Coughs, Age 11 and Younger

Topic Overview

Coughing is the body's way of removing foreign material or mucus from the lungs and upper airway passages or of reacting to an irritated airway. Coughs have distinctive traits you can learn to recognize. A cough is only a symptom, not a disease, and often the importance of a cough can be determined only when other symptoms are evaluated.

For information about coughs in teens and adults, see the topic Coughs, Age 12 and Older.

Productive coughs

A productive cough produces phlegm or mucus (sputum). The mucus may have drained down the back of the throat from the nose or sinuses or may have come up from the lungs. A productive cough generally should not be suppressed; it clears mucus from the lungs. There are many causes of a productive cough, such as:

  • Viral illnesses. It is normal to have a productive cough when you have a common cold. Coughing is often triggered by mucus that drains down the back of the throat.
  • Infections. An infection of the lungs or upper airway passages can cause a cough. A productive cough may be a symptom of pneumonia, bronchitis, sinusitis, or tuberculosis.
  • Chronic lung disease. A productive cough could be a sign that a lung disease is getting worse or that your child has an infection.
  • Stomach acid backing up into the esophagus. This type of coughing may be a symptom of gastroesophageal reflux disease (GERD) and may awaken your child from sleep.
  • Nasal discharge (postnasal drip) draining down the back of the throat. This can cause a productive cough or make your child feel the need to clear his or her throat frequently. Experts disagree about whether a postnasal drip or the viral illness that caused it is responsible for the cough.

Nonproductive coughs

A nonproductive cough is dry and does not produce sputum. A dry, hacking cough may develop toward the end of a cold or after exposure to an irritant, such as dust or smoke. There are many causes of a nonproductive cough, such as:

  • Viral illnesses. After a common cold, a dry cough may last several weeks longer than other symptoms and often gets worse at night.
  • Bronchospasm. A nonproductive cough, particularly at night, may mean spasms in the bronchial tubes (bronchospasm) caused by irritation.
  • Allergies. Frequent sneezing is also a common symptom of allergic rhinitis.
  • Exposure to dust, fumes, and chemicals.
  • Asthma. A chronic dry cough may be a sign of mild asthma. Other symptoms may include wheezing, shortness of breath, or a feeling of tightness in the chest. For more information, see the topic Asthma in Children.
  • Blockage of the airway by an inhaled object, such as food or a pill. For more information, see the topic Swallowed or Inhaled Objects.

Coughs in children

Children may develop coughs from diseases or causes that usually do not affect adults, such as:

Many coughs are caused by a viral illness. Antibiotics are not used to treat viral illnesses and do not change the course of viral infections. Unnecessary use of an antibiotic exposes your child to the risks of an allergic reaction and antibiotic side effects, such as nausea, vomiting, diarrhea, rashes, and yeast infections. Antibiotics also may kill beneficial bacteria and encourage the development of dangerous antibiotic-resistant bacteria.

A careful evaluation of your child's health may help you identify other symptoms. Remember, a cough is only a symptom, not a disease, and often the importance of a cough can only be determined when other symptoms are evaluated. Coughs occur with bacterial and viral respiratory infections. If your child has other symptoms, such as a sore throat, sinus pressure, or ear pain, see the Related Topics section.

Check your child's symptoms to decide if and when your child should see a doctor.

Check Your Symptoms

Does your child have a cough?
Yes
Cough
No
Cough
How old are you?
Less than 3 months
Less than 3 months
3 to 11 months
3 to 11 months
12 months to less than 3 years
12 months to less than 3 years
3 to 11 years
3 to 11 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Has your child had surgery in the past 2 weeks?
Surgery can cause problems that make your child cough.
Yes
Surgery within past 2 weeks
No
Surgery within past 2 weeks
Do you think your baby might be very sick?
A sick baby probably will not be acting normally. For example, the baby may be much fussier than usual or not want to eat.
Yes
Baby might be very sick
No
Baby might be very sick
How sick do you think your baby is?
Extremely sick
Baby is very sick (limp and not responsive)
Sick
Baby is sick (sleepier than usual, not eating or drinking like usual)
Is your baby having trouble breathing?
Sometimes babies may have trouble breathing because of a stuffy nose. If your baby's nose is stuffy, clearing the nose with a rubber bulb may help.
Yes
Difficulty breathing
No
Difficulty breathing
Would you describe the breathing problem as severe, moderate, or mild?
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Do you think your baby has a fever?
Yes
Fever
No
Fever
Did you take a rectal temperature?
Taking a rectal temperature is the only way to be sure that a baby this age does not have a fever. If you don't know the rectal temperature, it's safest to assume the baby has a fever and needs to be seen by a doctor. Any problem that causes a fever at this age could be serious.
Yes
Rectal temperature taken
No
Rectal temperature taken
Is it 100.4°F (38°C) or higher?
Yes
Temperature at least 100.4°F (38°C)
No
Temperature at least 100.4°F (38°C)
Has the coughing been so bad that it has made your baby vomit?
Yes
Vomiting after coughing spasm
No
Vomiting after coughing spasm
Is your baby coughing up blood?
Yes
Coughing up blood
No
Coughing up blood
Is your child having trouble breathing (more than a stuffy nose)?
Yes
Difficulty breathing more than stuffy nose
No
Difficulty breathing more than stuffy nose
Yes
Drooling and unable to swallow
No
Drooling and unable to swallow
Would you describe the breathing problem as severe, moderate, or mild?
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Is your child's ability to breathe:
Getting worse?
Breathing problems are getting worse
Staying about the same (not better or worse)?
Breathing problems are unchanged
Getting better?
Breathing problems are getting better
Is your child's ability to breathe:
Quickly getting worse (within minutes or hours)?
Breathing problems are quickly worsening
Slowly getting worse (over days)?
Breathing problems are slowly worsening
Staying about the same (not better or worse)?
Breathing problems are unchanged
Getting better?
Breathing problems are getting better
Does your child have a chronic health problem that affects his or her breathing, such as asthma?
A breathing problem may be more of a concern if your child normally does not have breathing problems.
Yes
Has chronic breathing problems
No
Has chronic breathing problems
Is the problem your child is having right now different than what you are used to?
Yes
Breathing problem is different than usual symptoms
No
Breathing problem is different than usual symptoms
Does your child make a harsh, high-pitched sound when he or she breathes in?
This often occurs with a loud cough that sounds like a barking seal.
Yes
Harsh, high-pitched sound when breathing
No
Harsh, high-pitched sound when breathing
Does your child have symptoms of a serious illness?
Yes
Symptoms of serious illness
No
Symptoms of serious illness
When your child is coughing, does his or her face turn blue or purple?
Yes
Color changes to blue or purple when coughing
No
Color changes to blue or purple when coughing
Is your baby eating less than usual?
Yes
Change in eating habits
No
Change in eating habits
Has your baby had a cough for more than 1 full day (24 hours)?
Yes
Cough for more than 24 hours
No
Cough for 24 hours or less
Do you think your child has a fever?
Yes
Fever
No
Fever
Did you take your child's temperature?
Yes
Temperature taken
No
Temperature taken
How high is the fever? The answer may depend on how you took the temperature.
High: 104°F (40°C) or higher, oral
High fever: 104°F (40°C) or higher, oral
Moderate: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Moderate fever: 100.4°F (38°C) to 103.9°F (39.9°C), oral
Mild: 100.3°F (37.9°C) or lower, oral
Mild fever: 100.3°F (37.9°C) or lower, oral
How high do you think the fever is?
High
Feels fever is high
Moderate
Feels fever is moderate
Mild or low
Feels fever is mild
How long has your child had a fever?
Less than 2 days (48 hours)
Fever for less than 2 days
From 2 days to less than 1 week
Fever for more than 2 days and less than 1 week
1 week or longer
Fever for 1 week or more
Does your child have a health problem or take medicine that weakens his or her immune system?
Yes
Disease or medicine that causes immune system problems
No
Disease or medicine that causes immune system problems
Does your child have shaking chills or very heavy sweating?
Shaking chills are a severe, intense form of shivering. Heavy sweating means that sweat is pouring off the child or soaking through his or her clothes.
Yes
Shaking chills or heavy sweating
No
Shaking chills or heavy sweating
Did the cough start after a recent choking episode?
The cough could mean that something is still stuck in the throat.
Yes
Choking episode
No
Choking episode
Is your child coughing up mucus, phlegm (say "flem"), or blood from the lungs?
This is called a productive cough. Mucus or blood draining down the throat from the nose because of a cold, a nosebleed, or allergies is not the same thing.
Yes
Coughing up sputum or blood
No
Coughing up sputum or blood
Is your child coughing up blood?
Yes
Coughing up blood
No
Coughing up blood
How much blood is there?
Thin streaks of blood
Streaks
More than just streaks
More than streaks
Has this been going on for more than 2 days?
Yes
Coughing up mucus for more than 2 days
No
Coughing up mucus for more than 2 days
Has the coughing been so bad that it has made your child vomit?
Yes
Vomiting after coughing spasm
No
Vomiting after coughing spasm
Has your child had a cough for more than 2 weeks?
Yes
Cough for more than 2 weeks
No
Cough for more than 2 weeks

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, herbal remedies, and supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Symptoms of serious illness may include:

  • A severe headache.
  • A stiff neck.
  • Mental changes, such as feeling confused or much less alert.
  • Extreme fatigue (to the point where it's hard for you to function).
  • Shaking chills.

