Don't assume your toddler's cough is just a cold—it could be something more threatening. Here's what to look for and what to do.
When to Worry: Coughs & Colds
Isn't it amazing how many tissues and bowls of soup your family can go through in one season? Don't assume, though, that your child's cough is simply a cold it might be something more serious. Here's when to worry and what to do.
The Barking Cough
Your child went to bed with a stuffy nose but he's been sleeping peacefully for a few hours. Suddenly, you hear what sounds like a barking seal in the next room. You run in and find your toddler struggling to catch his breath.
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What's probably causing it: Croup, a viral illness that causes inflammation in the larynx (voice box) and the trachea (windpipe). It's most common between October and March, and it usually affects children ages 6 months to 3 years. The telltale cough usually gets better during the day but returns later, and you may notice your toddler coughing at night. Your kid may also make a high-pitched whistling sound (called stridor) when he inhales. Some kids tend to get croup every time they have a cold.
How to help: When your child wakes up barking, bundle him up and go outside—cold air often helps relax the airways. Or turn on a hot shower and sit with your child in the steamy bathroom for 15 to 20 minutes, since the warm, moist air also may help him breathe, says Parents advisor Jennifer Shu, M.D., editor of The American Academy of Pediatrics' Baby and Child Health. Call 911 if your child is truly having trouble breathing or if he has stridor that gets worse with each breath or lasts for more than five minutes. Between attacks, use a cool-mist humidifier in his room, and make sure he drinks plenty of liquids. Although croup usually resolves on its own, always call your doctor when you suspect it. Recent research has found that one dose of oral steroids—which doctors used to prescribe only for severe croup—may also be helpful for milder cases.
The Phlegmy Cough
Your child's cough sounds mucousy, and she also has a runny nose, a sore throat, watery eyes, and a poor appetite.
What's probably causing it: A common cold, which can last for one to two weeks—although it's at its worst (and most contagious) in the first few days. Children get an average of six to ten colds a year, according to the National Institute of Allergy and Infectious Diseases, so you can expect more than a few this winter.
How to help: Since colds are caused by viruses, antibiotics won't help—don't even ask your pediatrician to prescribe one. (However, do call your doctor if your child has persistent green snot and a fever, because she may have developed a bacterial sinus infection.) If your child is too young to blow her nose, use saline nose drops and a bulb syringe to help clear the mucus and make her less likely to cough. Using a cool-mist humidifier and giving her a warm bath can also help. You may want to let your child inhale some vapor rub on a towel, but don't put the rub directly on her skin unless your doctor advises it. Also check with your doctor before giving your child any over-the-counter medicines, and ask when she'll be old enough to suck on cough drops.
The Dry, Nighttime Cough
Your child has had an annoying cough off and on all winter long. It gets worse every night and any time he runs around.
What's probably causing it: Asthma, a chronic condition in which the airways in the lungs become inflamed and narrowed, and they produce excess mucus. Although parents often think that wheezing is the primary sign of asthma, a hacking cough—particularly at night—may be a child's only symptom. "The mucus in the lungs creates a little tickle, which makes kids cough," explains Debbie Lonzer, M.D., assistant professor of pediatrics at Cleveland Clinic Children's Hospital. Other red flags: The cough is triggered by exercise, allergies, colds, or cold air. If your child is young or thin, you may see his chest caving in as he breathes.
How to help: See your doctor if you suspect asthma. Children who are old enough (usually age 5 or 6) will blow into a special tube to test lung function. To make a diagnosis in younger kids, doctors usually rely on the child's exam along with parents' reports about the pattern of symptoms and any family history of allergies or asthma. Children with mild cases can take inhaled bronchodilator medication during an attack, while kids with moderate-to-severe asthma also need a daily preventive medicine. Call 911 if your child ever has significant trouble breathing or he becomes unable to speak, eat, or drink.
The Miserable Cough
For the first time in her life, your child is too wiped out to play. She's got a weak, hoarse cough, as well as a high fever, muscle aches, and sniffles.
