Decoding Baby's Cough

What does that wheezing, hacking, or barking mean?
When to Worry: Coughs & Colds
When to Worry: Coughs & Colds

A baby's cough can mean very different things, and it's not as if you can ask your baby what's wrong. Sometimes it's hard to know if you should call your doctor for advice, make an appointment, or head straight to the emergency room.

Coughs are the body's way of protecting itself, explains Howard Balbi, MD, director of pediatric infectious diseases at Nassau County Medical Center in East Meadow, New York. Coughing serves as the method the body uses to keep the airways clear, ridding the throat of phlegm, postnasal drip (nasal mucus that drips down the back of the throat), or a lodged piece of food. There are two kinds of coughs that serve this purpose:

  • Dry cough: This occurs when a baby has a cold or allergies. It helps clear postnasal drip or irritation from a sore throat.
  • Wet cough: This results from a respiratory illness accompanying a bacterial infection. This causes phlegm or mucus (which contains white blood cells to help fight germs) to form in baby's airways.

Children younger than 4 months don't cough much, so if they do, it's serious, says Catherine Dundon, MD, an associate clinical professor of pediatrics at Vanderbilt University Medical School and a pediatrician in Goodlettsville, Tennessee. In the winter, if an infant is coughing terribly, it could be respiratory syncytial virus (RSV), a dangerous viral infection for infants. Once your child is older than age 1, coughs are less alarming. In most cases, chances are your baby's cough is nothing more than a cold.

To help you tell a wait-and-see cough from one that demands immediate medical attention, stay calm, listen carefully to the cough, and follow the directions below.

Common Cold or Flu

Signs that a baby's cough may indicate a cold include:

  • Stuffy or runny nose
  • Sore throat

Sounds like: Dry hack

Other symptoms: Coughs are usually dry, but depending on the severity of the cold, baby can have:

  • Some rattling mucus
  • A slight fever at night

Treatment: Try your own mother's "lots-of-fluids-and-plenty-of-rest" routine. Although you may be eager to give baby something stronger to quiet the cough, the American Academy of Pediatrics advises against using cough and cold medications for kids under 6 years because studies have shown that they don't work in little kids -- and they can have potentially fatal side effects. It's better to stick to natural methods such as honey (for babies over a year), saline drops, and a cool-mist humidifier.

Acetaminophen is safe to use to reduce a fever, but if your child's temperature is 100.4 degrees or higher and she looks sickly, call your doctor. It's likely that she has the flu. If your baby is 4 months or younger, call your doctor immediately if she has any fever; even a slight fever is serious in infants.

Croup

You know baby has croup when he wakes up in the middle of the night with a barking cough (the sound is hard to mistake) and difficulty breathing. Croup typically affects children under age 5 and often begins with a normal cold or sniffle earlier in the day.

Sounds like: Barking cough

Other symptoms: Usually caused by a viral infection, croup makes the lining of the trachea swell up and closes the airways, which is why baby has such a hard time breathing. You'll hear the seal-like cough when your child inhales (not on the exhale).

Treatment: First try to calm your child. Then consider one of the following techniques to ease her breathing.

  • Run the shower, close the bathroom door, and let your child breathe in the steamy air.
  • If it's a mild evening, take him outside; the damp air should make it easier for him to breathe.
  • Have your child breathe the air from a cool-mist humidifier.

Croup should clear up in three or four days; if it doesn't, call your doctor.

Pneumonia

Pneumonia is a viral or bacterial infection of the lungs brought on by a number of conditions, including the common cold.

Sounds like: Wet and phlegmy

Other symptoms: A baby with pneumonia will be very fatigued and will have a very "productive" cough, bringing up everything imaginable in the shades of green and yellow.

Treatment: Treatment depends on whether the cause is viral or bacterial, so call your doctor, especially if baby has a fever. Bacterial pneumonia is usually more dangerous and is most commonly brought on by strep pneumonae.

Bronchiolitis or Asthma

Both bronchiolitis and asthma come on after what seems to be a basic cold, with coughing and a runny nose. According to Ruffin Franklin, MD, of Capitol Pediatrics and Adolescent Center in Raleigh, North Carolina, many things cause wheezing or constriction of the airways, including environmental factors such as dust.

Doctors generally agree that asthma is not common in children younger than 2, unless the baby has had bouts of eczema and there's a family history of allergies and asthma. Until there is an absolute diagnosis of asthma, a tightening of baby's airways resulting in wheezing is referred to as Reactive Airway Disease.

The vast majority of cases of bronchiolitis in babies under age 1 are caused by respiratory syncytial virus (RSV). This virus causes a simple cold in kids older than 3, but it can penetrate the lungs of infants and can be potentially life-threatening, warns David Rubin, MD, chief of pediatrics at St. Barnabas Hospital in the Bronx, New York.

