When to worry about a cough.

November 24, 2011 Dr. Jim

“My toddler was up all night coughing!”I hear this a lot from tired parents when they bring their child to my office the next morning. I have experienced this frustration many times with my own kids: they seemed to have a mild runny nose most of the day - not much to worry about. But, about a minute after I tuck them into bed, I hear a cough... then a minute later a few more coughs, and soon they have a non-stop cough and I start to wonder if this is going to go on ALL NIGHT??


That is the million-dollar question. A cough can be caused by harmless cold, a sinus infection, bronchitis, pneumonia, and even life-threatening croup! How can parents know when to worry? Here is my general rule of thumb: I don't pay too much attention to the first hour after going to bed, and the first hour after waking up. Most simple colds will be accompanied by some sinus drainage and this can cause a nasty sounding cough when your child first lies down or wakes up in the morning. Usually, a child will cough for a while, then eventually clear it all out and then just have his mild runny nose the rest of the day. A cough that only happens every few hours is also usually not worrisome. Sinus drainage can slowly build up and your child will have episodes of hacking up mucous, even to the point of gagging. What's important to look for is how he is between episodes. These are my “worry signs:”

  • Chest pain when he is NOT coughing
  • Wheezing
  • Breathing seems labored
  • Croupy cough: sounds like a barking sea lion
  • Coughing fits that are so intense that it leaves child gasping for breath - this is a sign of whooping cough


Croup is a viral infection that affects mostly younger children. It causes swelling in the their vocal cords, which is what causes the barky cough. Croup usually lasts 5-6 days and is worse at night. The symptoms tend to peak on the second or third night. Croup may begin without warning when baby suddenly sits up in bed with a barking cough. Or it may begin as a cold that gradually escalates into a croupy cough.

Symptoms of Croup

  • Barky cough: A toddler will sometimes awaken from sleep with a croupy cough, and it can be frightening, for child and parent
  • High fever: Fever is common, but usually below 104 degrees
  • Hoarse voice: This is also from the swelling of the voice box
  • Stridor: This is the most concerning symptom of croup; Stridor is a harsh, raspy, whooping, gasping sound when your child breathes in
  • Symptoms of the common cold can precede the croup or they can linger afterwards

Treating Croup

It is important to keep your toddler calm. Steam-up the bathroom or go out in the misty cool night air. Treat any fever with acetaminophen or ibuprofen. This will help your child stay calm. Severe croup that doesn't quickly respond at home probably warrants a trip to the ER.


Pneumonia is an infection inside the lungs. It occurs when either bacteria or viruses get stuck in the lungs - the germs multiply and form an infected area. The major symptoms of pneumonia are:

  • Moderate to severe cough: often junky sounding, but not always
  • Cough is "forceful," often described as "mM child is trying to cough up a lung!"
  • Sustained rapid or labored breathing (as opposed to temporary rapid breathing from a high fever)
  • Medium to high fever: usually will be over 102 degrees, but not always.


Dealing with a cough

If kids are old enough for a cough suppressant (come brands are okay for 4 years and up, some are 6 years), then feel free to use one to help your child sleep. During the day, I like to let kids cough because all that mucous needs to come up and out.

Other remedies for the younger kids include:

  • Steam: Helps loosen mucous
  • Honey: This is a natural cough suppressant, but it's only safe for kids older one year
  • Nasal saline spray: Coughs can be due to nasal mucous dripping down the back of the throat; A few squirts of saline in the nose can help clear that all out.

Hope this helps sort out some of the confusion about coughs. I’ll write soon about boosting your child’s immune system this winter.

-- Dr. Jim