Cough
There are so many types of coughs in kids. I try to separate coughs into categories by the age of the kiddo and whether it is an acute or chronic cough.
Acute Cough in Babies
The most common cause of acute cough in babies is accidentally having the milk go down the wrong tube and baby needing to cough or gag it up. This type of coughing is infrequent but can be quite dramatic and end with a huge amount of spit-up. But just as quick as it came, it should stop just as quickly after the coughing dispels the liquid from the airway. Make sure to have baby in an upright position if they are coughing to prevent more milk from going down the airway.
Another cause of new-onset coughing in a baby is a viral upper respiratory infection. With their smaller airways and even smaller (nonexistent) sinuses, they make a lot of mucus that will just drip drip drip all day and night to the back of their throat, setting up a cough that is focused on clearing the mucus from their throat. The more that baby is propped up, the easier it is to cough up mucus while at the same time preventing the perfect architecture needed to get that post drip going to the back of the throat in the first place. Another way to decrease the postnasal drip is to use a nasal sucker like the NoseFrida or a bulb syringe every now and then to help suck out mucus that would otherwise be going to the back of the throat to cause a cough.
Coughs that worry me:
Any cough with a fever when the baby is under 2 months of age
Associated with increased work of breathing
Prolonged fast breathing even when not coughing
Coughing so much that they are not able to feed well and stay hydrated
Those are all things that the pediatrician needs to be made aware of.
Long-Lasting Cough in Babies
Because a baby has little to no sinuses, they can have a residual postnasal drip from a cough and cold for 2-4 weeks after the initial illness started. Super crummy, but okay. Baby should be otherwise happy and acting normally in between the coughs with normal feeds and a pretty much normal sleeping pattern; however, if the coughing is consistent and not associated with a recent viral illness, the pediatrician will want to take a look at baby to make sure everything is okay in the lungs and maybe discuss possible reflux that can cause upper throat irritation leading to a chronic cough.
Acute Cough in Older Kids
Coughing in older kids with a sudden onset is usually a new viral upper respiratory infection. The cough will start as not super productive and then get more so as the cold virus starts having the body make lots of mucus that will start dripping from the nose to the back of the throat. It is not unusual to see fevers during the first 24-72 hours of a viral cold. If the cough worsens with worsening fevers or new fevers after 72 hours of symptoms, that kiddo should be seen in the pediatrician’s office to make sure we don’t have a bacterial pneumonia or sinusitis going on that may respond to antibiotics. During the coughing episodes, a kiddo can get a little winded, but if the kiddo is always short of breath or wheezing, they need to be seen by the pediatrician to look for signs of asthma as well.
For the run-of-the-mill colds with cough, try to have your kiddo sip on warm apple juice throughout the day to help protect the throat and break up mucus better than Mucinex. Try to keep them as upright as possible throughout the day and while sleeping. If they let you, put some nasal saline spray in their nose every few hours; that can also help decrease congestion like if you go to the beach and dunk your head in the ocean when you are congested and everything opens up for a few minutes. It is the same effect with nasal saline without the sand everywhere.
Chronic Cough in Older Kids
If we have an older kid above age 6 or 7 years, meaning they have sinuses to hold extra mucus, who is still coughing for a few weeks to months, this puts them in the category of chronic cough. The three biggest culprits of chronic cough in older kids are having back-to-back viral upper respiratory infections, allergies, and asthma. If the coughing is raspy and wheezy and mainly occurs at night or around certain activities such as playing sports or being out in the cold, the kiddo should be seen for an asthma evaluation with the pediatrician. If the cough is a hacking, throat-clearing cough with chronic nasal congestion, that’s allergic rhinitis or nasal allergies until proven otherwise. We will often trial a child on an allergy nasal spray or oral allergy medicine to see if the symptoms improve quickly before referring to a pediatric allergist for testing for possible environmental allergens and triggers.
Of course, if the cough is lasting a long time and there are fevers, chest pain, shortness of breath, or labored breathing associated with it, that kiddo needs an urgent clinic or emergency department visit to rule out pneumonia or other concerning lung problems.