Sounds like: A cough accompanied by wheezing or noisy breathing

Other symptoms: The cough or wheezing associated with both bronchiolitis and asthma makes them hard to tell apart.

In the case of asthma, your infant will probably start out with:

  • Cold symptoms
  • Itchy and runny eyes

Bronchiolitis is usually seen in the fall and winter and may be accompanied by:

  • Slight fever
  • Loss of appetite

In the case of asthma, your baby will also suffering from retractions (a sucking in and out of the chest and diaphragm).

Treatment: Keep an eye on your child's respiratory rate. If it gets too high -- 50 breaths per minute or more -- your child is definitely in respiratory distress. Call 911.

Whatever the case, it's always best to call your doctor when you hear your infant wheezing. Even without a definitive diagnosis of asthma, doctors often use asthma medication to treat a bout of wheezing. Your doctor may prescribe a liquid form of the asthma medicine albuterol to open the airways. If the asthma attacks are very severe, albuterol is administered via a nebulizer -- a special device that delivers the medicine in a fine mist -- sometimes used with an infant-size face mask so baby can inhale the drug more easily.

You can treat bronchiolitis at home once baby's breathing is under control. Give baby lots of fluids, plenty of rest, and a cool-mist humidifier.

If a young baby has a terrible cough or one that worsens after a day or two, and her breathing becomes labored, call your pediatrician immediately.

Whooping Cough

This life-threatening bacterial infection was a leading cause of infant illness and death until the DTP vaccine was created in the 1960s and the disease was all but eradicated in the U.S. However, the disease has been making a comeback and there have been outbreaks in many states in recent years. In most cases of whooping cough (pertussis), baby has no cold symptoms or fever.

Sounds like: A loud, rapid whoop

Other symptoms: Frequent, alarming coughing spasms may be accompanied by:

  • Tongue sticking out
  • Bulging eyes
  • Face discoloration

Treatment: Prevention is key. Make sure your baby has been immunized, but because babies aren't fully protected until they've received three doses of the vaccine, it's essential that you and all of your infants' caregivers get vaccinated with the Tdap (tetanus, diphtheria, pertussis) booster.

If you suspect your baby is suffering from whooping cough, call 911 immediately. By the time the coughing fits develop, the infant must be hospitalized so he can receive oxygen during coughing spells, according to Ruffin Franklin, MD, of Capitol Pediatrics and Adolescent Center in Raleigh, North Carolina.

Generally, baby -- as well as every member of your household -- is also prescribed the antibiotic erythromycin to prevent the spread of this very contagious disease. If the child comes through the initial attack, whooping cough will need to run its course, which can take months.

Child with Whooping Cough
Child with Whooping Cough

Foreign Object

Food, such as a piece of carrot or hot dog, is the most common cause of choking. If a baby starts gasping or coughing suddenly while eating or playing with small toys, look in his mouth for an obvious culprit. He can usually cough it out himself.

And since babies are always sticking things in their mouth, it's possible to miss something that's stuck for days.

Sounds like: Small, persistent cough or gasping

Other symptoms: If your baby has an initial coughing spell and has a persistent cough or slight wheezing over a period of days afterward without any other cold symptoms and no recent history of cold or fever, chances are something is caught in his windpipe. In other cases, baby will get pneumonia as a result of food that he swallowed the wrong way and that got stuck in his lungs -- peanuts are very common culprits, says Dr. Dundon.

Treatment: If the object has totally blocked your baby's airway, she would exhibit the following symptoms:

  • Appearing to be in obvious distress
  • Making no sound at all
  • Turning pale or blue

If you suspect a totally blocked passageway, turn baby over and immediately deliver five back blows between his shoulder blades. If you're unable to dislodge the foreign object, call 911.

In the case of a partially lodged object, try to help baby cough it up by:

  • Tilting his head down
  • Giving him a few gentle pats on the back

If you suspect your baby is suffering from a partially lodged object, but she doesn't appear able to cough it up, she'll need a chest x-ray. If a bit of food is indeed stuck, the doctor will refer you to a specialist who can perform a bronchoscopy. During the procedure, the child is put under general anesthesia, and a tiny fiber-optic tube with tweezers at the end goes down the airway and picks out the foreign body.

When to Call for Help

Call your doctor if baby has:

  • Any cough, and she's younger than 4 months
  • A dry cough related to a cold (a runny nose but no fever) that lasts more than five to seven days
  • A dry or wet cough with a cold and a fever of 100 degrees or more
  • Mild, light wheezing
  • Fits of coughing

Call 911 if baby is:

  • Wheezing rapidly
  • Grunting
  • Unable to catch his breath
  • Turning blue
  • Rapidly retracting and expanding his stomach

 

Reviewed 2/02 by Jane Forester, MD

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

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