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Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of a cough can be determined only when other symptoms are evaluated.
For information about coughs in teens and adults, see the topic Coughs, Age 12 and Older.
A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses or may have come up from the lungs. A productive cough generally should not be suppressed; it clears mucus from the lungs. There are many causes of a productive cough, such as:
- Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat.
- Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis, sinusitis, or tuberculosis.
- Chronic lung disease. A productive cough could be a sign that a lung disease is getting worse or that your child has an infection.
- Stomach acid backing up into the esophagus. This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken your child from sleep.
- Nasal discharge (postnasal drip) draining down the back of the throat. This can cause a productive cough or make your child feel the need to clear his or her throat frequently. Experts disagree about whether a postnasal drip or the viral illness that caused it is responsible for the cough.
A nonproductive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a nonproductive cough, such as:
- Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night.
- Bronchospasm. A nonproductive cough, particularly at night, may mean spasms in the bronchial tubes (bronchospasm) caused by irritation.
- Allergies. Frequent sneezing is also a common symptom of allergic rhinitis.
- Exposure to dust, fumes, and chemicals.
- Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Children.
- Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed or Inhaled Objects.
Coughs in children
Children may develop coughs from diseases or causes that usually do not affect adults, such as:
- Infection of the lower respiratory system (such as bronchiolitis or respiratory syncytial virus [RSV]).
- Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy. For more information, see the topic Swallowed or Inhaled Objects.
- Exposure to secondhand smoke from parents or caregivers who smoke.
- Emotional or psychological problems. A dry, nonproductive "psychogenic cough" is seen more frequently in children than in adults.
Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not change the course of viral infections. Unnecessary use of an antibiotic exposes your child to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.
A careful evaluation of your child's health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of a cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If your child has other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Topics section.
Check your child's symptoms to decide if and when your child should see a doctor.
Check Your Symptoms
The medical assessment of symptoms is based on the body parts you have.
- If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
- If your symptoms aren’t related to those organs, you can choose the gender you identify with.
- If you have some organs of both sexes, you may need to go through this triage tool twice (once as "male" and once as "female"). This will make sure that the tool asks the right questions for you.
Many things can affect how your body responds to a symptom and what kind of care you may need. These include:
- Your age. Babies and older adults tend to get sicker quicker.
- Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
- Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
- Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
- Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.
Try Home Treatment
You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.
- Try home treatment to relieve the symptoms.
- Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.
Symptoms of difficulty breathing can range from mild to severe. For example:
- You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
- It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you're at rest (severe difficulty breathing).
Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:
- The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).
- The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).
Severe trouble breathing means:
- The child cannot eat or talk because he or she is breathing so hard.
- The child's nostrils are flaring and the belly is moving in and out with every breath.
- The child seems to be tiring out.
- The child seems very sleepy or confused.
Moderate trouble breathing means:
- The child is breathing a lot faster than usual.
- The child has to take breaks from eating or talking to breathe.
- The nostrils flare or the belly moves in and out at times when the child breathes.
Mild trouble breathing means:
- The child is breathing a little faster than usual.
- The child seems a little out of breath but can still eat or talk.
You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby's nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.
To use the bulb:
- Put a few saline nose drops in each side of the baby's nose before you start.
- Position the baby with his or her head tilted slightly back.
- Squeeze the round base of the bulb.
- Gently insert the tip of the bulb tightly inside the baby's nose.
- Release the bulb to remove (suction) mucus from the nose.
Don't do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.
If you're not sure if a child's fever is high, moderate, or mild, think about these issues:
With a high fever:
- The child feels very hot.
- It is likely one of the highest fevers the child has ever had.
With a moderate fever:
- The child feels warm or hot.
- You are sure the child has a fever.
With a mild fever:
- The child may feel a little warm.
- You think the child might have a fever, but you're not sure.
A baby that is extremely sick:
- May be limp and floppy like a rag doll.
- May not respond at all to being held, touched, or talked to.
- May be hard to wake up.
A baby that is sick (but not extremely sick):
- May be sleepier than usual.
- May not eat or drink as much as usual.
Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.
Oral (by mouth), ear, or rectal temperature
- High: 104° F (40° C) and higher
- Moderate: 100.4° F (38° C) to 103.9° F (39.9° C)
- Mild: 100.3° F (37.9° C) and lower
A forehead (temporal) scanner is usually 0.5° F (0.3° C) to 1° F (0.6° C) lower than an oral temperature.
Armpit (axillary) temperature
- High: 103° F (39.5° C) and higher
- Moderate: 99.4° F (37.4° C) to 102.9° F (39.4° C)
- Mild: 99.3° F (37.3° C) and lower
Note: For children under 5 years old, rectal temperatures are the most accurate.
Symptoms of serious illness in a baby may include the following:
- The baby is limp and floppy like a rag doll.
- The baby doesn't respond at all to being held, touched, or talked to.
- The baby is hard to wake up.
Symptoms of serious illness may include:
- A severe headache.
- A stiff neck.
- Mental changes, such as feeling confused or much less alert.
- Extreme fatigue (to the point where it's hard for you to function).
- Shaking chills.
Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:
- Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
- Steroid medicines, which are used to treat a variety of conditions.
- Medicines taken after organ transplant.
- Chemotherapy and radiation therapy for cancer.
