How to Treat Coughs in Kids

A pediatrician explains what causes coughs, how long they can persist, and when parents should be concerned.

For parents and caregivers, winter can feel like a never-ending stretch of coughing and sniffles. During cold and flu season, children can have as many as seven to 10 respiratory infections and spend up to 140 days with a symptom related to a cold, says Dr. Melanie Wilson-Taylor, a pediatrician at NewYork-Presbyterian Komansky Children’s Hospital.

Among the most nagging symptoms of a respiratory virus is a cough. “We are seeing quite a bit of coughs right now, and cases will likely continue to rise for the next few weeks,” says Dr. Wilson-Taylor. “Many of the coughs are caused by colds. But we always tease out the different kinds of coughs and figure out if there’s something more serious happening versus just recurrent viral infections.”

Health Matters spoke to Dr. Wilson-Taylor about what causes a cough, how long they can last, and when to worry.

Dr. Melanie Wilson-Taylor

What is a cough?
A cough is usually a reflex response to an irritant — from a virus, to pollen, to cigarette smoke. Coughs are a way for the body to protect itself. They prevent irritants from getting deep into the lungs and help open our airways to exchange oxygen and carbon dioxide. For example, if you swallow water the wrong way, you’re going to cough it up.

How do you diagnose what’s causing the cough?
First, we ask some basic questions. How long has the cough been happening and how often? What triggers it? Does the cough last just a couple of seconds or does it take minutes to recover? What makes it better? All of the information gives us hints to determine the cause of the cough.

With technology available, I also encourage parents to record the cough. Bringing a recording to your physician  or the emergency department is very helpful, so we can observe any concerning signs of respiratory distress based on what we’re seeing on the video or hear on an audio recording.

Then we do a physical exam with a stethoscope to listen for sounds in the chest wall, neck, or the nose. This helps differentiate the cough between an upper respiratory cause versus a lower respiratory condition.

Some causes of cough can be detected with specific tests. Certain conditions like COVID, the flu, RSV, or strep can be checked in the office or emergency room if there is a high likelihood of these illnesses. Other conditions, like asthma, may require special exams like a pulmonary function tests.

How long do coughs usually last?
It depends on what’s causing of the cough. Most colds take three to five days to peak, but the symptoms can last up to two weeks — so coughing for 10 to 14 days for a common cold is not unusual, especially in pediatrics.

With other conditions, like pneumonia, the cough may last a month after the main part of the illness is over. If the cough is lasting beyond the expected time, your provider may ask the child to come in more often to be monitored.

How long is a child contagious?
It depends on the virus. In most cases, the first five to seven days of a cold is when your child is contagious. Fever can be an indicator of the contagious period. The likelihood of spreading the virus decreases after a week. Your doctor can give specific advice based on the virus.

When should children see a doctor about a cough?
We always think about whether the cough interferes with daily activity.  So for children, daily activity means going to school, sleeping, playing, or eating. If it interferes with any of those, that is a reason to see a physician. If the child has a cough and a fever that lasts more than five days, then those are signs to see a doctor too.

Another concern is respiratory distress. If the cough causes your child to breath faster than normal, or parents are noticing the breathing is visible underneath the rib cage or in the neck bone, or the nostrils are flaring to breathe — those are signs that the body is working too hard. Many children can breathe 30 breaths per minute. For an adult, that would be way too fast. The older you are, the slower your normal breathing rate is. So if a child is breathing faster than normal, that would be reason to seek medical attention.

Causes of Coughs

There are many viruses that cause the “common cold.” Depending on the age of the child, certain viruses can cause more symptoms and respiratory distress. For mild colds, symptoms might only include a runny nose and mild cough. Some viruses cause worse symptoms at night, when a child is lying flat causing the secretions go to the back of the throat and cause irritation.

