough in the form of long-lasting fits should be evaluated carefully, especially in babies whose immunizations are not complete.

How Is a Pneumonia Cough Recognized?

An evaluation for pneumonia is needed if the cough comes together with:

• Rapid breathing
• Shortness of breath
• Pulling in of the chest wall
• High or continuing fever
• Chest or abdominal pain
• A marked decline in the child's general condition

In addition, if during a viral infection the child is getting better at first but then develops a fever again a few days later, the cough clearly increases, or shortness of breath develops, the child should be examined again.

Why Is a Sudden-Onset Cough Important?

If a child who was completely well suddenly starts coughing severely while eating or while playing with a small object, foreign body aspiration should be considered.

In young children in particular, the following can pass into the airway:

• Hazelnuts
• Peanuts
• Pieces of nuts
• Small toy parts

Even if the cough lessens afterward, an evaluation may be needed if the child seemed to be choking or a sudden cough started just before it.

If the child cannot breathe or is turning blue, this is an emergency.

Which Cough Is Dangerous?

The level of danger is determined by the accompanying signs rather than by the cough itself.

In the situations below, the child should be evaluated urgently or quickly:

• Difficulty breathing
• Very rapid or labored breathing
• Pulling in between the ribs or of the chest wall
• Blueness of the lips or the skin
• A constant high-pitched sound while breathing
• A change in consciousness or difficulty waking the child
• Pauses in breathing
• A cough that starts after sudden choking
• Coughing up blood
• A marked inability to take in fluids

A serious worsening of the general condition.

Signs of breathing difficulty should be evaluated more quickly, especially in small babies.

How Does a Child's Cough Get Better?

The treatment of a cough changes according to its cause.

In a cough due to a viral upper respiratory tract infection, a special cough medication is mostly not needed.

At home, the following may be helpful:

• Taking in enough fluids
• Relieving a blocked nose with saline (salt water)
• Keeping the child away from cigarette and electronic cigarette smoke
• Providing suitable room conditions

Relieving a blocked nose can reduce night-time coughing and sleep problems, especially in young children.

Does Honey Help Coughing in Children?

In children older than 1 year, honey can be tried to ease a cough due to an acute viral infection.

Some studies suggest that it may give limited benefit, especially in night-time coughing.

However, honey does not remove the cause of the illness, and it is not a treatment that has been shown to definitely shorten the length of an infection.

Honey should not be given to babies younger than 1 year because of the risk of botulism.

Does Steam Help a Cough?

There is not enough evidence to show that hot water vapor treats coughing in children.

What is more, boiling water or hot steam applications can cause serious burns in children.

For this reason, holding the child's face over hot water vapor or using containers of boiling water is not recommended.

Are Cough Syrups Used in Children?

Cough syrups are not medications that are used automatically in children.

The benefit of over-the-counter cough and cold medicines is limited, especially in young children, and some products can lead to serious side effects.

For this reason a cough syrup should not be used without looking at the child's age, the cause of the cough and the active ingredients in the product.

Products sold as "herbal," "natural" or "homeopathic" should also not be accepted as safe or effective just because of these words.

Are Cough Syrups Given to Babies?

Using over-the-counter cough and cold medicines at random is not appropriate, especially in babies and young children.

Some medications can cause serious side effects such as:

• Suppression of breathing
• Changes in heart rate
• Drowsiness
• Agitation
• Overdose

In this age group, identifying the cause of the cough is far more important than giving a syrup.

Should an Expectorant Syrup Be Used?

An expectorant does not need to be given for every productive cough in children.

A productive cough is a protective mechanism that helps clear the secretions in the airways.

Routine use of expectorant or mucolytic medications is not recommended, especially in young children.

A medication should be used only if the physician considers it appropriate according to the child's age and clinical condition.

Is It Right to Use a Cough Suppressant?

Not always.

A cough helps clear the airways, especially in conditions where there are secretions.

For this reason it may not be appropriate to use a medication that suppresses the cough without knowing the cause.

The effectiveness of cough suppressant medications in children is also limited, and there may be safety concerns depending on age.

Do Antibiotics Make a Cough Go Away?

In coughs due to viral infections, an antibiotic does not make the cough go away.

An antibiotic should be used only when a bacterial infection has been found or is strongly considered.

The presence of a runny nose, a cough or phlegm is not enough on its own to start an antibiotic.

Is Asthma Medication Given to Every Child Who Coughs?

No.

Asthma medications such as bronchodilators or inhaled corticosteroids should be used only if these treatments are considered necessary for the child's clinical condition.

It is not right to start a bronchodilator or an inhaled corticosteroid in every child in order to make a simple viral cough go away faster.

Is a Chest X-ray Needed for a Cough?

A chest X-ray does not need to be taken for every child who coughs.

In acute coughs that fit with a simple viral infection and are gradually improving, imaging is mostly not needed.

However, additional investigation may be needed if there is:

• Suspicion of pneumonia
• Suspicion of a foreign body
• A chronic cough
• Repeated lung infections
• Abnormal findings on examination

Which Tests Are Done for a Cough That Does Not Go Away?

The same tests are not done for every child.

Depending on the features of the cough, the following may be planned:

• A chest X-ray
• A pulmonary function test if the child's age is suitable
• An allergy evaluation
• Tests for certain infections
• More advanced investigations when needed

In a cough lasting longer than 4 weeks in particular, the tests should be chosen according to the child's history and examination.

When Should a Cough in Children Be Shown to a Doctor?

Even if there are no emergency signs, the child needs to be evaluated if:

• The cough is gradually increasing
• It has gone beyond 4 weeks
• It comes back every night
• It appears constantly with exercise
• Wheezing comes along with it
• There is recurrent fever
• The child is not gaining weight
• There is a constantly wet/productive cough
• There is a history of repeated pneumonia
• The coughing fits cause vomiting or turning blue