Cough in children

Coughing is an important reflex that helps to clear mucus from your airways. It is a common symptom in children, especially when they are under 5 years of age. A cough can sound awful, but it is rarely a sign of serious illness.

Key points about cough in children

Many children get a cough when they have a cold and will continue coughing for 3 weeks or more.
The cough will normally get better on its own, given rest and time.
However, it's important to know when you should see your doctor for your child's cough (see red box below).
There are many causes of a cough and treatment depends on the cause.
Most coughs though can be treated at home by giving your child rest and lots of water to drink.

See your doctor straight away if your child has a cough and:
is working hard to breathe or is breathing fast has a temperature higher than 38.5 degrees Celsius has difficulty speaking normally or is unable to finish a whole sentence because of their coughing or breathing you can hear wheezing or whistling in their chest. Call 111 if the cough could be due to choking.Food or an object going down the wrong way causes a cough that starts suddenly when eating or playing. You should also see your doctor if your child has a cough that has lasted more than 4 weeks. If you are worried about your child's cough and unsure what to do, call Healthline on 0800 611 116.

See your doctor straight away if your child has a cough and:

is working hard to breathe or is breathing fast
has a temperature higher than 38.5 degrees Celsius
has difficulty speaking normally or is unable to finish a whole sentence because of their coughing or breathing
you can hear wheezing or whistling in their chest.

Call 111 if the cough could be due to choking.Food or an object going down the wrong way causes a cough that starts suddenly when eating or playing.

You should also see your doctor if your child has a cough that has lasted more than 4 weeks.

If you are worried about your child's cough and unsure what to do, call Healthline on 0800 611 116.

What are the different types of cough?

A cough is often described as being wet or dry.

A wet cough:	A dry cough:
sounds chesty and phlegmy is also known as a productive cough.	is less likely to produce phlegm (mucus) can sound irritated, harsh, barking, or whooping is also known as a non-productive cough.

What are the causes of cough in children?

Colds or chest infections

Young children usually have between 6 and 12 upper respiratory tract infections each year. These may cluster around the winter months. If they are at daycare, this can be more. A wet, chesty cough may be due to a chest infection. If it lasts more than 2 weeks you need to see a doctor. Read more aboutcolds or chest infections.

Bronchiolitis

Bronchiolitis is a common viral chest infection in children under 12 months of age. Read more aboutbronchiolitis.

Post-viral cough

Some children can have a persistent dry cough for 3 weeks after a viral infection. As children may have many infections in a year this can seem like one long infection.A persistent wet cough for more than 4 weeks is unusual and you should see your doctor.

Asthma

An asthma-related cough is usually dry and happens at night, with sport or in the early morning. An asthma cough is usually associated with other symptoms such as wheeze, allergy (eczemaorhay fever), or a history of asthma and allergy in the family.

If coughing is the only symptom your child has, it is very unlikely to be due to asthma. Read more aboutasthma in children.

Smoke exposure

二手烟childr常见原因en to cough even when they are well. Make sure your child's environment is smokefree. Ask all visitors and whānau to smoke outside and keep your car smokefree too.

Support family/whānauand friends toquit smoking. Call Quitline on 0800 778 778. See also why tobe smokefree for your kids.

Whooping cough

This can start like a cold or flu, but the cough persists and gets worse with coughing spasms which can last weeks.It is often serious in babies which is why vaccination is so important.Read more aboutwhooping cough.

Croup

This can also start like a cold or flu and after a day or two can lead to a barking cough and raspy breathing. Read more aboutcroup

Bronchiectasis

If your child has a cough that lasts more than 4 weeks, they should see a doctor. One of the serious conditions to be considered is bronchiectasis.If a wet, persistent cough is left without treatment there is arisk of scarring and permanent damage to their lungs. Read more aboutbronchiectasis.

Inhaled foreign body

A cough, choking or breathing difficulty that starts suddenly while a child is eating or playing could be due to food or another object (foreign body) being breathed (inhaled) into their lungs. This can be immediately life-threatening so call 111 if your child has difficulty breathing or turns a pale or blue colour.

Looking after a child with a cough

Making your child more comfortable is the main focus. There are no medicines to treat the commonest viral causes of cough.
Encourage rest and give lots of water to drink.
For children older than 12 months, honey can help soothe their cough.
Vapour rubs can be applied to their chest and back. However, there is little scientific evidence as to how well they work and they are not recommended for babies under 3 months. Avoid putting the rub near the nostril area.
Simple pain relievers such asparacetamol(commonly known as Pamol or Panadol) can be used to reduce pain or fever and make your child more comfortable.
Keeping your homesmokefree,warm, clean and dry is best for your children’s health.