Temperature varies a little depending on how you measure it. For children up to 11 years old, here are the ranges for high, moderate, and mild according to how you took the temperature.

Oral (by mouth), ear, or rectal temperature

  • High: 104 °F (40 °C) and higher
  • Moderate: 100.4 °F (38 °C) to 103.9 °F (39.9 °C)
  • Mild: 100.3 °F (37.9 °C) and lower

Armpit (axillary) temperature

  • High: 103°F (39.5°C) and higher
  • Moderate: 99.4 °F (37.4 °C) to 102.9 °F (39.4 °C)
  • Mild: 99.3°F (37.3°C) and lower

Note: For children under 5 years old, rectal temperatures are the most accurate.

If you're not sure if a child's fever is high, moderate, or mild, think about these issues:

With a high fever:

  • The child feels very hot.
  • It is likely one of the highest fevers the child has ever had.

With a moderate fever:

  • The child feels warm or hot.
  • You are sure the child has a fever.

With a mild fever:

  • The child may feel a little warm.
  • You think the child might have a fever, but you're not sure.

You can use a small rubber bulb (called an aspirating bulb) to remove mucus from your baby's nose or mouth when a cold or allergies make it hard for the baby to eat, sleep, or breathe.

To use the bulb:

  1. Put a few saline nose drops in each side of the baby's nose before you start.
  2. Position the baby with his or her head tilted slightly back.
  3. Squeeze the round base of the bulb.
  4. Gently insert the tip of the bulb tightly inside the baby's nose.
  5. Release the bulb to remove (suction) mucus from the nose.

Don't do this more than 5 or 6 times a day. Doing it too often can make the congestion worse and can also cause the lining of the nose to swell or bleed.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of difficulty breathing can range from mild to severe. For example:

  • You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
  • It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Symptoms of serious illness in a baby may include the following:

  • The baby is limp and floppy like a rag doll.
  • The baby doesn't respond at all to being held, touched, or talked to.
  • The baby is hard to wake up.

Sudden drooling and trouble swallowing can be signs of a serious problem called epiglottitis. This problem can happen at any age.

The epiglottis is a flap of tissue at the back of the throat that you can't see when you look in the mouth. When you swallow, it closes to keep food and fluids out of the tube (trachea) that leads to the lungs. If the epiglottis becomes inflamed or infected, it can swell and quickly block the airway. This makes it very hard to breathe.

The symptoms start suddenly. A person with epiglottitis is likely to seem very sick, have a fever, drool, and have trouble breathing, swallowing, and making sounds. In the case of a child, you may notice the child trying to sit up and lean forward with his or her jaw forward, because it's easier to breathe in this position.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

Coughs, Age 12 and Older

A baby that is extremely sick:

  • May be limp and floppy like a rag doll.
  • May not respond at all to being held, touched, or talked to.
  • May be hard to wake up.

A baby that is sick (but not extremely sick):

  • May be sleepier than usual.
  • May not eat or drink as much as usual.

Symptoms of difficulty breathing in a baby or young child can range from mild to severe. For example:

  • The child may be breathing a little faster than usual (mild difficulty breathing), or the child may be having so much trouble that the nostrils are flaring and the belly is moving in and out with every breath (severe difficulty breathing).
  • The child may seem a little out of breath but is still able to eat or talk (mild difficulty breathing), or the child may be breathing so hard that he or she cannot eat or talk (severe difficulty breathing).

Severe trouble breathing means:

  • The child cannot eat or talk because he or she is breathing so hard.
  • The child's nostrils are flaring and the belly is moving in and out with every breath.
  • The child seems to be tiring out.
  • The child seems very sleepy or confused.

Moderate trouble breathing means:

  • The child is breathing a lot faster than usual.
  • The child has to take breaks from eating or talking to breathe.
  • The nostrils flare or the belly moves in and out at times when the child breathes.

Mild trouble breathing means:

  • The child is breathing a little faster than usual.
  • The child seems a little out of breath but can still eat or talk.
Postoperative Problems

Certain health conditions and medicines weaken the immune system's ability to fight off infection and illness. Some examples in children are:

  • Diseases such as diabetes, cystic fibrosis, sickle cell disease, and congenital heart disease.
  • Steroid medicines, which are used to treat a variety of conditions.
  • Medicines taken after organ transplant.
  • Chemotherapy and radiation therapy for cancer.
  • Not having a spleen.

Make an Appointment

Based on your answers, the problem may not improve without medical care.

  • Make an appointment to see your doctor in the next 1 to 2 weeks.
  • If appropriate, try home treatment while you are waiting for the appointment.
  • If symptoms get worse or you have any concerns, call your doctor. You may need care sooner.