What's probably causing it: Influenza, otherwise known as the flu, a viral illness that attacks the respiratory system. The flu has a long incubation period in kids, so they can walk around with the virus for days before they get sick, sharing it with friends and family. "It's spread through little droplets, so when a classmate sneezes just once, the flu virus flies across the room," says Dr. Lonzer.
How to help: Give her plenty of fluids, as well as either acetaminophen or, in children older than 6 months, ibuprofen with food or milk to bring down her fever and relieve aches. Next year, be sure she gets the flu vaccine.
The Wheezy, Gurgly Cough
Your little one has had a cold for a few days, and now his cough has a raspy, whistling sound. He seems to be breathing rapidly and is very irritable.
What's probably causing it: Bronchiolitis, an infection of the bronchioles, the tiniest airways in the lungs. When they swell and fill with mucus, it's difficult for a child to breathe. The most common cause is the respiratory syncytial virus (known as RSV). Bronchiolitis most often strikes young babies during the winter months, says Allan Lieberthal, M.D., clinical professor of pediatrics at the University of Southern California, in Los Angeles.
How to help: Contact your pediatrician immediately if your child seems to be having difficulty breathing or drinking. Your doctor can diagnose bronchiolitis with a physical exam and a thorough history. Encourage your child to rest and drink plenty of fluids. Most children don't need medication (bronchodilators, antibiotics, or steroids), according to guidelines. In serious cases, a child may need to be hospitalized to receive oxygen, fluids, or medication.
When to Worry: RSV
The Whoopy Cough
Your child has had a cold for more than a week and now she's having coughing fits—sometimes she'll cough more than 20 times in one breath. Between coughs, she has trouble breathing and makes a strange whooping sound as she inhales.
What's probably causing it: Whooping cough, which has recently been on the rise. Bacteria called pertussis attack the lining of the breathing passages, producing severe inflammation that narrows—and sometimes even blocks—the airways. Children who've not yet been fully immunized are most likely to catch whooping cough (the five-dose DTaP vaccine is usually given at 2, 4, and 6 months, between 15 and 18 months, and between 4 and 6 years). However, young babies are at greatest risk. "Infants under 6 months don't have enough strength in their lungs to make the characteristic whooping noise, so it's harder for parents to detect," says Gordon Bloomberg, M.D., associate professor of pediatrics at Washington University School of Medicine in St. Louis. Instead, their coughs may come in continuous bursts ending with gagging or vomiting, they may briefly stop breathing, and their lips may turn purple because they're not getting enough oxygen.
How to help: Call your doctor immediately if you suspect whooping cough. Babies under 6 months will need to be hospitalized. The infection is treated with antibiotics, and other adults and children in your household may need preventive antibiotics and a booster shot to avoid getting sick. (Whooping cough is highly contagious, and immunity begins to wane five years after immunization.) Antibiotics will clear up the infection after about five days if they're started early enough, but your child's cough may linger for months and also return when she gets subsequent respiratory infections.
The Really Gross Cough
Your child's had a cold for a week now, and it's getting worse. His cough is wet and phlegmy, and his breathing seems to be faster than usual.
What's probably causing it: Pneumonia, in which a virus or bacterium invades the lungs, causing them to fill up with fluid. "Because the child is trying to get the fluid out of his lungs, a pneumonia cough tends to be pretty ugly," says Dr. Lonzer. "This is the hacking-up-goobers one."
How to help: Your pediatrician may be able to diagnose pneumonia with a physical exam but might need to send your child for an X-ray. She may do an oxygen-saturation test (placing a bandage-like strip around your child's finger) to check for a low oxygen level. If the doctor determines from the test results that the pneumonia is bacterial, she'll prescribe antibiotics; viral pneumonia has to run its course. Pneumonia can usually be treated at home, but if it's severe, your child may need to stay in the hospital for a few days.
Simple Cough Soothers
- Plenty of water
- Nasal aspirator
- Chicken soup
- Cool-mist humidifier
What Does Whooping Cough Sound Like?
Originally published in the February 2007 issue of Parents magazine. Updated in 2018.