Special Health Report: Your Kid's Cough

How can you tell the common cold from croup? And when is a cough a sign of something more serious? We've got the answers every parent needs to know.

Decode Your Child's Cough

You can't sleep. All you hear from your child's room is that nasty cough, over and over again.

The good news: Coughs usually sound much worse than they are. "It's the body's way of clearing and protecting the airways from irritating mucus and other secretions," says Charles Shubin, M.D., director of the Children's Health Center at Mercy FamilyCare in Baltimore. In addition, coughs offer valuable clues about your child's illness.

Follow our guide to decipher what's trouble — and what's not — and which comforts and cures really work.

COUGH CLUES: A distinctive, shrill, dry, seal-like bark, which frequently starts in the middle of the night.
Other symptoms: Your child's illness is 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.
Likely culprit: Croup, a contagious viral infection that causes the throat and windpipe to swell and narrow. It typically affects kids between 6 months and 3 years of age. (Older children and adults have wider windpipes, so swelling is less likely to affect breathing.)
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. At night, bundle her up in warm pajamas, open her window and run a humidifier; the cold, moist air may reduce airway swelling. Call your doctor right away if her cough worsens or she's having trouble breathing. She may need medicine to reduce inflammation. Croup often runs its course in three to seven days.

COUGH CLUES: A wet cough without wheezing or fast breathing, day or night.
Other symptoms: Sneezing, runny nose, watery eyes and a mild fever (usually under 101.5 degrees Fahrenheit).
Likely culprit: The 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.
What to do: Keep your child's nasal passages as clear as possible; congestion and postnasal drip worsen his cough. For babies and toddlers who can't blow their nose yet, use nasal saline drops and a bulb aspirator to suction a runny nose. An over-the-counter nasal decongestant may help children over age 2; ask your pediatrician for a recommendation. If your child's cough and stuffy nose persist for more than 10 days without improving, see your doctor. Your little one could have sinusitis (a bacterial infection often brought on by a cold) or another problem, such as asthma, allergies, pneumonia or enlarged adenoids, which can inhibit breathing.

COUGH CLUES: Dry, hacking coughing fits — as many as 25 coughs in a single breath. When your child inhales sharply, she makes a whooping sound.
Other symptoms: Before the cough starts, your child has a week of cold-like symptoms, possibly with a mild fever. In babies, mucus may bubble from the nostrils. In severe cases, a baby may have convulsions.
Likely culprit: Whooping cough, or pertussis, a highly contagious bacterial infection of the throat, windpipe and lungs. Children who haven't been immunized are most vulnerable. Babies routinely get shots at 2, 4 and 6 months, and boosters between 12 and 18 months and again between 4 and 6 years. Immunity wanes with age, so adults may carry pertussis and pass it on to a child.
What to do: Call a doctor if the cough worsens after a week. Babies usually are hospitalized to control the cough and have mucus suctioned from the throat. It's treated with antibiotics; the cough can last months.

COUGH CLUES: A phlegmy or wheezy cough often accompanied by fast or shallow breathing.
Other symptoms: Your child starts out with cold symptoms and may develop a fever up to 103 degrees. He's lethargic, and he wheezes when he exhales.
Likely culprit: Bronchiolitis, an infection of the lungs' tiny lower airways, called bronchioles. It is usually caused by respiratory syncytial virus (RSV) and most often occurs from late fall to early spring. Not to be confused with bronchitis, bronchiolitis is common. "Almost all kids will get a bout of it by age 3," says Susanna McColley, M.D., division head of pulmonary medicine at Children's Memorial Hospital in Chicago.
What to do: Call your pediatrician right away if your little one is struggling to breathe or is too irritable to eat or drink. Put a cool-mist humidifier in his room to help loosen mucus, and be sure he drinks plenty of fluids. Infants sometimes need to be hospitalized.

COUGH CLUES: A mildly hoarse, throaty cough that comes in frequent spells and can be 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 also may have a runny nose, fever and nausea.
Likely culprit: Flu, a viral respiratory illness that's most common November through April.
What to do: Call your doctor if your child has a fever above 101.5 degrees, 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 loosen congestion in his airways. Also, to ward off future bouts of the flu, ask your pediatrician about getting your child an annual flu shot in late fall. Experts recommend the vaccine particularly for babies 6 to 23 months of age, who are most susceptible to complications associated with the flu.

COUGH CLUES: A wheezy, crackly, persistent cough after your child eats. It worsens when she lies down.
Other symptoms: She may feel a burning sensation or may vomit or belch when swallowing. A baby might be fussy or be labeled colicky. Toddlers may develop wheezing and picky eating habits.
Likely culprit: GERD (gastroesophageal reflux disease), caused by a weak or immature band of muscle between the esophagus and stomach that lets acid flow back up. Sometimes the irritating juices enter the lungs, causing a cough.
What to do: See your doctor if the 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. Prescription medicine also can control GERD symptoms.

COUGH CLUES: A persistent cough, often wheezy or whistling, lasting longer than 10 days; it's worse at night, after exercise or after exposure to pollen, smoke.
Other symptoms: Your child is wheezing or has labored, rapid breathing.
Likely culprit: Asthma, a chronic condition in which small airways in the lungs swell, narrow, become clogged with mucus, and spasm, making breathing difficult. "Children with asthma, in essence, have sensitive lungs," says Mark Widome, a Parents adviser and author of Ask Dr. Mark.
What to do: In mild cases, a cough may be the only symptom. See a doctor for an accurate diagnosis. A family history of allergy, asthma or eczema can increase your child's odds of getting the disease.

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