What To Do When Your Baby Has A Cough

With respiratory viruses and illnesses circulating constantly, parents often worry about babies — with their brand-new immune systems and small airways. And if your baby comes down with a cough, we’re guessing that your number one question is what to do for a baby with a cough.

Fortunately, generally speaking, coughs can be a good thing — a natural reflex and the body’s way of clearing unwanted, potentially harmful secretions. But babies are little, and it’s natural to worry. That’s why, if you’re wondering what to do for a baby with a cough this season. We touched base with three pediatricians. Here, more about coughs in babies, when to worry, and how to help little ones feel more comfortable.

Types of cough and causes

There is a long list of different “types” of coughs in babies, and they all sound different and can have different root causes. Some coughs in babies — including whooping cough, or pertussis, under 6 months of age — can be very concerning, according to the Centers for Disease Control and Prevention (CDC). Dr. Michael D. Patrick, Jr., M.D., an emergency medicine physician at Nationwide Children’s Hospital and host of the hospital’s podcast PediaCast notes that he’s also seen more cases of pertussis recently with people falling behind on vaccinations due to the pandemic (a whooping cough vaccine is recommended for pregnant women).

Some coughs, however, are more on the mild side. Here are five types of coughs you may hear in your baby:

• A dry or nonproductive cough. This cough does not “produce” mucus or phlegm much like a “wet cough” would. Sometimes, a cough can start as a dry cough and progress to a wet cough or vice versa, explains Dr. Katie Lockwood, M.D., an attending physician at Children’s Hospital of Philadelphia Primary Care, Flourtown.
• A wet or productive cough. A productive cough is when your child is coughing up mucus or phlegm. It may have more of a “wet” sound to it — the result of coughing up mucus, Patrick explains.
• A wheezing cough. A wheezing cough is a high-pitched, whistling-like noise. Babies have smaller airways than adults so they can be at an increased risk for symptoms like wheezing. Lockwood says that wheezing is a sign to see your baby’s doctor — especially if you notice your child is having any kind of trouble breathing — as they may need assistance breathing.
• A barking cough. A barking cough sounds like a seal’s bark and is often the sign of a respiratory virus called croup that makes the airways swell, and calls for a visit to the doctor, advises Patrick. Often, croup can be treated at home. (For babies older than 6 months, you can use medications like acetaminophen or ibuprofen to help with discomfort or fever). But sometimes children need breathing treatments in the hospital or steroid medications to help with airway swelling, says Patrick.
• Whooping Cough (Pertussis). Whooping cough, or pertussis, is a respiratory infection where you may notice your child repeatedly coughing, followed by trouble catching their breath, explains Patrick. “We call that a paroxysmal cough, where you’re coughing so much that it's hard to catch your breath.” Especially if it’s accompanied by difficulty breathing or vomiting, it’s a sign to see a doctor, he says.

When to see a doctor for your baby’s cough

If you’re wondering what to do for a baby with a cough, it’s important to know when to call your child’s pediatrician about symptoms. While you should always trust your parental instincts and call the doctor if you feel like you should, experts also point to these signs as reasons to seek medical attention:

• If your baby is under 3 months old and has a fever over 100.4 degrees Fahrenheit.
• If your baby is 3 months or older and has a temperature of 102 degrees Fahrenheit or higher.
• If your baby has been coughing for more than two weeks.
• If your baby has a fever that returns after going away.
• If your child is showing signs of respiratory distress (flared nostrils, fast breathing, sucking in of the rib cage, wheezing, noisy breathing, discoloration).
• Coughing with vomiting or bleeding.

Home remedies for Baby’s cough

First things first, if you’re wanting to know what to do for a baby with a cough, you have to know that you’re going to want to skip over-the-counter (OTC) cough medicines. “I think it's important for parents to remember that the cough is a natural mechanism to try to get mucus that’s not supposed to be in the airway out of the airway,” says Lockwood. “In general, we try not to suppress the cough because we want the body to do what it's supposed to do, so we don't use cough suppressants in children.”

In fact, The CDC notes that OTC cough and cold medicines should not be used in children under 4 “unless a doctor specifically tells you to” and that for children over 4, it’s best to discuss medications with your child’s doctor. The pediatricians we spoke to remind us that often coughs are the immune system’s natural response to clearing excess mucus, and in that sense, suppressing them shouldn’t always be the goal.

Of course, there are exceptions. For instance, sometimes, in the case of croup, your child may require steroid medications, and with pertussis, they may need an antibiotic, says Patrick. So it’s always a good idea to touch base with your doctor.

Otherwise, home remedies such as the below ones can go a long way in helping a baby with a cough feel better. Just remember: Your baby doesn’t always need home remedies. The American Academy of Pediatrics (AAP) only recommends treating symptoms if your child seems uncomfortable or bothersome or has trouble sleeping. If that’s the case, start with these:

• Steam. Have your baby sit on your lap or in the bathroom while a hot shower runs. The steam can help loosen excess mucus and ease symptoms associated with coughing, says Lockwood.
• Cold air. For a “croup-like” cough, Lockwood says to try exposing your baby to cold air, either by opening the freezer and having your baby breathe in the cold air or, if it’s the winter and not too chilly, going for a walk outdoors.
• A cool mist humidifier near their crib. Cool mist humidifiers are effective at helping break up secretions and relieve some of the drainages that can happen at the back of the throat, particularly when children sleep, says Dr. Colleen Kraft, M.D., an attending physician at Children’s Hospital Los Angeles.
• If your baby is over 1, honey. Try a teaspoon or so of honey every 4 to 6 hours mixed in with small amounts of fluid, suggests Kraft. This combo will help with hydration and loosening secretions. Under 1, honey isn’t safe as tongue babies cannot process the botulinum spores in honey, explains Lockwood.
• Warm or cold fluids. Both warm and cold fluids — say, a popsicle — for children over 6 months could help break up the drip in the back of the throat and provide comfort, says Kraft.
• Saline nose drops. Two or three drops per nostril could help break up mucus for a child who is stuffed up, easing cough-related symptoms, says Kraft.
• A nasal aspirator. Nasal aspirators can help you suck out mucus, making breathing more comfortable. “They are fantastic for getting mucus out of the nose,” says Patrick. You might try this, especially before bottle or breastfeeding, to help make feeding easier for your baby.

The bottom line: Coughs in babies can be concerning for parents, and if you’re ever worried about your child’s cough, it’s always smart to bring them in to see their pediatrician. However, it’s also worth remembering that often, coughs are the body’s natural immune response to pathogens and can be helpful in clearing out excess mucus, keeping viruses from worsening. Using home remedies — and avoiding ones that aren’t safe for babies — is key, as is knowing when to have your child seen by a medical professional.

Experts:

Katie Lockwood, M.D., MEd, an attending physician at Children’s Hospital of Philadelphia Primary Care, Flourtown.

Michael D. Patrick, Jr., M.D., an emergency medicine physician at Nationwide Children’s Hospital and host of the hospital’s podcast PediaCast.

Colleen Kraft, M.D., MBA, an attending physician at Children’s Hospital Los Angeles.