What to Know About the Types, Causes, and Treatment of Cough in Toddlers
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Toddlers most often cough when the lining of their windpipe becomes irritated, which commonly happens when they are sick and fighting off an illness. While coughing can sometimes be helpful—removing extra mucus and allowing air to flow more easily through the windpipe into the lungs—it can also be disruptive to sleep and downright miserable for everyone. Here are the most common types of toddler coughs, their causes, and the best ways to diagnose and treat them to get your little one feeling better.
Types of Toddler Coughs
The most common reasons for toddler coughs are respiratory infections, allergies, and asthma. Coughing associated with a viral or bacterial infection often comes with other tell-tale symptoms like a sore throat, runny nose, and fever. Asthma-related coughs commonly come with some wheezing and are often worst at night. Coughing associated with environmental or seasonal allergies, on the other hand, will develop when your child is exposed to the substance they're allergic to such as pet dander or pollen.
If your child is getting over an illness, then their cough will probably be the last symptom to get better. It's not uncommon for a dry, hacking cough to linger for as long as three weeks after a cold (although you should see some gradual improvement between 10 and 14 days) in toddlers and young children.
There are four distinct types of coughs: dry, wet, croup, and whooping. It is important to know what type of cough your child has and what it might mean.
Dry cough
A dry cough sounds like a rough, hacking cough, and does not contain mucus.
An infection of the upper respiratory tract such as a cold or influenza can cause a dry, hacking cough. Your toddler's cough may get worse at night with a cold or flu, and warm, dry rooms may also worsen the symptoms. A dry cough is also one of the most common symptoms of COVID-19 (though a wet cough or even a croup-like cough is also possible).
However, a dry cough may also be an early sign of an infection of the lower respiratory tract, like bronchitis, which is inflammation of the small airways in the lungs. Other causes of dry coughs in toddlers include asthma, which first appears as dry coughing at night and often worsens with exposure to cigarette smoke or other similar irritants.
A dry cough isn't always due to an illness, sometimes it is a response to the environment from things like dust, tobacco smoke, pollen, or pollutants. According to the American Lung Association, exposure to environmental irritants can produce wheezing, coughing, and shortness of breath.
Wet cough
A wet cough includes phlegm or mucus that may be clear, yellow, or green; these coughs sound wet.
If your toddler has a wet cough (a cough accompanied by mucus or the sound of mucus), it's likely caused by fluid secretions and mucus found in the lower respiratory tract which includes the windpipe and lungs.
Common causes of wet cough include respiratory infections and asthma, but allergies can also cause a wet cough. According to the University of Missouri, grass and tree pollen, mold and fungi spores, dust, and animal dander are all common allergens that can irritate the lining of the nose, triggering a post-nasal drip that causes a chronic, wet cough.
It is common for colds and influenza to initially cause a wet cough. However, as the viruses run their course, a wet cough can turn into a lingering, persistent dry cough that can last several days or weeks.
A sinus infection, also called acute sinusitis, can also lead to a wet cough. When mucus builds up in the sinus cavity, it pushes mucus and phlegm into the throat and nasal passages, leading to a wet cough. This type of cough can last up to eight weeks and can be treated with over-the-counter medicines.
Pneumonia is a lung infection that is characterized by a wet, mucusy cough. Additionally, pneumonia also causes a crackling, bubbly, or rumbling sounds while breathing.
Respiratory syncytial virus (RSV) is a common virus that can present as a mild cold. But for kids under the of age 1, RSV can be serious and is the most common cause of pneumonia and bronchiolitis, which is when the small airways in the lungs become inflamed. An RSV cough sounds wheezy, wet, and forceful. It can also make breathing difficult for the child.
Croup cough
Croup is a disease that causes a harsh, dry cough that can sound similar to a seal's bark. Croup in toddlers results in a swollen upper trachea or windpipe and is usually caused by a viral infection. A child with croup may make a high-pitched sound, known as stridor when breathing in.
Whooping cough (pertussis)
Whooping cough has symptoms similar to the common cold, but the cough gradually becomes worse with severe fits of deep, fast coughing. It especially causes toddlers to cough at night.
Frequent coughing fits are generally a series of five to 15 staccato coughs in rapid succession. After coughing, the child will breathe deeply, sometimes making a "whooping" sound. Whooping cough can lead to breathing problems and a change in the appearance of the child's skin (often resulting in a bluish, grayish, or purplish appearance, especially around the lips, gums, and nail beds) because of a temporary oxygen shortage.
Is Something Stuck in Their Throat?
While most coughing in toddlers is caused by respiratory infections, the sudden onset of intense coughing may be caused by something irritating or getting stuck in their throat or windpipe. Toddlers can sometimes cough and gag when eating or drinking, for example, especially when they overstuff their mouths or drink too quickly.