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don't have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Home Treatment

Coughing is the body's way of removing foreign substances and mucus from the lungs and upper airway passages. Productive coughs are often useful, and you should not try to eliminate them. Sometimes, though, coughs are severe enough to impair breathing or prevent rest. Home treatment can help your child feel more comfortable when he or she has a cough.

  • Prevent dehydration. Fluids may help soothe an irritated throat. Honey or lemon juice in hot water or tea may help a dry, hacking cough. Do not give honey to children younger than 1 year of age. It may contain bacteria that are harmful to babies.
  • Cough and cold medicines may not be safe for young children. Before you give them to a child, check the label. If you do give these medicines to a child, always follow the directions about how much to give based on the child's age and weight. These medicines may help with your child's symptoms, but they don't help your child get better faster. For more information, see Quick Tips: Giving Over-the-Counter Medicines to Children.
  • If your child's doctor tells you to give a medicine, be sure to follow what he or she tells you to do. How much medicine to take and how often to take it may be very different for children than for adults.
  • Do not give your child leftover antibiotics, or antibiotics or medicines that were prescribed for someone else.

If your child has a barking cough during the night, you can help him or her breathe better by following the home treatment for a barking cough.

  • Hold your child in a calming manner.
  • Keep your child quiet, if possible. Crying can make breathing more difficult. Try rocking or distracting your child with a book or game.
  • Use a humidifier to add moisture to the air. Do not use a hot vaporizer. Use only water in the humidifier. Hold your child in your lap, and let the cool vapor blow directly into your child's face.
  • If there is no improvement after several minutes, take the child into the bathroom and turn on the shower to create steam. Close the door and stay in the room while he or she breathes in the moist air for several minutes. Make sure your child is not burned by the hot water or steam. Do not leave your child alone in the bathroom.
  • If there is still no improvement, bundle your child up and go outside in the cool night air.

For more information on treating coughs and other respiratory problems, see the Home Treatment section of the topic Respiratory Problems, Age 11 and Younger.

Medicine you can buy without a prescription
Try a nonprescription medicine to help treat your child's fever or pain:

Talk to your child's doctor before switching back and forth between doses of acetaminophen and ibuprofen. When you switch between two medicines, there is a chance your child will get too much medicine.

Safety tips
Be sure to follow these safety tips when you use a nonprescription medicine:
  • Carefully read and follow all directions on the medicine bottle and box.
  • Do not use more than the recommended dose.
  • Do not give your child a medicine if he or she has had an allergic reaction to it in the past.
  • Do not give aspirin to anyone younger than age 20 unless your child's doctor tells you to.
  • Do not give naproxen (Aleve) to children younger than age 12 unless your doctor tells you to.

Symptoms to watch for during home treatment

Call your child's doctor if any of the following occur during home treatment:

  • Other symptoms develop, such as difficulty breathing, a productive cough, or fever.
  • Your child starts coughing up blood.
  • A cough lasts longer than 2 weeks without other respiratory symptoms.
  • Symptoms become more severe or more frequent.

Prevention

There is no sure way to prevent a cough. To help reduce your child's risk:

  • Make sure your child washes his or her hands often during the cold and flu season. This helps prevent the spread of a virus that may cause a cold or influenza.
  • If your child goes to a day care center, ask the staff to wash their hands often to prevent the spread of infection.
  • Make sure that your child gets all of his or her vaccinations, especially for diphtheria, tetanus, and pertussis (DTaP) and for Haemophilus influenzae type b (Hib). For more information, see the topic Immunizations.
  • Help your child avoid secondhand smoke. Don't allow smoking in your home or around your child.
  • Try to avoid people who have colds or flu. If one of your children is sick, separate him or her from other children in the home, if possible. Put the child in a room alone to sleep.

For information on preventing allergies or asthma, see the topic Allergic Rhinitis or Asthma in Children.

Preparing For Your Appointment

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your child's condition by being prepared to answer the following questions:

  • How long has your child had the cough?
  • How often does your child cough?
  • Does the cough have a pattern, such as worsening at night or becoming more frequent in the morning?
  • What situations increase your child's coughing?
  • Is your child exposed to any irritants, such as smoke, dust, or chemicals, at home or elsewhere?
  • Is the cough productive (brings up sputum) or unproductive (dry and hacking)? Be prepared to describe the color (bloody, rusty, white, yellow, or green), amount, and consistency of any sputum.
  • Does your child have other symptoms that may be related to the cough, such as nasal drainage, fever, shortness of breath, wheezing, or other suspected cold symptoms?
  • What home treatment have you tried for the cough? Did it help?
  • What prescription and nonprescription medicines or other treatments have you tried? Did they help?
  • What prescription and nonprescription medicines does your child take regularly?
  • Has your child ever been diagnosed with allergies or asthma? Does anyone else in your family have allergies or asthma?
  • Has your child traveled recently?
  • Does your child have any health risks?

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD
Last Revised May 9, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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