Learn what different types of coughs mean

By Kristina Herndon, RN 

 Medically reviewed by Jonathan B. Jassey, DO

A toddler coughing at night is usually from a minor cause, such as a common cold. When laying down, drainage can run down the back of the throat causing them to cough.

But your child may have something that needs to be diagnosed and treated by a healthcare provider. And sometimes, you need to get them to the emergency room. The deciding factor is often the type of cough—frequent, persistent, dry, wet, barking, whooping, or more.

This article explains the most common types of childhood coughs. You'll also learn how to tell if your child's cough means you need to make an appointment with their pediatrician or go to the ER.

Frequent and Persistent Cough

A frequent, persistent cough in kids can be caused by something fairly simple, like throat irritation from mucus. However, a child's cough that doesn't go away can also be a sign that they're having breathing trouble.1

A kid who is coughing a lot may have asthma, a chronic condition where the airways of the lungs become inflamed and narrow. Your child's healthcare provider can diagnose the condition and recommend treatment, like an inhaler or nebulizer.

If your child's cough is frequent—more than every five minutes for more than two hours—call your pediatrician.

Short and Fast (Whooping) Cough

A child's cough that has a specific sound can be a symptom of an infection. Pertussis, commonly called whooping cough, causes a fast cough and a "whoop" sound when a child takes a breath.

People of any age can get whooping cough, but it is most serious for children younger than 1-year-old. Infants can die from whooping cough.

However, infants with pertussis do not always have a cough. Instead, they may briefly stop breathing (apnea) and their skin can turn blue (cyanosis).2

The best way to prevent whooping cough is to ensure your baby gets a pertussis vaccine. It is usually given as a combination vaccination called the DTaP, which includes protection against two other serious bacterial diseases: diphtheria and tetanus.

The combination vaccine can be given starting at 2 months old. Adults should get a booster (Tdap)—especially if they are pregnant or have young children at home.

Productive (Wet) Cough

A child's cough that's productive or "wet" brings up fluid like mucus. When your child coughs, you'll be able to hear the fluid moving in their airways. Usually, the fluid has drained from the head or is phlegm that's being made in the respiratory tract.

The common cold and the flu are common causes of wet coughs in kids. These illnesses are usually not serious, and your child can be cared for at home.

While having a productive cough is no fun, it has an important purpose: it helps clear the lungs and prevent infection. That's why healthcare providers don't usually recommend trying to suppress a child's cough unless it's making it hard for them to rest or breathe.

Is My Child's Cough COVID-19?

People with COVID-19 often have a dry (nonproductive) cough, but you can also have a wet cough from COVID.3 If your child has a cough and other COVID symptoms, or if they have been around someone who has COVID, they should be tested.

If your child's cough from COVID lasts longer than three weeks, call their pediatrician. If at any point your child's cough is so bad they can't breathe, take them to the ER.

Infection

Sometimes, a loud, wet cough is a warning sign that your child has an illness or condition that needs medical treatment.

If your child's cough is bringing up green or yellow mucus, and they have to sneeze or blow their nose a lot, they might have a sinus infection.

You'll want to take them to the pediatrician, as they might need antibiotics or allergy medication to help clear up the infection and ease their symptoms.

Pneumonia

You should also watch for signs of pneumonia, an infection caused by viruses or bacteria that get into the lungs and cause them to fill with fluid.

Even if you've already seen your child's healthcare provider about their cough, call them again if your child has:

• A cold lasts for more than a week

• A cough that's wet, loud, and phlegmy

• Breathing that seems faster than normal

Bacterial pneumonia is treated with antibiotics, but viral pneumonia needs to run its course. If your child gets severe pneumonia, they might need to be treated in the hospital.

Dry Nighttime Cough

If your child's cough is an annoying "on-and-off" cough that gets worse at night and with activity, call your pediatrician. A dry cough at night can also mean your child's body is making too much mucus. It can also be a sign of asthma.

When to Call 911

If your child is having trouble breathing or becomes unable to speak, eat, or drink, call 911 or go to the nearest ER right away.

Barking Cough

A child's cough that sounds like a seal or small dog barking is a sign of an upper airway infection called croup.

Croup is most common in children under the age of 8. It usually starts or gets worse at night. A child may wake up with a barking cough and make a loud whistling sound when they breathe (stridor).4

A child's cough that makes these sounds can be scary for kids and parents—but they don't always mean you have to take a trip to the ER.

If your child wakes up with a barking cough, there are a few ways to help them at home. First, take them to the bathroom and turn on the hot water in the shower. Let the room steam up, and sit in it for about 15 minutes.

Often, sitting in a humid bathroom for a while is enough to help with the coughing and stridor from croup—at least enough to get through the rest of the night. If it does help, you can go back to sleep and call your pediatrician in the morning.

However, if it doesn't help and your child is still coughing and having trouble breathing, go to the ER right away.

Wheezing Cough

A child's cough is not always wheezing, even if it sounds like it. People often confuse the term "wheezing" with the normal sounds a congested child makes when they breathe.

If you can hear mucus when your child is breathing, it probably is not a cause for concern. True wheezing is a high-pitched whistling sound a child makes when they're breathing out.

If your child is coughing and wheezing, you'll want to call your pediatrician. If your child is having a hard time breathing, take them to the ER.

If your child has asthma and is coughing and wheezing, follow your family's asthma action plan.

When to See a Healthcare Provider for a Child's Cough

A child's cough is not always a reason to panic. With time and experience, caregivers learn when it's time to call their child's healthcare provider or head to the ER.

Some warning signs mean a child's cough is not something you can handle at home. If your child is coughing and has these symptoms, you'll need to get them medical care right away:

• A fever of 100.4 F or higher in an infant 2 months old or younger

• A fever of 102 F or higher in a child of any age

• Blue lips

• Excessive crankiness or sleepiness

• Labored breathing (e.g., nostrils widening with each breath, wheezing, fast breathing, or shortness of breath)

• Loss of appetite or thirst, with signs of dehydration (such as urinating less often)

• Persistent ear pain

• Severe headache

• Worsening general health5

Comfort Care for a Child's Cough

There are some things that you can do at home to help with your child's cough.

• Use a humidifier at night to put extra moisture in the air which can soothe airway irritation

• Give children 12 and up cough drops (do not give them to younger children because they are a choking hazard5

• Give your child plenty of cool drinks or popsicles to ease throat pain and help them stay hydrated

Should I Give My Child Cough Medicine?

Never give a child OTC medicines that are meant to be taken by adults. Kids under the age of 2 should not be given OTC cold medicines that have a decongestant or antihistamine in them because they can cause a rapid heart rate and/or convulsions.6

If you have older children, ask your pediatrician about which products are safe to give them for a cough.

Summary

A child's cough can be a common symptom of an illness that isn't serious, but it can also be a sign of a more pressing problem. If in doubt, call your child's healthcare provider. They will ask you to describe what the cough sounds like—or may even have you hold your phone up so they can hear your child's cough.

There are different types of coughs that kids can get. You may need to take your child to the pediatrician to figure out what is causing their cough and get them a treatment that will help.

Even if your child's cough can be managed at home at first, if they are not getting better, develop new or concerning symptoms, or are having trouble breathing, they need medical care right away.

Sources

Children’s Health. "What your child's cough is telling you."

Nemours Foundation. Coughing.

Welte T, Ambrose LJ, Sibbring GC, Sheikh S, Müllerová H, Sabir I. Current evidence for COVID-19 therapies: a systematic literature review. Eur Respir Rev. 2021;30(159):200384. doi:10.1183/16000617.0384-2020

Cleveland Clinic. How to care for your child’s croupy cough.

U.S. Food and Drug Administration. When to give kids medicine for coughs and colds.

U.S. Food and Drug Administration. Use caution when giving cough and cold products to kids.

Landstra AM, Postma DS, Boezen HM, Van Aalderen WMC. Role of serum cortisol levels in children with asthma. Am J Respir Crit Care Med. 2002;165(5):708-712. doi:10.1164/ajrccm.165.5.2102115

Paul IM, Beiler JS, King TS, Clapp ER, Vallati J, Berlin CM. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics. 2010;126(6):1092-1099.

Consumer Reports. Many people swear by Vicks VapoRub. Is the love justified?

By Kristina Herndon, RN
Kristina Herndon, BSN, RN, CPN, has been working in healthcare since 2002. She specializes in pediatrics and disease and infection prevention.