While some short-lived reflexive coughing and gagging can be normal and is not a medical emergency, it's important to be able to distinguish it from true choking, which is when the airway is blocked and the child is having trouble breathing.
Symptoms of true choking include difficulty breathing, wheezing or gasping, high-pitched sounds or no sound, throat-grabbing motions, skin tugging at the chest, skin color changes (ranging from blue to purple to gray/ashen), and appearing in obvious distress. If you suspect your toddler is choking, you should immediately administer choking first aid (in children older than 1 year, that means performing the Heimlich maneuver) and call 911.
For a partially lodged object (your child can still breathe fine), you can try wiggling it free with pats on the back, then visiting the doctor if that doesn't work. Often an X-ray will show the cause, but sometimes a child will need a bronchoscopy, in which a tube travels down the windpipe to look around and clear the airway.
Peanuts, popcorn, and bits of hard foods like raw carrots are especially prone to be aspirated, so you should not give them to children under 4 years old. Aspiration can also eventually lead to pneumonia, which would cause your child to develop a fever, be short of breath, and start to look and act sick.
RELATED: How to Decode Your Baby's Cough
When to Call Your Doctor
While most toddler coughs resolve on their own, there are times when coughing signals a more serious problem or complications that require treatment.
If your toddler develops any of the following symptoms along with their cough, it's time to call their pediatrician according to the American Academy of Pediatrics:
Their cough is accompanied by wheezing, whistling, or stridor.
They vomit or turn red during coughing fits.
They start running a fever that lasts more than three days.
If, on the other hand, your toddler is showing any of these symptoms, you should seek more immediate care:
They have trouble breathing or are breathing rapidly.
They show changes in skin color (bluish, grayish, or purplish), especially around the lips, gums, and nail beds.
They seem lethargic or "out of it."
They experience severe chest pain.
They have a fever over 104°F.
As always, trust your gut. If your child looks or acts very sick or you think your child needs to be seen, seek medical care.
How to Help Your Toddler's Cough
Is your toddler coughing at night or throughout the day? Try the following treatment options.
Keep them hydrated
Give your toddler plenty of clear, ideally unsweetened, liquids to drink. If they have a wet cough, staying hydrated can help prevent the mucus from thickening making their coughs more effective. Warm liquids or broth-based soups can also ease soreness and irritation in the throat and chest, relax the airways, and loosen mucus.
Take advantage of humidity
Let your child inhale humidified air (air that has moisture in it). Dry air can make coughs worse, and water vapor can ease your child's coughing. This can be done in several ways:
Use a cool-mist humidifier in your child's bedroom.
Run a warm shower in the bathroom with the door shut. When the room is filled with steam, sit in the bathroom with your child for about 10 minutes. Read or sing to them so that they will be relaxed.
Hang a damp towel in your child's bedroom.
Let in cool air
For a dry cough or a croup cough, you can also try encouraging your toddler to inhale cool air. Cool air can reduce the swelling in the respiratory tract, which can help suppress the coughing. You can do this in several ways:
If the weather is cool or cold, go outside or open the window so that your child can inhale cool air.
Take your child outside for a drive with the car windows open.
Let your child inhale the cool air from an open refrigerator or freezer.
Limit physical activity
A toddler with a distinct dry cough should avoid exercise. Older children often notice their cough gets worse during physical activity. Encourage your toddler to listen to their body. Many toddlers can go about their day as normal with a cough, but encourage periodic rest and restful activities.
Avoid over-the-counter cough medicines
The American Academy of Pediatrics (AAP) advises against over-the-counter cough medicine and cough syrup for toddlers younger than 4 years old since they might cause serious side effects. The AAP also says cough medicines aren't very effective for those under age 6 (and aren't approved for this group). Instead, toddlers will benefit from all-natural approaches, such as honey (if the child is older than 1) or warm liquids.
Get vaccinated
Vaccines are a safe and effective way to prevent infections and disease. Getting vaccinated against illnesses known to cause severe coughing is one of the best ways to prevent cough. In addition to getting your toddler vaccinated if and when they are able, it's also important that parents, older siblings, and other family members be vaccinated to reduce the risk of passing an infection to your toddler.
Here are a few vaccines to consider:
Whooping cough: This highly contagious respiratory disease can be prevented by the DTaP vaccine for children and the Tdap or DTaP vaccine for adults who are often in contact with children.
Influenza and cold: The influenza vaccine, more commonly called the flu shot, is an annual vaccine that can prevent the spread of the flu.
COVID-19: COVID-19 vaccines are widely available for adults, children, and infants over the age of 6 months. This vaccine may not prevent COVID-19 infection, but it will reduce the risk of developing severe illness that can lead to hospitalization or death.
Pneumococcal: The pneumococcal vaccine can help prevent pneumonia, as well as meningitis and sepsis in kids under the age of 2 and older adults.
