Toddler and Baby Cough gives information on causes of acute and chronic cough

This page answers questions about toddler and baby cough - the causes of and how to manage the cough.

Studies have shown that normal children can cough up to 10 times a day, and this can increase up to 100 times a day with a cold.

Cough is a common symptom seen in babies and toddlers and can be

acute cough - lasting 2 weeks or less. Approximately 80% of cough in pre-school children will last less than 2 weeks

chronic cough - lasting more than 4 weeks

What causes acute toddler or baby cough?

Acute cough - so cough lasting less than 2 weeks - is most commonly caused by viral respiratory tract infections in children.

Cough associated with wheezing is most usually caused by asthma.

In a small proportion, toddler or baby cough is caused by bronchitis or pneumonia.

Toddlers who put small objects in their mouths can inhale them into the lungs and this can cause cough, so if your toddler has had a choking episode, you may need him to be evaluated for an inhaled foreign body - this usually involves an chest x-ray.

Are there any complications from acute cough in children?

Most (approximately 9 out of 10) toddler or baby cough will have no complications.

Of those children that do get complications,

painful ears and otitis media are the most common complications,
followed by diarrhea and vomiting,
then a small number will get bronchitis or pneumonia.

Some children will have a protracted course, so the cough will last longer than 2 weeks and may last up to 4 weeks. The features will be of a non-specific cough - see below.

What are the features of a non-specific chronic cough in children?

Non-specific cough in children has the following features:

it is a dry cough
your child will not have any difficulty breathing
your child will be growing normally
your child will not be unwell in any other way
lasts less than 2 months in the summer or 3 months in the "cold" season

What is the treatment of non-specific chronic cough in children?

The most important thing you can do is to ensure your child is not exposed to tobacco smoke.

Simple measures to stop cough are all that are usually required.

What should I do for acute cough in my baby or toddler?

In most cases of toddler or baby cough, as the cause is a viral upper respiratory tract infection, only supportive treatment is needed, so keep your infant or toddler's fluids up so he doesn't get dehydrated, and give paracetamol or acetaminophen for fever if he is uncomfortable.

If you are concerned your toddler may have aspirated (inhaled) a foreign object, so if you can remember a choking episode at the beginning of the cough, see your doctor for a chest x-ray. It is important that foreign bodies in the lungs are removed as they can cause long term lung damage if they are not removed.

If your child has wheezing with the cough, asthma medication may be required so see your doctor.

If your child is unwell or is having difficulty breathing, see your doctor as he may have an infection that requires antibiotics.

Does the type of cough help in determining the cause?

There are some coughs that help make a specific diagnosis, such as:

a barking cough - seen in croup
a paroxysmal cough with a "whoop" at the end - usually due to pertussis (whooping cough)
a wet/moist cough is often seen with infection

When should I see a doctor for acute cough?

See your doctor if your toddler or baby cough is associated with:

a choking episode
your child being unwell
your child having signs of difficulty breathing
paroxysms of coughing, particularly if there is a whoop

What are the causes of chronic toddler or baby cough?

There are a number of reasons a toddler or infant may have cough lasting longer than 4 weeks of age.

Assessment including clinical examination by a doctor will be required looking for a specific causes, such as:

protracted bacterial bronchitis - a moist cough lasting more than 2 - 4 weeks that responds to antibiotics

cystic fibrosis - a genetic condition that causes frequent chest infections and poor growth

immunodeficiency - poor immune function means that children have limited natural fight mechanisms against disease

suppurative lung disease, such as bronchiectasis - is associated with repeated moist cough after waking, after infections and after exercise. It is seen more commonly in some populations, such as in Pacific children

TB (tuberculosis) - this is an infectious disease and there is usually a history of contact with an infected person

cardiac disease

congenital lung problem

Investigations for chronic cough include chest x-ray and consideration of the Mantoux test for TB.

Specific causes of toddler or baby cough, if found, will be treated accordingly. However, quite a number of children with chronic cough will have non-specific features.

Non-specific cough is quite common in children, and if your toddler has features of non-specific cough, little investigation other than a chest x-ray will be required.

What is protracted bronchitis?

Protracted bronchitis is a common cause of chronic cough in children. The features are:

wet/moist cough
symptoms resolve with a course of antibiotics
no symptoms or signs of a specific cause of the chronic cough

The treatment is antibiotics.

Is asthma a cause of isolated cough in children?

Not usually. Asthma in children is usually associated with wheezing and distress in breathing. Isolated cough is usually not asthma and does not respond to asthma medication.

Why doesn't my child produce sputum?

Children do make sputum, particularly if they have an infection. However, they tend to swallow the sputum rather than spit it out so it is uncommon to see sputum when children have infections.

Sometimes, the coughing associated with an infection can cause vomiting and the vomit will have mucus (sputum) in it.

References

Chang et al. Cough in Children:definitions and clinical evaluation. MJA 2006.184(8):398-403
Alastair D Hay and Andrew D Wilson. The natural history of acute cough in children aged 0 to 4 years in primary care:a systematic review. British Journal of General Practice, 2002, 52, 401-409

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Last reviewed 24 May 2010

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