When is it time to worry about the cough?

Written By Jennifer Shaer MD, FAAP, FABM, IBCL

CoughIt seems like kids cough all winter long. When is it time to worry about the cough? When can you treat it at home and when should you go to the doctor?

There are many causes of coughing in children. Most commonly, a cough is caused by a viral upper respiratory infection. However, coughs can also be caused by asthma, pneumonia, croup, bronchiolitis, whooping cough, sinusitis, allergies, reflux and even an inhaled foreign body. This article will review the …

Viral upper respiratory infections

This is the common cold. A cough from a cold will typically last two weeks. There is commonly some productive phlegm toward the end of a cold. Antibiotics do not help viral illness so it is best to let this type of cough run it’s course. It is common to have some fever with a viral upper respiratory infection for the first few days. However, you should visit the doctor if the fever lasts more than a few days. You should also be seen if the cough lasts more than a week or the fever comes back after having stopped.

Whooping cough (pertussis)

Recently there has been a resurgence of pertussis. Pertussis will start off looking like the common cold. However, instead of getting better, the cough gets worse. Children with pertussis will cough many times in a row.

They will often lose their breath and take a big “whoop” breath at the end of a series of coughs. Babies with pertussis will sometimes stop breathing and turn blue. Pertussis is extremely dangerous to babies and is preventable by vaccine. It is important to make sure that your baby gets all his pertussis vaccines. In addition, we now give teenagers and adults a pertussis vaccine.


A cough from asthma is usually not associated with a fever. Kids with asthma will cough more with exercise and at night. Asthma is usually triggered by a cold so children who have a history of wheezing should always see the doctor when they are coughing.


Bronchiolitis is when a viral upper respiratory infection moves into your baby’s chest and causes wheezing. Signs that your baby’s cold might be bronchiolitis include trouble nursing or taking a bottle, heavy or fast breathing and wet sounding cough. In general, babies with a cough should see the doctor.

To learn more about coughs, or any other medical conditions your child may be facing, visit HealthyChildren.org.

Dr. Shaer is a pediatrician and a board certified lactation consultant (IBCLC). She is director of the Breastfeeding Medicine Center of Allied Pediatrics of New York.


In Defense of Cough

Written by Nelson Branco MD


There are always coughing kids, but this time of year the number of visits to pediatricians for “cough” begin to outnumber almost everything else. Once the kids have been back in school for a few weeks, and they’ve had a chance to cough and sneeze all over each other, the cough season has begun.

Most parents worry that their child might have asthma, pneumonia or some other infection causing the cough. Your doctor will be running through a much longer list of possible reasons for cough – pneumonia, wheezing, croup, asthma, bronchitis, congestive heart failure, viral upper respiratory illness, bronchiolitis, reflux, post nasal drip due to allergies or sinus infection, habit cough, aspirated foreign body and a few others. It usually takes only a few questions to narrow down the possibilities, but sometimes it takes a bit more work, especially if the cough has been going on for some time or has not responded to treatment.

Obviously, many of these causes will have a specific treatment – antibiotics for pneumonia or sinusitis, steroids and albuterol for asthma, antihistamines or nasal steroids for allergies, antacids for acid reflux. But how about if your child has a viral illness? These illnesses – upper respiratory infections (the common cold), tracheitis, bronchitis, and bronchiolitis, are usually self-limited and don’t need any specific treatment.

Cough is a protective reflex that keeps the lungs clear of mucous, irritants and infection. Cough is usually involuntary, and it’s difficult to suppress a cough when your brain says it’s necessary. Cough can interrupt sleep, be disruptive at school or irritating to your child, and cough is a very efficient way to pass infections to others (Cover That Cough!). So, given all this, why don’t we generally prescribe cough suppressants? The first reason is that most don’t work. Even codeine, when studied in large groups of children, doesn’t work well at suppressing cough. Over-the-counter medications don’t work too well either, though there are many available and lots of people use them.

