Why does my child cough more at night? Cough Q&A

This year’s cold and flu season has been a doozy. I’m reviewing the most common questions I get asked on social media when it comes to managing your child’s cough!

How long should I wait to have a cough evaluated by my pediatrician?

There’s no set amount of time that you should wait before having your child’s cough evaluated. If you’re concerned-feel free to chat with your doctor because we’ll want to know a few things about how your child is acting with the cough. Typical coughs caused by a common cold should be improving or resolved within ten to fourteen days. Coughs lasting longer than this time frame should be evaluated by your child’s pediatrician for other etioligies. I do want to note that you DON’T have to wait ten to fourteen days to be evaluated. You can absolutely bring your child in earlier! In fact, I believe comparing lung exams throughout the progression of the cough can help determine if it’s trending better, worse, or if its stable.

Are there signs I should look out for?

One sign parents should look out for when their child is sick is difficulty breathing. Objectively, we pediatricians call these “work of breathing” or retractions. Retractions indicate that your child is working very hard to breathe. Signs of retractions include nostrils flaring, their belly moving in and out, and breathing in so much the lines of the ribs and/or trachea outline are pronounced. I do want to mention that retractions can be present with normal and abnormal oxygen levels so don’t use oxygen levels to determine if your child is in respiratory distress. If you see any of these signs, speak with your pediatrician as soon as possible!

What is too long for residual cough after virus?

As I mentioned earlier, it can take up to two weeks for a residual cough to improve completely. During this time, your child should start to cough less and be able to resume daily activities without the cough interfering. If the cough hasn’t resolved by ten to fourteen days or is changing/worsening, I recommend taking your child to the pediatrician to rule out other illnesses such as pneumonia.

Is the cough from a lingering cold or allergies?

Whether a cough is from a lingering cold or allergies largely depends on the exam done by the pediatrician. Typically, a cough from allergies is accompanied by a runny nose, watery eyes, or red eyes while a cough from a cold is accompanied by a fever, runny nose, and bodyache-like symptoms. To determine the cause of your child’s cough I recommend being evaluated by your pediatrician. We can use other factors to help determine the nature of the cough like when it’s present and at its worst.

What pre-cautions should I take if my child is coughing?

First, it is important to keep your child home if they are contagious. If your child has a fever, and is not acting theirself it is best to err on the side of caution and keep them home. Once your child’s fever has resolved and is feeling back to his/her normal self, they can return to daycare or school. I do want to note that just because your child still has a cough doesn’t necessarily mean they can’t go back to school. Coughs can linger after any illness and even longer in some uncontrolled asthmatics. If the above criteria have been met, and the cough isn’t interfering with your child’s daily activities, then he/she is safe to return to school. Also be sure to adhere to your child’s school’s sick policy when making this determination.

Make sure to review cough hygiene with your child as well. You can also teach your child how to cover their mouth when coughing or sneezing. Depending on the age, they may need gentle reminders to do so. You can also offer positive praise and reinforcement when your child does cover his/her mouth when coughing or sneezing. Lastly, you can model the behavior for them and explain why you did it.

When do I start to give to give my child medicine for cough? And when do I let it run its course?

I don’t recommend giving a child cough medicine for several reasons. Cough medicines aren’t studied in children and may have sedating side effects that can affect a child’s respiratory rate. Personally, I don’t want to suppress a cough in children either because coughs are protective mechanisms for the body. Pediatricians also like to see how the cough evolves to aid in a diagnosis. Some alternative options to cough medicines are using saline and suctioning to prevent post-nasal drip and honey if your child is over 1 year. You can also speak with your pediatrician to determine if the cough is from allergies and if so, discuss allergy medications as an alternative option.

Is there anything to give to help them with the nighttime coughing?

Nighttime coughing occurs due to congestion from the nose drifting to the back of the nasopharynx when a child lays down which in turn causes a cough. Saline or bath time followed by suctioning can help clear up congestion before you child goes to bed. You can also offer honey if over 1y to help soothe the throat. Again, I generally don’t recommend cough medicines.

What is a habit cough?

Habit coughs are exactly what the name sounds like. It’s a cough that develops out of habit. Habit coughs are usually triggered by a cold but never resolve and are a feed forward cycle. Your child feels a tickle in their throat which causes him/her to cough. The tickle resolves and your child feels better. He/She feels the tickle again which causes him/her to cough again and the cycle continues. Determining if your child has a habit cough is a diagnosis of exclusion. It largely depends on the activity when the coughing is occuring, when it is present, and how it affects the child. The cough should be dry in nature and should not be accompanied by other symptoms. It should not be worse with activity, and should not occur when asleep or distracted. Treatments for habit coughs include reversal therapy and positive reinforcement.

How to keep toddler from coughing so much he/she vomits mucus?

Some children can have overactive gag reflexes causing a feed-forward cycle, like coughing, to be that much worse. If your child is coughing so much he/she vomits, I recommend offering small sips of water to help move the phlegm down to the stomach and prevent retching. If your child is older you can teach him/her to clear his/her throat to suppress the cough. You can also offer warm fluids and throat lozenges to older children.

If your child is vomiting frequently due to coughing, talk to your pediatrician! I’ve seen this occur in children who often have bronchospasm from uncontrolled asthma and really have difficulty managing their cough until they have asthma controller meds on board!

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