Cough in children and colds: home relief, treatment and warning signs

Coughing is how the body clears mucus from the airways. Young children catch many colds a year, so a wet, runny-nose cough is very common and usually passes on its own.

With a cold, symptoms usually peak in the first 2 to 3 days and improve within a week, although the cough can linger.

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Most coughs come from viral infections:

• Common cold: runny nose, sneezing, cough, sore throat and sometimes a low fever.
• Flu and COVID-19: higher fever, body aches and tiredness. See flu and COVID-19.
• Bronchiolitis: inflammation of the small airways, mostly in babies. RSV is the most common cause in children under 1.
• Croup: a hoarse, barking cough, sometimes with a high-pitched noise when breathing in.
• Allergies or asthma: a cough that keeps coming back, with sneezing or wheezing. See allergies.

These steps are safe for most children:

• Saline (salt water) nose drops and, for babies, a bulb syringe to clear mucus before feeds and sleep.
• A cool-mist humidifier in the bedroom.
• Plenty of fluids to help thin mucus.
• Rest, and keep your child away from cigarette smoke.
• Frequent handwashing so the rest of the family does not catch it.

Many adult medicines are not safe for children:

• Under 4: over-the-counter cough and cold medicines are not recommended. From 4 to 6, only if a doctor recommends them. Under 2, never give products with a decongestant or antihistamine.
• Honey: never under 12 months, because it can cause infant botulism. From age 1, a little honey can help ease a cough.
• Aspirin: never give it to a child unless their doctor says so.
• Cough drops: not under age 3, because of the choking risk.
• Dose by weight: acetaminophen and ibuprofen for fever are dosed by your child's weight, using the device that comes with the medicine.
• Do not combine products with the same ingredient. We do not prescribe codeine cough syrups or any other controlled substance.

Colds, flu and most chest colds (bronchitis) are viral, and antibiotics do not work on viruses, even when mucus is thick, yellow or green. If the doctor finds signs of a bacterial infection and it is appropriate, she prescribes treatment and we send your prescription to your pharmacy. If a test would help her decide, she gives you a lab order for a lab near you. Read more on antibiotics by telehealth. If there is also a fever, see fever in children.

Croup causes a hoarse cough that sounds like a barking seal, a raspy voice and sometimes a harsh, high-pitched noise when breathing in (stridor). According to MedlinePlus, it is most common between 3 months and 5 years, gets worse at night and usually lasts up to 3 nights, sometimes up to 7; the first two are often the worst.

If the barking cough is mild and your child is breathing comfortably, the doctor can evaluate them by video with you on camera. Call [911](tel:911) if the noisy breathing happens at rest or keeps getting worse, the muscles between the ribs pull in with each breath, your child drools or cannot swallow, or the lips or skin look blue.

Bronchiolitis inflames the smallest airways and is most common under age 2; RSV is the most common cause. It starts like a cold and within 2 to 3 days can bring wheezing, fast breathing and ribs that pull in with each breath. It usually improves by day 3 and clears in about a week; antibiotics do not help because it is a virus.

At home: fluids, moist air, saline nose drops with gentle suction, and no smoke. Go to the ER if your baby breathes very fast or very hard, the nostrils flare, the chest pulls in, the skin, nails or lips look blue, they are extremely tired, or they will not eat or drink. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher goes to the ER now.

For their safety, call 911 or go to the ER, at any age, if the skin pulls in between your child's ribs or below the neck with each breath, the nostrils flare, they grunt at the end of each breath, make a high-pitched noise when breathing at rest (stridor), have bluish lips or face, or are drooling and unable to swallow.

With your child calm or asleep, count how many times the chest rises in one full minute. More than 60 breaths a minute at any age is an emergency. Get seen in person soon if a baby 6 to 12 months old breathes more than 50 times a minute, or a child 1 to 5 years old more than 40. A baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the ER. A child with asthma whose shortness of breath does not improve with the inhaler is also an emergency.