Antibiotics don’t help coughing caused by a viral infection

Antibiotics are not helpful for a cough caused by a viral infection. But if your doctor finds that your child's cough is due to a bacterial infection in their throat or chest, they may prescribe antibiotics.

Can cough medicines be used for children?

Cough and cold medicines are designed to help reduce the symptoms of the common cold such as runny nose and cough. They do not cure the infection.

The ingredients in these medicines can cause serious side effects in young children. To avoid harm:

over-the-counter cough and cold medicines are not recommended for children under 6 years of age
only those labelled as safe for children should be given to children 6 years of age and older.

For more information,ask your pharmacist orseecough and cold medicines – advice for parents.

Learn more

The following links provide further information about cough in children. Be aware that websites from other countries may have information that differs from NZ recommendations.

Cough卫生部,新西兰
CoughKidsHealth, NZ

Reference

Cough in childrenAuckland Regional HealthPathways, NZ, 2020

Reviewed by

	Dr Alice Millertrained as a GP in the UK and has been working in New Zealand since 2013. She has undertaken extra study in diabetes, sexual and reproductive healthcare, and skin cancer medicine. Alice has a special interest in preventative health and self-care, which she is building on by studying for the Diploma of Public Health with the University of Otago in Wellington.

Credits: Health Navigator Editorial Team. Reviewed By: Dr Alice Miller, FRNZCGP Last reviewed: 12 Jan 2021 Page last updated: 07 Jul 2022

Information for healthcare providers on cough in children

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Red flags for cough in children
Infants who have apnoea or cyanosis during paroxysms of coughing Infants whose cough is triggered by feeding Children with an episode of choking on food or while playing

Investigations

If acute cough,assess risk and test for COVID-19according to the latest Ministry of Health guidelines (COVID-19: Information for health professionals卫生部,新西兰, 2020):

Other investigations to consider in children with cough:

chest x-ray - rarely indicated for cough in the primary care setting, with some exceptions. Indications include:
- Equivocal clinical signs of pneumonia
- Possible inhaled foreign body
  - Most lodge in intrathoracic tracheobronchial tree.
  - Need films in full inspiration and expiration to demonstrate air trapping or collapse.
- In asthma or bronchiolitis only if:
  - diagnosis is unclear.
  - 严重的攻击不responding to standard therapy.
- Note that focal signs with or without fever are most likely due to mucus plug and viral illness rather than pneumonia.
- FBC - indicated if the cough is associated with failure to thrive, night sweats, or suspicion of serious disease. Almost never indicated in well children with chronic cough.
- spirometry in older child
- sputum microbiology in older child if productive

进一步的调查would be done in secondary care.

When to refer a child with cough

The following information comes from the Auckland Regional HealthPathway oncough in children(accessed January 2021):

Requestacute paediatric assessmentif:
- any red flags
- family history of tuberculosis or recently arrived via a refugee camp.
- suspicion of inhaled foreign body after chest X-ray.
Requestnon-acute paediatric assessmentif:
- regular trigger or association with the cough such as with feeding.
- persistent choking or vomiting episodes with the cough.
- abnormal examination findings indicative of serious disease (eg clubbing, anaemia, poor weight gain).
- suspected tracheomalacia or bronchomalacia.
- suspected bronchiectasis.
- suspected cystic fibrosis.
- significant chest X-ray findings other than acute infection.
- coughing> 4 weeks and you have not reached a firm diagnosis.
If need for admission is uncertain, seekpaediatric advice.
Discuss with local Public Health team, if:
- cough follows exposure to adult pulmonary TB.
- recently in refugee camp.

Clinical resources

COVID-19 child assessment and managementAuckland Regional HealthPathways, NZ, 2020
Cough in childrenAuckland Regional HealthPathways, NZ, 2020
CoughStarship Clinical Guidelines, NZ, 2019
Cough in children guideBPAC, NZ, 2010
Clinical pointers– managing recurrent or persistent cough in children under 5BMJ学习,皇家New Zealand College of General Practitioners Modules (requires registration)
Effect of honey, dextromethorphan, and no treatment on nocturnal coughJAMA Pediatrics
Cough in children–when does it matter?Paediatric Respiratory Reviews
Chronic Cough Hypersensitivity SyndromeBioMed Central

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers.If you do not know the login details, contact your DHB or PHO for more information: