Cough

Is this your child's symptom?

• The sound made when the cough reflex clears the airway of irritants
• Most coughs are part of a cold
• A coughing fit or spell is over 5 minutes of nonstop coughing
• Coughs can be dry (no mucus) or wet (with white, yellow or green mucus)

Causes of Cough

• Common Cold. Most coughs are part of a cold that includes the lower airway. The medical name is viral bronchitis. The bronchi are the lower part of the airway that go to the lungs. Bronchitis in children is always caused by a virus. This includes cold viruses, influenza and croup. Bacteria do not cause bronchitis in healthy children.
• Sinus Infection. The exact mechanism of the cough is unknown. It may be that post-nasal drip irritates the lower throat. Or pressure within the sinus may trigger the cough reflex.
• Allergic Cough. Some children get a cough from breathing in an allergic substance. Examples are pollens or cats. Allergic coughs can be controlled with allergy medicines, such as Benadryl.
• Asthma. Asthma with wheezing is the most common cause of chronic coughs in children. In adults, it's smoking.
• Cough Variant Asthma. 25% of children with asthma only cough and never wheeze. The coughing spells have the same triggers as asthma attacks.
• Air Pollution Cough. Fumes of any kind can irritate the airway and cause a cough. Tobacco smoke is the most common example. Others are auto exhaust, smog and paint fumes.
• Exercise Induced Cough. Running will make most coughs worse. If the air is cold or polluted, coughing is even more likely.
• Serious Causes. Pneumonia, bronchiolitis, whooping cough and airway foreign object

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

• Struggling for each breath or shortness of breath
• Tight breathing so that your child can barely speak or cry
• Ribs are pulling in with each breath (called retractions)
• Breathing has become noisy (such as wheezes)
• Breathing is much faster than normal
• Lips or face turn a blue color

Phlegm or Sputum: What's Normal?

• Yellow or green phlegm is a normal part of the healing of viral bronchitis.
• This means the lining of the trachea (windpipe) was damaged by the virus. It's part of the phlegm your child coughs up.
• Bacteria do not cause bronchitis in healthy children. Antibiotics are not helpful for the yellow or green phlegm seen with colds.
• The main treatment of a cough with phlegm is to drink lots of fluids. Also, if the air is dry, using a humidifier will help. Sipping warm clear fluids will also help coughing fits.

Vaping Risks

• Talk with your child about the dangers of vaping.
• Vaping can cause severe lung injury. The lung damage can be permanent.
• Vaping can even cause death.
• Vaping tobacco also causes nicotine addiction.
• The legal age to purchase vaping products is 21 in the US.
• Encourage your teen to avoid vaping. If they have started, urge them to quit.
• Warning: never use home-made or street-purchased vaping solutions. Reason: they have caused most lung damage.

When to Call for Cough

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• Passed out or stopped breathing
• Lips or face are bluish when not coughing
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe.
• Lips or face have turned bluish during coughing
• Harsh sound with breathing in (called stridor)
• Wheezing (high-pitched purring or whistling sound when breathing out)
• Breathing is much faster than normal
• Can't take a deep breath because of chest pain
• Severe chest pain
• Coughed up blood
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• High-risk child (such as cystic fibrosis or other chronic lung disease)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Fever over 104° F (40° C)
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Nonstop coughing spells
• Age less than 6 months old
• Earache or ear drainage
• Sinus pain (not just congestion) around cheekbone or eyes
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• Chest pain even when not coughing
• Concerns about vaping
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Coughing causes vomiting 3 or more times
• Coughing has kept home from school for 3 or more days
• Allergy symptoms (such as runny nose and itchy eyes) also present
• Runny nose lasts more than 14 days
• Cough lasts more than 3 weeks
• You have other questions or concerns

Self Care at Home

• Cough with no other problems

Care Advice for Cough

1. What You Should Know About Coughs:
   • Most coughs are a normal part of a cold.
   • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
   • A cough can be a good thing. We don't want to fully turn off your child's ability to cough.
   • Here is some care advice that should help.
2. Homemade Cough Medicine:
   • Goal: decrease the irritation or tickle in the throat that causes a dry cough.
   • Age 6 months to 1 year: give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: use a dose of 1-2 teaspoons (5-10 mL). Give 4 times per day when coughing. Caution: do not use honey until 1 year old.
   • Age 1 year and older: use honey ½ to 1 teaspoon (2-5 mL) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup. You can also buy cough products that have honey in them at drug stores. They do not work better than plain honey and cost much more.
   • Age 6 years and older: use Cough Drops to decrease the tickle in the throat. If you don't have any, you can use hard candy. Avoid cough drops before 6 years. Reason: risk of choking.
3. Non-Prescription Cough Medicine (DM):
   • Non-prescription cough medicines are not advised. Reason: no proven benefit for children and not approved under 6 years old (FDA).
   • Honey has been shown to work better for coughs. Caution: do not use honey until 1 year old.
   • If age 6 years or older, you might decide to use a cough medicine. Choose one with dextromethorphan (DM), such as Robitussin Cough syrup. DM is present in most non-prescription cough syrups. Follow the instructions on the package.
   • When to Use: give only for severe coughs that interfere with sleep or school.
   • DM Dose: give every 6 to 8 hours as needed.
4. Coughing Fits or Spells - Warm Mist and Fluids:
   • Breathe warm mist, such as with shower running in a closed bathroom.
   • Give warm clear fluids to drink. Examples are apple juice and lemonade.
   • Age less than 6 months, only give breast milk or formula.
   • Age 6 - 12 months. Give 1-2 teaspoons (5-10 mL) each time. Limit to 4 times per day.
   • Age older than 1 year. Can also offer warm lemonade or herbal teas. Amount: a few ounces (30 mL) each time.
   • Reason: both relax the airway and loosen up any phlegm.
5. Vomiting from Hard Coughing:
   • For vomiting that occurs with hard coughing, give smaller amounts per feeding.
   • Also, feed more often.
   • Reason: vomiting from coughing is more common with a full stomach.
6. Encourage Fluids:
   • Try to get your child to drink lots of fluids.
   • Goal: keep your child well hydrated.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
   • It also will thin out the mucus discharge from the nose.
7. Humidifier:
   • If the air in your home is dry, use a humidifier. Reason: dry air makes coughs worse.
8. Fever Medicine:
   • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol).
   • Another choice is an ibuprofen product (such as Advil).
   • Note: fevers less than 102° F (39° C) are important for fighting infections.
   • For all fevers: keep your child well hydrated. Give lots of cold fluids.
9. Avoid Tobacco Smoke:
   • Tobacco smoke makes coughs much worse.
10. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of coughs and colds cannot be prevented.
11. Extra Advice- Allergy Medicine for Allergic Cough:
    • Allergy medicine can bring an allergic cough under control within 1 hour. The same is true for nasal allergy symptoms.
    • A short-acting allergy medicine (such as Benadryl) is helpful. No prescription is needed. Age limit: 1 and older.
    • Do not use Benadryl longer than a few days.
    • Switch to a long-acting antihistamine, such as Zyrtec. Age limit: 2 and older.
12. What to Expect:
    • Viral coughs most often last for 2 to 3 weeks.
    • Sometimes, your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow or green.
    • Antibiotics are not helpful.
13. Call Your Doctor If:
    • Trouble breathing occurs
    • Wheezing occurs
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.