- Not having a spleen.
Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.
The epiglottis is a flap of tissue at the back of the throat that you can't see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.
The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it's easier to breathe in this position.
Seek Care Now
Based on your answers, you may need care right away. The problem is likely to get worse without medical care.
- Call your doctor now to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care in the next hour.
- You do not need to call an ambulance unless:
- You cannot travel safely either by driving yourself or by having someone else drive you.
- You are in an area where heavy traffic or other problems may slow you down.
Seek Care Today
Based on your answers, you may need care soon. The problem probably will not get better without medical care.
- Call your doctor today to discuss the symptoms and arrange for care.
- If you cannot reach your doctor or you don't have one, seek care today.
- If it is evening, watch the symptoms and seek care in the morning.
- If the symptoms get worse, seek care sooner.
Call 911 Now
Based on your answers, you need emergency care.
Call 911 or other emergency services now.
Sometimes people don't want to call 911. They may think that their symptoms aren't serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.
Make an Appointment
Based on your answers, the problem may not improve without medical care.
- Make an appointment to see your doctor in the next 1 to 2 weeks.
- If appropriate, try home treatment while you are waiting for the appointment.
- If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.
Coughing is the body's way of removing foreign substances and mucus from the lungs and upper airway passages. Productive coughs are often useful, and you should not try to eliminate them. Sometimes, though, coughs are severe enough to impair breathing or prevent rest. Home treatment can help your child feel more comfortable when he or she has a cough.
- Prevent dehydration. Fluids may help soothe an irritated throat. Honey or lemon juice in hot water or tea may help a dry, hacking cough. Do not give honey to children younger than 1 year of age. It may contain bacteria that are harmful to babies.
- Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included. For more information, see Quick Tips: Giving Over-the-Counter Medicines to Children.
- If your child's doctor tells you to give a medicine, be sure to follow what he or she tells you to do. How much medicine to take and how often to take it may be very different for children than for adults.
- Do not give your child leftover antibiotics, or antibiotics or medicines that were prescribed for someone else.
If your child has a barking cough during the night, you can help him or her breathe better by following the home treatment for a barking cough.
- Hold your child in a calming manner.
- Keep your child quiet, if possible. Crying can make breathing more difficult. Try rocking or distracting your child with a book or game.
- Use a humidifier to add moisture to the air. Do not use a hot vaporizer. Use only water in the humidifier. Hold your child in your lap, and let the cool vapor blow directly into your child's face.
- If there is no improvement after several minutes, take the child into the bathroom and turn on the shower to create steam. Close the door and stay in the room while he or she breathes in the moist air for several minutes. Make sure your child is not burned by the hot water or steam. Do not leave your child alone in the bathroom.
- If there is still no improvement, bundle your child up and go outside in the cool night air.
For more information on treating coughs and other respiratory problems, see the Home Treatment section of the topic Respiratory Problems, Age 11 and Younger.
Try a nonprescription medicine to help treat your child's fever or pain:
Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.
Be sure to follow these safety tips when you use a nonprescription medicine:
Symptoms to watch for during home treatment
Call your child's doctor if any of the following occur during home treatment:
- Other symptoms develop, such as difficulty breathing, a productive cough, or fever.
- Your child starts coughing up blood.
- A cough lasts longer than 2 weeks without other respiratory symptoms.
- Symptoms become more severe or more frequent.
There is no sure way to prevent a cough. To help reduce your child's risk:
- Make sure your child washes his or her hands often during the cold and flu season. This helps prevent the spread of a virus that may cause a cold or influenza.
- If your child goes to a day care center, ask the staff to wash their hands often to prevent the spread of infection.
- Make sure that your child gets all of his or her vaccinations, especially for diphtheria, tetanus, and pertussis (DTaP) and for Haemophilus influenzae type b (Hib). For more information, see the topic Immunizations.
- Help your child avoid secondhand smoke. Don't allow smoking in your home or around your child.
- Try to avoid people who have colds or flu. If one of your children is sick, separate him or her from other children in the home, if possible. Put the child in a room alone to sleep.
Preparing For Your Appointment
To prepare for your appointment, see the topic Making the Most of Your Appointment.
You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:
- How long has your child had the cough?
- How often does your child cough?
- Does the cough have a pattern, such as worsening at night or becoming more frequent in the morning?
- What situations increase your child's coughing?
- Is your child exposed to any irritants, such as smoke, dust, or chemicals, at home or elsewhere?
- Is the cough productive (brings up sputum) or unproductive (dry and hacking)? Be prepared to describe the color (bloody, rusty, white, yellow, or green), amount, and consistency of any sputum.
- Does your child have other symptoms that may be related to the cough, such as nasal drainage, fever, shortness of breath, wheezing, or other suspected cold symptoms?
- What home treatment have you tried for the cough? Did it help?
- What prescription and nonprescription medicines or other treatments have you tried? Did they help?
- What prescription and nonprescription medicines does your child take regularly?
- Has your child ever been diagnosed with allergies or asthma? Does anyone else in your family have allergies or asthma?
- Has your child traveled recently?
- Does your child have any health risks?
Current as of: June 26, 2019
Author: Healthwise Staff
William H. Blahd Jr. MD, FACEP - Emergency Medicine
John Pope MD - Pediatrics
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine