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If you look down my schedule in the winter time, the most common complaints you will see are fever and cough. I have already addressed fever, so now it’s time to address coughs. So many things can cause a cough. Just discussing the common causes will be a long post, but here it is!

Children get many illnesses in the winter that cause a cough. Parents often worry that the cough is a sign of something ominous. Furthermore, coughs last so long that they are often distressing to both the child and the parent, as well as the teacher, classmates, friend’s parents…etc. This post will breakdown the common causes of coughs, how to help your child and when you should worry.

What is a cough?

Coughing occurs when something other than air gets into the airway below the vocal cords. The upper airway starts at the back of the nose and moves down to the vocal cords. The lower airway includes the trachea, the right and left bronchus which leads to each lung, the small tubes of the lungs called bronchioles, and the air sacks. Because the airway prefers air instead of anything else (like mucous), as soon as something gets into the lower airway, it is quickly expelled. (Take a look at this animated video showing how a cough occurs in the body.) Therefore, coughs can occur due to any foreign object anywhere along the airway. Coughs in children are most commonly due to post nasal drip. Mucous drains from the upper airway into the lower airway. However, some coughs originate in the lower airway and it’s important to differentiate.

What causes a cough?

The list of what causes a cough is a mile long and would take many posts to cover. For the purpose of this post, I am going to cover the common infectious causes that we see in children. A careful history and physical exam usually lets the doctor know what the cause may be. Sometimes an xray may be needed. It is very helpful for the parent to be able to describe the cough. Here is a description of some different cough sounds.

Common Cold: Colds are viral illnesses that cause mucous production in the upper airway. The cough occurs from post nasal drip of the mucous. They last about 10 days but the cough may linger beyond that.
Viral cough: This is similar to a cold but the lower airway is infected by the virus. This means patients will not have the typical runny nose or congestion that occurs with a cold. Again, this cough can last for weeks.
Influenza: The flu is a severe viral infection that causes fever, body aches, fatigue, headache, sore throat and cough. There is usually less mucous production in the upper airway with the flu compared to a cold. Also, the fever is usually higher compared to the common cold.
Pneumonia: This is probably what parents worry about the most. Pneumonia is not usually present at the start of a cough or cold as it is frequently a secondary infection to the cold virus. This is because the sticky environment that the cold virus creates is a perfect home for bacteria. The infection, and pus it creates, fills the air sacks, making it hard to breathe and causing a high fever. If your child has any difficulty breathing, seek medical care right away. Pneumonia is also caused by viruses so not all pneumonia infections require antibiotics. Furthermore, older kids and teens can get walking pneumonia which is caused by the bacteria Mycoplasma. Your child’s doctor may want a chest x-ray to determine if your child has pneumonia and what type they may have.
Bronchiolitis: Caused by RSV, bronchiolitis is an infection of the bronchioles, or small tubes in the lungs. The extreme amount of mucous production plugs the airway causing cough, distress with breathing and sometimes wheezing. RSV is more severe for young babies so please take your child to the doctor right away if you suspect it.
Croup: Croup is a viral illness that causes swelling in the upper airway. The cough is described as barky and some children will make a sound when breathing in known as stridor. Placing the child in a steamy bathroom or going out into the cool night air can calm a croupy cough.
Sinusitis: The diagnosis of sinusitis is made after a cold and cough have been present for at least 10-14 days. The diagnosis is not made for a child that has a dry lingering cough that is gradually getting better, which is the typical pattern. The diagnosis should be made in the setting of continued congestion, worsening symptoms after 2 weeks, headache or face pain, and possibly new onset of fever. Even if your child has symptoms of sinusitis, it will often get better on its own, so there is not a rush to start antibiotics. However, it is a good idea to discuss treatment options with your child’s doctor.
Whooping cough: Sadly we still diagnose this dangerous vaccine-preventable infection that is caused by the bacteria Bordatella pertussis. The infection starts with mild cold symptoms but eventually progresses to a severe spasmodic cough. Young babies and children will create the classic whoop sound when breathing in following a coughing fit but older children may not. Furthermore, babies may stop breathing all together. Older children will cough so hard that they will throw up following the coughing fit. Unfortunately, whooping cough can be fatal at worst and cause 3 months of cough at best, so make sure your whole family is up to date on their whooping cough vaccines.
Bronchitis: Bronchitis is inflammation in the bronchus, or large tubes, of the lower airway. While it is a common diagnosis in adults, especially smokers, it is not common in young children. The symptoms typically overlap with either a cold or asthma. The most common cause of bronchitis is a viral infection so antibiotics are not indicated unless there is a secondary pneumonia that has developed.
Asthma: While asthma is not an infection and is going to require its own post, the most common trigger for asthma is a cold. Therefore, if you think your child is wheezing during their illness, it is best to see the doctor. Some chronic coughs may actually be cough-variant asthma even in the absence of wheezing so this is something your doctor may consider if your child has a chronic cough lasting more than 4 weeks.

How should you treat a cough?

If your doctor has prescribed antibiotics for pneumonia, a sinus infection or whooping cough, give the whole course as prescribed. Because most causes of coughs are viral, there isn’t anything we can give to make it go away any faster and antibiotics are not appropriate. But there are things you can do to comfort your child and ease their symptoms.

  1. Clear the airway by using saline in the nose
  2. Keep secretions looser by maintaining good hydration
  3. Soothe the throat with warm fluids and honey (only over 1 year of age)
  4. Use cough drops for children over 4 years old
  5. Use steam or a humidifier to keep the nasal passages from clogging up
  6. Avoid smoke exposure
  7. Only give decongestants or cough suppressant medications to children over age 6 and only give if it seems to temporarily help the symptoms

When is it time to worry?

As already mentioned above, if your child is coughing longer than 10 days, has any distress with breathing or chest pain, seek medical care. Watch for rapid breathing, retractions (when the muscles sink between the ribs) and extra labor with breathing. Listen for sounds with breathing like stridor (whistle sound with inspiration) or wheezing (whistle sound with expiration). Sometimes parents hear a whistling sound that they think is wheezing but is actually from breathing through a blocked nose. Also, parents often worry in a small child that they can feel a rattle in the chest. This is the child breathing through mucous that is most likely in the upper airway. When in doubt, take your child to see the doctor and if your child is getting tired from breathing, can’t seem to catch their breath or looks blue around the lips, call 911.

Overall, if your child is coughing but is not having any difficulty breathing and has had a normal exam by the doctor, don’t worry. It is likely to pass. However, if things get worse or the breathing looks labored, seek medical care.

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Showing 28 comments
  • Shelia Larkin

    My granddaughter has asthma hadn’t been to long got sick with a cold triggered her asthma now she’s coughing bad again to where she throws up some time and has been running fever the highest was 103 I’ve been giving her prescription cough medicine benadryl and Tylenol and Motrin her nose started to run and also her eyes but she’s still coughing and breathing hard when she’s sleep

    • levans

      Hello Shelia, I sincerely hope that you took your granddaughter to see her pediatrician or to an urgent care location. We can’t always respond here as quickly as we’d like, nor can we give you medical advice online. We sure hope that she’s feeling better soon.

  • Elizabeth

    My 3 year old was diagnosed with a sinus infection after months of coughing with wheezing he is currently on day 3 of antibiotics and still requires albuterol and budesonide morning and night. How long does it take for the wheezing to get better. Specialist said it’s post nasal drip triggering asthma from the sinuses. Have you all heard of this or similar situations

    • Jaime Friedman, MD

      Hi Elizabeth. Sorry for the late reply. Asthma adds a whole new level of complexity when treating coughs and every patient is different. I hope your child is feeling better and always call the doctor back or ask for a second opinion if you have questions.

  • Mrs Richardson

    Sheila Larkin , did you get a diagnosis? My 4 year old symptoms are exactly the same. I have gotten several different diagnosis. I am curious to get other feedback.

  • Marilyn

    My 3 yr old granddaughter has been coughing for weeks and hardly ever has socks nor a jacket it’s been 40 to 60 degrees with the Texas weather constantly changing
    She bows throws up her food because of the cough
    Plz help?
    Her mother has not taking her to the doctors and the older two 5 & 6 yr old have a pretty bad cough as well

    • levans

      Hello Marilyn, sorry for the delayed response. I hope your granddaughter is getting the medical attention it sounds like she needs. Please encourage her parents to take her to her pediatrician.

  • linda esquivel

    My son is 5 years old and has been having a cough on and off but when he gets it he can last up to 2-3 hours non stop coughing I don’t hear any noice on he’s chest and I took him to his doctor and they say it’s normal. And that he will get thru it but then two weeks later it comes back. Has anyone gone thru this situation. I really don’t know what to do anymore.

    • levans

      Hi Linda
      I recommend having your son rechecked. Don’t forget to ask about a whooping cough test!
      Dr. Friedman

  • Mary c

    I took my daughter to a clinic and they said she had an ear infection and bronchitis. That was around 3 weeks ago. She recieved antibiotics and has had no fever or symptoms except for coughing. She mostly coughs at night and morning but sometimes more. Shell wake up coughing and sometimes it will a few minutes. If i give her honey it usually stops. I need to make her an appointment but Im still worried is this unusual after bronchitis? Should her cough be gone? She has a good appetite and alot of energy no fever. Please help.

    • levans

      Hi Mary
      It is not unusual for coughs to linger for a long time. I’m glad you took her back in to be checked and I hope she is feeling better.
      Dr. Friedman

  • Carrie

    Hello!! You’re post was very helpful and informative! My 7 year old daughter has been coughing for 2-3 weeks now… it’s a mucousy cough (you can really tell it isn’t a dry cough).. she will NOT blow her nose, I’ve tried to show her how and explain how helpful it could be but she just CANT seem to do it! Could that prolong her cough?? Since she is basically swallowing her nose drainage? She has no other symptoms aside from her super stuffy nose. Should I be worried??? What can I do to help??

    • levans

      Hi Carrie
      I would have your daughter checked by the doctor. It is ok though that she swallows her mucous. It will not prolong the cough.
      Dr. Friedman

  • Kelli Hyatt

    Hi, I am kind of at a loss here…this is by far the longest BOTH of my kids have been sick…it’s been 7 days and they have both had continuous fevers, stuffy noses, and now their coughs are absolutely HORRIBLE..and their chest hurts… my question to you is I just started them both on antibiotics. Was that the wrong move?

    • levans

      Hi Kelli,
      Please have them checked by the doctor.
      Thank you
      Dr. Friedman

  • Sarah E Meagher

    My 5-year-old daughter has what I am guessing is a post nasal drip cough. there are no other symptoms. Some sneezing, but that has been in. This has been going on and off most of the month. I say its postnasal drip as it seems to switch from a wet cough (at night in her room with a humidifier) to a dry cough during the day no as many humidifiers. Last night when got home from school it was bad when she was laying flat, but improved when we propped her head. Today I got her from school (early release) and she hasn’t stopped coughing. I set up an aromatherapy thing up without oils in the living room where she is hanging out and gave her some musinex with a decongestant that says it is safe for ages 4 and above, she is drinking water when she coughs as well. As far as I know she no fever, but I do think a cough is tiring her out. She also seems to be losing her voice a bit. I am a loss like Kelli above. I don’t know if I should try to get her to a doctor or just try to treat at home. I am not that concerned She some dental surgery last week and they listened to her lungs and her lungs were clear. But at times when she coughs, it sounds like she can’t catch her breath. Our house is very dusty and dirty, could this be allergies?

