Dr. Sandro Cantoni. Updated: 27 July 2021
All children have coughs, and often colds, at different times of the year, especially when they go to daycare or school.
- Why does my baby or child have a cough?
- Upper airway infections.
- Lower respiratory tract infections.
- Asthmatic bronchitis or bronchospasm.
- Allergic bronchial asthma
- Inhaled foreign body.
- How do you treat cough in children?
- What can I do to make my baby feel better ?
- What medications can be used to calm a cough in children?
- Are cough syrups useful? Which ones and how to use them?
- When should I call the doctor if my child has a cough?
- When should I be worried, and call the doctor for an urgent visit or take the child to the emergency room ?
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Why does my baby or child have a cough?
Coughing is often very bothersome to the child, and to the family, but only rarely is it a sign of a serious illness.
The causes of coughing in children can be different. The most common are as follows.
Upper airway infections.
These are usually viral infections of the respiratory tract such as colds, pharyngitis, or laryngospasm (known as croup). The child often has a cold, with nasal discharge, sore throat and cough that will go away after a couple of weeks.
These infections are viral in origin, usually heal on their own, and therapy is used to relieve the symptoms.
Lower respiratory tract infections.
Other causes of coughing in children include bronchitis, bronchiolitis, or pneumonia.
In these diseases, which may be associated with an upper airway infection, the bronchi or lungs are affected.
The viral infection causes an irritation of the mucous membrane of the airways, which then produces more secretion, such as mucus or phlegm, which causes coughing.
Asthmatic bronchitis or bronchospasm.
Sometimes this irritation of the bronchi causes a narrowing of the airways, then the child has difficulty breathing and you may hear a wheezing sound while breathing.
This is called asthmatic bronchitis or bronchospasm or obstructive bronchitis, and the child should be taken to the pediatrician for an examination.
In the first two years of life, especially in the fall and winter months, coughing may be due to a viral infection of the small bronchi, called bronchiolitis.
Normally the child heals well on its own without the need for therapy, but sometimes, especially in infants who are only a few months old or have significant difficulty breathing, hospitalization is necessary.
In rare cases, the cause of the cough is a bacterial infection (such as pneumonia), which requires antibiotic therapy. In this case, the child usually also has a fever, often high, and is very tired. The child has difficulty breathing, or has rapid breathing.
Allergic bronchial asthma
In some cases, for example in the spring period and without fever, the conditions responsible for the cough in children are not infections, but something else, for example, an allergic bronchial asthma.
This condition usually appears in children 4-5 years and older, who may develop an allergy to graminaceous plants or dust mites.
Inhaled foreign body.
If your child suddenly starts coughing, he or she may have inhaled a foreign body, such as a small piece of toy, or food.
How do you treat cough in children?
Treatment obviously depends on the disease responsible for the cough.
In fact, the treatment is different if it is a pneumonia, in which antibiotics are needed, or another viral infection, in which they are useless.
In normal viral infections of the upper respiratory tract, the cough is treated symptomatically, to try to make the child feel better, especially if the cough disturbs him or her during the night.
What can I do to make my baby feel better ?
The most important thing to do is to keep your baby hydrated, to fluidify secretions.
For example, you can offer him liquids such as milk, broth or tea, fresh water or fruit juices.
Also, your child should avoid secondhand smoke as much as possible, otherwise the coughing will continue.
Basically, if one of you parents smokes, the ideal would be to do it outside, change all your clothes after smoking and don’t go near the child for at least an hour.
I know it’s hard, but otherwise the baby’s cough won’t go away.
If your child has a cold as well, nasal douches can help decrease the cough as well.
Humidify the environment.
Especially if your child coughs at night, you can soothe the cough by humidifying your child’s room with a cold humidifier. But be careful. If the humidifier is not cleaned well, following the manufacturer’s instructions, stagnant water can promote the development of bacteria and mold.
What medications can be used to calm a cough in children?
As we mentioned above, antibiotics are not needed for a cough, unless the child has a bacterial infection such as pneumonia.
Other medications that are not needed are corticosteroids, except in very special cases, such as coughing from asthma crisis or laryngospasm.
Also be careful not to use combination medications or syrups that contain, for example, acetaminophen and other substances such as an antihistamine.
These are not good because the two components have different indications.
It is also important to remember that paracetamol or ibuprofen are not useful for coughs, but only in case of high fever or pain.
Are cough syrups useful? Which ones and how to use them?
Medications to soothe coughs in children are not always helpful
and may also have side effects.
Beware of one thing. Some of these syrups contain paracetamol, and if they are taken together with tylenol for fever, there is a risk of overdose, with paracetamol poisoning, which can be very serious.
There are often other errors in administering over the counter cough syrups. For this reason they should always be taken after contacting the pediatrician.
Depending on the age of the child there are syrups or drops that can be used.
Babies under one year of age.
In babies under one year of age, no syrup can be used. The reason is that the side effects outweigh the benefits.
Balsamic ointments, which can irritate the child’s airways, should not be used either. But warm liquids can be administered to relieve the cough.
Above six months of age, a recipe that seems to have some effectiveness is a combination of apple juice and lemonade. One to three teaspoons (basically 5-15 ml) can be given four times a day.
Do not give honey to children under one year of age.In fact there is an increased risk of infant botulism, a rare but very serious disease.
Children over one year of age.
Above the age of one year there are syrups that can be used to try to calm coughs, especially at night. According to several scientific researches the most effective substance to relieve cough is honey.
So the syrups that I recommend are those with honey.
There are other cough syrups, but it is important to know that they do not have a proven effectiveness and often the effect is limited and transient.
Some syrups based on dextromethorphan or carbocysteine have some effectiveness. But before using them it is better to contact the pediatrician, because some are not approved in children under 3 years.
When should I call the doctor if my child has a cough?
If your child has any of the symptoms listed below, you should contact your doctor:
– while your child is breathing, you hear wheezing.
– complains of pain in the chest.
– seems to be struggling to breathe, or seems to be breathing faster than usual.
– has also had a fever for 2-3 days.
– very tired or agitated, or eats less than usual
– the cough lasts a long time, more than 2 weeks.
– the baby is less than 6 months old.
When should I be worried, and call the doctor for an urgent visit or take the child to the emergency room ?
In some cases, coughing can be a symptom of a major infection that requires prompt evaluation. For example, if:
– baby is less than 1 month old.
– If during breathing there are retractions of the skin within the spaces between the ribs, or if he opens his nostrils while breathing.
– If you think the baby has swallowed a foreign body (small parts of toys, pieces of food). For example, after a meal or while playing he suddenly starts coughing.
– If his lips turn blue while coughing.
In these cases, if you can’t contact your doctor, take your child to the hospital right away.
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Linjie Zhang, Nebulized Hypertonic Saline for Acute Bronchiolitis: A Systematic Review. Pediatrics. October 2015, VOLUME 136 / ISSUE 4
Wang GS, e al. Medication Errors from Over-the-Counter Cough and Cold Medications in Children. Acad Pediatr. 2019 Sep 25.