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 certain traits you can learn to recognize. A cough is only a symptom, not a disease. Often, you can't tell how serious the problem is until you also look at your child's other symptoms.
Productive coughs
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 it may have come up from the lungs. In most cases, you shouldn't suppress a productive cough. The cough clears mucus from the lungs. There are many causes of a productive cough, such as:
Viral illnesses. It's normal to have a productive cough with the 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.
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 their throat often. Experts disagree about whether the postnasal drip or the viral illness that caused it is causing the cough.
Nonproductive coughs
A nonproductive cough is dry. It doesn't produce sputum. A dry, hacking cough may occur 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. They include:
Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms. It often gets worse at night.
Bronchospasm. A nonproductive cough, particularly at night, may mean spasms in the bronchial tubes 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.
Blockage of the airway by an inhaled object, such as food or a pill.
Coughs that affect children
Children may have coughs from diseases or causes that usually don't affect adults, such as:
Blockage of the airway by an inhaled object, such as food, a piece of a balloon, or a small toy.
Exposure to secondhand smoke from parents or caregivers who smoke.
Emotional or psychological problems. A dry, nonproductive "psychogenic cough" is seen more often in children than in adults.
Antibiotic use
Many coughs are caused by a viral illness. Antibiotics aren't used to treat viral illnesses. They don't change the course of viral infections. Using an antibiotic when it's not needed 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 helpful bacteria and encourage the growth of dangerous antibiotic-resistant bacteria.
Check Your Symptoms
Does your child have a cough?
Yes
Cough
No
Cough
How old are you?
Less than 3 months
Less than 3 months
3 to 11 months
3 to 11 months
12 months to less than 3 years
12 months to less than 3 years
3 to 11 years
3 to 11 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
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.
Has your child had surgery in the past 2 weeks?
Surgery can cause problems that make your child cough.
Yes
Surgery within past 2 weeks
No
Surgery within past 2 weeks
Does your baby seem sick?
A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.
Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don't know the rectal temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.
Yes
Rectal temperature taken
No
Rectal temperature taken
Is it 100.4°F (38°C) or higher?
Yes
Temperature at least 100.4°F (38°C)
No
Temperature at least 100.4°F (38°C)
When your child is coughing, does his or her face turn blue or purple?
Yes
Color changes to blue or purple when coughing
No
Color changes to blue or purple when coughing
Is your baby eating less than usual?
Yes
Change in eating habits
No
Change in eating habits
Has your baby had a cough for more than 1 full day (24 hours)?
NOTE: Most people have an average body temperature of about 98.6°F (37°C). But it can vary by a degree or more and still be considered normal. If a low body temperature is your only symptom, it’s usually not something to worry about. But be sure to watch for other symptoms.
High: 104°F (40°C) or higher, oral
High fever: 104°F (40°C) or higher, oral
Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Does your child have shaking chills or very heavy sweating?
Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.
Yes
Shaking chills or heavy sweating
No
Shaking chills or heavy sweating
Did the cough start after a recent choking episode?
The cough could mean that something is still stuck in the throat.
Yes
Choking episode
No
Choking episode
Is your child coughing up mucus, phlegm (say "flem"), or blood from the lungs?
This is called a productive cough. Mucus or blood draining down the throat from the nose because of a cold, a nosebleed, or allergies is not the same thing.
Yes
Coughing up sputum or blood
No
Coughing up sputum or blood
Is your child coughing up blood?
Yes
Coughing up blood
No
Coughing up blood
How much blood is there?
Thin streaks of blood
Streaks
More than just streaks
More than streaks
Has this been going on for more than 2 days?
Yes
Coughing up mucus for more than 2 days
No
Coughing up mucus for more than 2 days
Has the coughing been so bad that it has made your child vomit?
Yes
Vomiting after coughing spasm
No
Vomiting after coughing spasm
Has your child had a cough for more than 2 weeks?
Yes
Cough for more than 2 weeks
No
Cough for more than 2 weeks
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, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or 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.
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. Don't try to stop a productive cough. Sometimes, though, coughs are severe enough to impair breathing or prevent rest. Here are some things you can do at home to help your child feel more comfortable when they have a cough.
Fluids may help soothe an irritated throat. Honey or lemon juice in warm water or tea may help a dry, hacking cough. But don't give honey to children younger than 1 year of age. It may contain bacteria that are harmful to babies.
Gargle.
Children who can gargle can try gargling with warm salt water to help ease a sore throat caused by coughing.
Try moist air.
Try a cool-mist vaporizer or humidifier to add moisture to the room. Warm or cool mist may help relieve symptoms. Follow all cleaning instructions and precautions for the machine.
Be careful with cough and cold medicines.
Don't give them to children younger than 6. 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.
Follow directions. How much medicine to take and how often to take it may be very different for children than for adults. Always follow the directions about how much to use based on age and, in some cases, weight.
Don't give your child leftover antibiotics, or antibiotics or medicines that were prescribed for someone else.
Take special care with a barking cough.
Try to stay calm and soothe your child. Your child's crying can make the swelling in the windpipe worse and make it even harder to breathe.
Give your child a hug or offer a favorite toy.
If symptoms improve with these methods, put your child back in bed. If the symptoms happen during the middle of the night, it's a good idea to sleep in or near your child's room until morning.
Be sure to keep your child well hydrated. Offer water, flavored ice pops (such as Popsicles), or crushed ice drinks several times each hour.
Do not let anyone smoke around your child or in the house.
Do not give your child over-the-counter cough or cold medicines. They don't help with croup, and they may not be safe for young children.
When to call for help during self-care
Call a doctor if any of the following occur during self-care at home:
Author: Ignite Healthwise, LLC Staff Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
Clinical Review Board All Healthwise education is reviewed by a team that includes physicians, nurses, advanced practitioners, registered dieticians, and other healthcare professionals.
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