Another reason not to suppress all coughing is to prevent pneumonia or lung infection. Cough is a helpful reflex – it keeps mucus from the throat and upper airway out of the lung, and helps move mucus up and out of the lung. Most of this mucus is swallowed; this is fine. The lungs are lined with cells that have tiny hair-like projections called cilia. These cilia all beat in one direction to help move mucus and debris out of the lungs, like an escalator. The cough helps move things along even faster.

One of the biggest problem with cough is that it can interrupt sleep. Because sleep and rest is important to help fight off any virus or other infection, we often recommend treatments that will help with sleep. A teaspoon of honey given at bedtime has been proven to be just as effective as an over the counter cough syrup. You can also use herbal tea with lemon and honey, and vaporizers/humidifiers, steamy bathrooms, and saline nose drops can help to thin the mucous so that it’s easier to cough up.

Remember – not all cough is bad. Sometimes cough is a sign that there is a problem that you need to talk to your doctor about. Most of the time, though, cough is just doing its job to keep the lungs clean. Teach your kids to wash their hands frequently, cough into their elbow instead of onto surfaces or their hand, make sure to get a flu shot and, as much as possible, avoid people who are obviously sick.


Dr. Branco is a practicing pediatrician in the San Francisco Bay Area and is very active with the local chapter of the AAP.


Fall Colds: What To Do, And When To Take Your Child To The Pediatrician

Written by Jennifer Gruen MD

The fall cold and cough season seems to be in full swing. The ragweed pollen and mold in the air is also causing a lot of congestion and cough symptoms. Below are a few hints on how to make your child feel better, and when you need to bring them in for a visit:

 What constitutes a common cold?

  • Runny nose, mild cough, sore throat, decreased appetite, occasionally low grade fever (<101.)
  • Children can have 7-10 colds in one season, particularly the first year they are in any sort of a daycare or school setting.
  • Colds are most contagious in the first two days – usually accompanied by a clear runny nose.
  • The change in color of the mucous to yellow or green after 5-7 days (in the absence of fever or headache) usually signifies the end of the cold and will be gone in 2-3 days. Green noses don’t automatically need antibiotics!

Is it an allergy or a cold?

Visit this link to read more on the diagnosis and treatment of allergy symptoms.

What will help?

For children under one use nasal saline, bulb syringe, elevating mattress (put rolled up towels underneath the head of the mattress) or allowing to sleep in car seat if they can breathe more easily this way. Use nasal saline drops, with suctioning only if there is a lot of loose mucous, before feeding and sleeping. A warm bath will help bring break up the mucous.

For children 1-3, nasal saline washes may help (try Simply Saline or the NeilMed sinus rinse for children). A trial of Benadryl may be necessary to relieve congestion. (click here for dosage information.) It is especially helpful at night if cough is interrupting sleep.

For older children (>4) with congeston try mint tea with 1 teaspoon of sugar or honey to soothe sore throats and help break up congestion. For difficulty breathing through nose at night try Breathe Right strips for children. (Dr. Nikki loves them!) For persistent nighttime cough try humidifier, elevation and possibly Benadryl. Other cough syrups that we have found help include Delsym and long acting single ingredient dextromethorphan preparations.

“Just a spoonful of sugar….”- sucking on a lollipop or a teaspoon of honey has been shown to decrease sore throat as much as cough medicines. Tylenol or motrin is appropriate for fever or sore throat, but doesn’t work for cough.

When to worry?

  • Any fever >100.4 in infants less than 6 months old – call for an appointment
  • Fever for greater than 3 days in any age child
  • Fussiness, not eating well, pulling on ears, breathing quickly or pulling in at ribs when breathing.
  • Green, yellow nasal discharge that is accompanied by fever, headache, sinus pressure or that persists more than 5-7 days.
  • Drainage out of ear canals.
  • A cold that persists longer than 2 weeks, or that after several days is suddenly accompanied by a fever.
Dr. Gruen opened her practice, Village Pediatrics, in 2009, but prefers spending time creating fantastic kids birthday parties.