COVID, flu, and RSV can cause coughs that lead to the lower airway becoming narrow and inflamed. These symptoms may last longer than a common cold and can cause significant respiratory distress. Infants, especially those born premature or have an underlying respiratory or cardiac illness, may require hospitalization. “For the youngest children, RSV and flu are significantly more problematic, and so I highly recommend vaccines for RSV, flu, and COVID,” says Dr. Wilson-Taylor.

Croup is an upper airway infection that causes a cough that sounds barky, like a dog or a seal. It often happens in the middle of the night and is more common in younger children. “If the cough is waking up a child from sleep or happening at rest, that’s more concerning — versus a child who, for example, is crying and crying, has a bit of a barking cough, and the cough resolves once they calm down,” says Dr. Wilson-Taylor. Moderate to severe croup requires medication like oral steroids and racemic epinephrine and close observation by a medical team in the emergency room or hospital.

Asthma is caused by narrow lower airways and mucous in the lungs. There are a number of triggers, including viral respiratory infections, cigarette smoke, and allergens, like pollen or perfume, that can cause a wheeze. If a child is wheezing (whistling sound when breathing out) or coughing so much that they can’t speak in full sentences, it might be asthma. Speak to a pediatrician early to prevent worsening wheeze because medications are required to treat it.

Whooping cough
Whooping cough, also known as pertussis or the 100-day cough, is a highly contagious respiratory infection that causes a deep, heavy cough. “Kids may cough for minutes at a time, and when they end the cough, they make a whooping sound,” says Dr. Wilson-Taylor. The pertussis vaccine protects against whooping cough, but younger children who may not have had their full vaccination series are at highest risk. Says Dr. Wilson-Taylor: “It can be very alarming, and very dangerous for infants.”

Are there prescription medications for coughs?
If the cough is from a bacterial illness, such as an ear infection, pneumonia or sinusitis, then an antibiotic would be helpful. If there’s a concern for asthma, a bronchodilator or albuterol may be prescribed. Most coughs from a regular cold will go away on their own without medication.

Do you recommend cough suppressants?
Most medications listed as cough suppressants are not proven by scientific research to work. It’s important to look at the ingredients and be really careful, especially with young children. For example, some cough suppressants contain acetaminophen, which is a fever reducer, so you don’t want to use it with other products that have acetaminophen because it could cause an overdose. Medications that contain pseudoephedrine should never be used in children under six years of age.

Oftentimes as pediatricians we think about, is there a potential for harm versus benefit? If a cough medicine that is not prescribed by a doctor has a potential for harm, then it should never be used. Also always discuss all medications with your provider first — even over-the-counter medicine.

Does honey help a cough?
Honey helps to soothe some of the irritation in the back of the throat. But it should never be given to children less than 1 year because of the risk of botulism. Botulism is a caused by a spore that can be found in honey and can cause nerve issues, paralysis, difficulty breathing, and even death in young children. It is rare, but parents should be aware of the risk for young children.

Are there other home remedies you recommend?
Simple things like using a humidifier or bringing your child into a steamy bathroom can be helpful to ease congestion. Nasal saline can also relieve some of the mucus and make it easier for a little kid to breathe. Vapor rubs can also have some benefit for coughs. Just be mindful of the ingredients. If it contains menthol, is should never be used on small children because it can cause irritation to the eyes, skin, and lungs.

Drinking fluids is also very important. Kids are losing a lot of fluids just from breathing fast, and small children are at risk of dehydration much faster than adults.

How does cold air affect coughs?
Cold air can sometimes help ease constriction of the airways. For a child with croup, it is not uncommon to have a cough at home and while going to the doctor’s office or emergency department in the cold air the cough disappears. Often, by the time parents show up at the hospital, their child is no longer coughing. The parents are saying, “I swear it happened at home.” And an hour later the cough might return.

Are there ways to prevent coughs?
In general, a healthy diet and plenty of sleep are the most helpful. Vitamin C can sometimes provide a temporary boost to the immune system, but it’s not recommended for all children, and you should talk to the pediatrician first.

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