Children's Hospital Colorado

Types of Coughs in Children

A girl coughing into her arm

Coughs are good. They’re the body’s built-in mechanism for protecting the airways and fighting infection — a signal your child is sick, but also a part of getting better. But they can be annoying, and occasionally they can be a sign of more concerning problems. How can you tell?

In general, says pediatric pulmonologist Mark Brown, MD, coughs come in two classes: wet and dry. Dry coughs are typically the result of irritation in the upper airways — the sinuses, throat and vocal cords. Irritation in the airways below the windpipe can also produce a dry cough, but generally, the lower airways produce mucus in response to irritation — which leads to the other type: wet coughs.

Both types tend to get worse at bedtime (due to what doctors rather grossly call “secretions” resettling when kids go from upright to lying down), and both tend to be most present in the winter, when viruses are making the rounds. But there are plenty of non-seasonal reasons kids might be coughing as well.

As it turns out, the sound of a cough can tell medical professionals like Dr. Brown a lot, from type to severity. Here’s what he looks for:

Cough sounds #1: the stridor

Croup is a dry, barky, brassy cough, but what really gives it away is the stridor, a distinctive, high-pitched whistling on breathing in. The potential result of several different viruses, croup is basically a swelling of the upper airways, which makes it difficult to get air where it needs to go — hence the whistling.

When to get care for your child

When you hear that stridor, it’s time to make an appointment. A same-day primary or urgent care visit should be fine — unless your child seems to be struggling to get enough air, in which case, head straight to the emergency department. The treatment is usually a steroid, which reduces the swelling. The sooner they get it, the less they’ll need and the better they’ll feel.

Cough sounds #2: the wheeze

Coupled with another dry cough, it’s the telltale sign of asthma. “People use the word wheezing for a lot of different sounds,” says Dr. Brown, “but in asthma it’s a whistling coming from inside the chest, more often when breathing out than breathing in, but sometimes both.”

Unlike your typical viral cough, which gets worse at bedtime but clears up after a while, the asthma cough can really get going in the middle of the night, and it doesn’t go away. “It’s not just a few coughs here and there,” says Dr. Brown. “It’s 20 to 30 minutes of sustained coughing.”

When to get care for your child

The wheeze is your call to action. If your child has an asthma diagnosis, you might already have an asthma action plan. (If you don’t, ask your doctor.) If not, get them checked out by your primary care provider. And as always, if your child seems to be struggling to breathe, seek emergency care right away.

Cough sounds #3: the aspirated object

When you think of choking, you might think of a child with a blocked windpipe, unable to breathe, but sometimes it’s more subtle. If a child has a choking episode and then a dry cough that hangs around afterward, they might have part of the object (or another object altogether) still lodged in their lungs. A cough that hangs around with no runny nose or other cold symptoms can be a telltale sign.

When to get care for your child

If a child has something in their lung, it needs to come out. A medical provider can listen with a stethoscope for changes in the sound of the breath in different parts of the lungs, which can point to a foreign object. Specialists can confirm it by looking for areas of air trapping with an X-ray. If there is something in there, a pediatric surgical team can generally remove it under anesthesia with a bronchoscope. “As you can imagine,” says Dr. Brown, “we have extensive experience removing stuff from children’s lungs.”

Cough sounds #4: the wet cough

If it’s during the winter, a wet cough is usually the result of a virus, although the cause can also be ongoing exposure to cigarette smoke or other irritants. Wet coughs can sound bad, so forceful at times they can trigger the gag reflex and a kid vomits. Surprisingly, though, according to Dr. Brown, that’s not necessarily a big deal in and of itself. “Unless it doesn’t stop,” he says. “Then you may be looking at a GI illness as well.”

When to get care for your child

A wet cough and a high fever (higher than 102°) points to a more serious infection that needs medical attention. Look for increased breathing rate, too, as that can be a sign of airway trouble. It’ll be more apparent when the child is asleep, as that’s normally not a time they’d be breathing fast. If they don’t seem to be struggling, it’s okay to wait until the next morning to take them in.

Why won’t my child’s cough go away?

A typical viral infection tends to last about 7 to 10 days, but at the height of cold season, there are dozens of them going around. “There’s influenza A and B and rhinovirus A and B and C and going on and on, the whole alphabet,” says Dr. Brown. “A virus evolves very quickly, and relatively subtle changes mean your immune system doesn’t recognize it and can’t fight it off as well.”

That’s why you need a new flu vaccine every year: the shot you get is actually a mix of vaccinations against whatever forms of influenza virus experts think will be most prevalent in the coming season. (That’s also why it’s possible, although much less likely, to get the vaccine and then get the flu anyway.)

And it’s why your daycare- and school-aged kids’ cough can hang around for weeks on end.

“They get a virus that lasts 7 to 10 days, and then they catch a different virus,” says Dr. Brown. “It’s just a string of not-serious viral infections that can keep a child coughing for weeks, even months.”

How to treat a child’s cough at home

For the most part, says Dr. Brown, it’s just like your grandmother told you: stay hydrated, eat well and get a lot of rest. Dr. Brown also recommends a humidifier at night, which can alleviate irritation in dry airways. Just make sure to clean it. “Empty it and let it dry every day,” he says, “and wash it out every week.”

What not to use: over-the-counter cough medicines. “There’s not much evidence they help in anyone,” says Dr. Brown, “and they can cause adverse reactions in young children.”

How to clean a humidifier

Without proper cleaning, bacteria can build up in the humidifier and make matters worse. Every week, Dr. Brown recommends filling the tank with enough distilled white vinegar to cover any parts in contact with water. Let that sit for 20 minutes. Then use a toothbrush to scrub the cracks and corners, rinse it well and let it air dry.

When to get help for a child with a cough

Generally, says Dr. Brown, the younger the child, the greater the chance of breathing trouble. Because their airways are smaller, constriction or swelling that might just cause a cough in an older kid and can render a baby or toddler unable to breathe.

Anytime a child seems to be struggling to get enough air, get emergency medical help right away.

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