  • Aga

    My son got sick with the flu few days ago . Fever went away after two days and he seemed fine besides the fact that he’s got very dry asthmatic cough. There is no mucus whatsoever but every time he’s trying to take a deeper breath starting to cough uncontrollably even talking irritates his throat and makes him cough to the point that is difficult for him to catch a breath . I do give him some breathing treatments with albuterol but it doesn’t seem to work I would even say that it makes it worse . What Else can I do ?

  • Aga

    My 11 years old son got sick with the flu few days ago . Fever went away after two days and he seemed fine besides the fact that he’s got very dry asthmatic cough. There is no mucus whatsoever but every time he’s trying to take a deeper breath starting to cough uncontrollably . Sometimes he’s got difficulty talking because he cannot take a breath . I do give him some breathing treatments with albuterol but it doesn’t seem to work I would even say that it makes it worse . What Else can I do ?

  • Alicia

    Hello my 5 year old son has had a dry cough for a month and half now. They said it was a viral, and he would get over it. I was worried he had asthma. Because he has allergies and exama. He has had a fever on and off as well as throwing up..im so worried about him. I have tooken him to the doctors at least 5 times in a month and half. I have not had him checked for wooping cough yet..but im sure he had the vaccine.

  • Shweta

    Hello Dr., my daughter is 4 years old and it’s been more than a week she is coughing with stuffy nose…no others symptoms…any advice

  • Geneva Salley

    My three year old has a bad cough for about a week now and she cough to the point she throws up she won’t eat and half drink . she sleeps more then anything

  • Liz

    Our 5 yesr old started with bad coughs that lasted weeks when she was 3 years old. She ended up having cough variant asthma triggered by colds and allergies. We recently removed our carpets and her allergic coughing ceased!

  • Mecca

    My 6year old son has allergies asthma and lately he’s been non stop coughing. We taken him to the dr and prescribed with inhaler but he coughs alot still, not sure what to do.

  • Missy

    My four year old just started with a runny noise and cough. The drainage is clear and when she blows her noise there is not much to it. We are on day two and she is now having a hard time sleeping because of this cough. My concern is that this could be an allergic reaction to a puppy we just got but don’t know for sure. Should we wait it out the ten days or get her tested? My husband has allergies and so does my oldest son.

  • Brittany Scarberry

    I too my child to the doctor on the 31st over a cough that sounded like a bark. She gave her antibiotics to help clear that up, but now starting last night she coughed none stop . She’s acting normal . Trying to talk when she’s not coughing but it’s consistent. I’ve gave her what I could and did a warm bath nothings helping.

  • Denise

    Hello, I recently took my 10 month old to the ER and they diagnosed her with upper respiratory infection and pneumonia. They took x Rays and a flu swab that came out negative. They prescribed me Amoxicillin for 10 days. That didn’t sit well with me so I made an appointment with her pediatrician. When I went in they had me stop giving her the medication and told me she just had the infection and it would heal on it’s own. They said it was early signs of pneumonia. My question to you is you think because I didn’t finish giving my baby the antibiotics it may come back or worsen? She doesn’t cough much anymore she just has mucus? Thank U.

  • Shpresa

    Hi my daughter turns 3 on February and she got this chough going on from beginning of November to now still choughin at nap time during dhe day and nights also early in the morning it gets her a lot ,through the day not as much she sometimes has like white mucus with bubbles coming out when choughing also I clean her nose with nose spray but nothing comes out and when she breath it sounds stuffy took her to her dr 100 times she says it’s cold it’s normal children get sick it is just worrying me dont know if it’s normal to be choughing for this long she also lost appetite quit a lot but still eats what ever she feels comfortable I guess,she drinks plenty water,no fever so far ,she gets all sweat at night around her shoulder and neck even if it’s not that warm inside what would u suggest in this case. Thank you so much

  • Ranjit kaur

    Hi it’s been week my 8 months son having cough what should I do he’s not having problem with breathing he has runny nose too respiration 30 per minutes should I take him to doctor thank you.