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Decode Your Child’s Cough

It’s always distressing to hear your child cough, especially in the middle of the night. Still, as common as this symptom is, it’s helpful to know that a cough often sounds worse than it actually is.

“Coughing is the body’s way of clearing and protecting the airways from irritating mucous and other secretions,” says Dr. Charles Shubin, MD, director of the Children’s Health Center at Mercy Family Care in Baltimore, Maryland. Coughs also provide valuable clues about your child’s illness. Follow our guide to figure out what’s worrisome and what’s not—and help your child feel better fast.

Asthma

Cough Clues: A persistent cough that’s often whistling or wheezy, lasts longer than 10 days, and worsens at night or after your child exercises or is exposed to pollen, cold air, animal dander, dust mites, or smoke.

Other Symptoms: Your child is wheezing or has labored, rapid breathing.

Likely Culprit: Asthma, a chronic condition in which small airways in the lungs swell, narrow, become clogged with mucous, and spasm, making breathing difficult. Common asthma triggers include environmental irritants, viral infections, and exercise.

“Children with asthma, in essence, have sensitive lungs,” says pediatrician Dr. Mark Widome, MD, author of Ask Dr. Mark.

What to Do: In mild asthma cases, a chronic cough may be the only symptom, Dr. Widome says. Have a doctor examine your child for an accurate diagnosis. Mention any family history of allergies, asthma, or eczema, which can increase your child’s likelihood of the disease.

Bronchiolitis

Cough Clues: A phlegmy or wheezy cough that’s often accompanied by fast, shallow, or difficult breathing.

Other Symptoms: Your child starts out with cold symptoms, such as sneezing or a stuffy nose, that last about a week. He may develop a fever up to 103 degrees. He’s lethargic and makes a wheezing sound when he exhales.

Likely Culprit: Bronchiolitis, an infection of the tiny lower airways in the lungs called bronchioles. It’s usually caused by respiratory syncytial virus (RSV) and most often occurs from late fall to early spring. Not to be confused with bronchitis (a frequent upper-respiratory infection in older kids and adults), bronchiolitis is common among babies and toddlers.

“Almost all kids will get a bout of it by age three,” says Dr. Susanna McColley, MD, division head of pulmonary medicine at Children’s Memorial Hospital, in Chicago, Illinois.

What to Do: Call your pediatrician right away if your little one seems to be struggling to breathe or is too irritable to eat or drink. Infants with bronchiolitis sometimes need to be hospitalized to receive oxygen treatment. If your child’s symptoms are mild (a wheezy cough without breathing trouble), put a cool-mist humidifier in his room to help loosen mucous in his lungs, and make sure he drinks plenty of fluids.

The Common Cold

Cough Clues: A wet cough without wheezing or fast breathing, day or night.

Other Symptoms: Sneezing, a runny nose, watery eyes, and a mild fever (usually less than 101.5 degrees Fahrenheit).

Likely Culprit: The common cold, a viral infection of the nose, sinuses, throat, and large airways of the lungs. Coughing usually lasts the entire length of the cold (about seven to 10 days) but can linger twice as long, with mild improvement each day.

What to Do: Keep nasal passages as clear as possible; congestion and postnasal drip worsen this cough. For babies and toddlers who can’t blow their noses, use nasal saline drops and a bulb aspirator to suction a runny nose.

An over-the-counter nasal decongestant may help kids older than two; ask your pediatrician for her recommendation. If your child’s cough and stuffy nose persist for more than 10 days without improving, return to the doctor. Your child could have sinusitis (a bacterial infection that’s often brought on by a cold) or another problem such as asthma, allergies, or even enlarged adenoids, which inhibit breathing.

Croup

Cough Clues: A distinctive, shrill, dry, seal-like bark, which frequently starts in the middle of the night. “The sound is unlike any cough you’ve ever heard before,” says Dr. Widome.

Other Symptoms: Your child’s illness follows a circadian rhythm: better during the day, worse at night. She may also have a slight fever. In severe cases, your child may develop stridor, a harsh, high-pitched sound every time she inhales—similar to the noise kids make after a long crying jag.

Likely Culprit: Croup, a contagious viral infection that causes the throat and windpipe to swell and narrow. It typically affects kids between six months and three years. (Adults and older children have wider windpipes, so swelling is less likely to affect breathing.)

What to Do: Sit with your child in a steamy bathroom for five minutes; the humidity will help move mucous from her lungs and calm her cough. At night, if the temperature is chilly, bundle her up in warm pajamas but don’t be afraid to open her bedroom window and run a humidifier in the room; the cold, moist air may reduce airway swelling. Call your doctor right away if the cough worsens or she’s having trouble breathing. She may need medicine to reduce inflammation. Otherwise, croup often runs its course in three to four days.

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