A Parent’s Guide To Kids’ Coughs

As a parent, there are few skills more vital than being able to decipher the various sounds that come out of your kids. For example, some sounds are good—like laughter, while others are … less good—like the shriek of a child who has bumped their head or even the lack of sound when a toddler disappears into another room and is just a little too quiet. And then there are those sounds that could go either way. Like a cough, which can range from benign to “Are they choking?!” to “Oh, no—I hope that’s not contagious!”

The challenge, though, is that there are many types of coughs. They can be wet, dry, unproductive, and/or persistent. Some make your child sound like a seal or a broken radiator. And the causes behind them can vary just as much as the coughs themselves, ranging from dry air and the common cold to allergies, pneumonia, asthma, croup, and COVID.

So, then, wouldn’t it make life simpler if there were a way for parents to easily decode each one and know exactly what to do?

Unfortunately, a specific cough doesn’t always neatly line up to a specific illness, says Allison Mangini, DO, a general pediatrician with Northwell Health. “Both dry and wet coughs can be infectious, and we can’t tell what it is by merely looking at a child,” she says, adding that physicians need to also listen and do tests to get to the root cause.

Mangini offers some advice for what parents should look for, and what to consider when deciding whether a trip to the pediatrician is in order:

A cough that happens once or twice and then disappears is probably nothing to be concerned about. But one that persists for two to three days should be checked. “The caveat is with babies,” says Mangini. “Since they don’t have the lung strength or the ability to blow their noses, and they can’t tell you what’s wrong, the threshold is lower for when to bring them in to be examined.” In these cases, she adds, children under the age of 1 who develop a persistent cough should be seen by their pediatrician right away.

Respiratory distress starts at the bottom of the torso with belly breathing, a sign that your kid isn't comfortable and is having to work harder to breathe and break up mucus. In addition to their bellies, parents should watch their rib cages. “If you see the muscles on and under your child’s ribs pulling in, it’s another sign of distress,” explains Mangini. And again, if it’s a baby or a child with a compromised immune system, head to the doctor right away.

Coughs usually don’t happen in isolation. In other words, there are likely to be other symptoms, too. If there’s a fever, loss of appetite, runny nose, and lethargy—and especially if any of those become worse—you should err on the side of caution and get your child checked.

You also want to think if anything has changed that might have caused a cough to develop. It could be eating before bed that brings on acid reflux. Or, if you’re starting to use indoor heating because of colder weather, the air could be dry, and a humidifier could be the solution. It could also be allergy season—look for pollen on the cars—which can cause coughing and sneezing. This might be the first time your child has been affected, so after they’ve been outside, brush their hair and have them shower to keep it from getting on their sheets and pillows while they sleep. And, of course, have them see their doctor to establish a treatment regimen.

One thing you don’t want to do is rush to over-the-counter medications. “All these will do is mask the symptoms and suppress the cough,” says Mangini.

And while some signs are obvious, like a high fever or labored breathing, the biggest thing to cue in on is how your child is behaving—after all, you know what their “normal” is. So if they’re coughing but nothing else seems different, you can take a wait and see approach to gauge how their condition progresses. But if they don’t have their usual energy or appetite, and if they’re not sleeping or going to the bathroom normally, that can tell you that it’s time to make an appointment.

“It’s the whole picture,” Mangini says. “You know how your child usually acts. If that’s different, that’s something to pay attention to.”

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