700 Children's® – A Blog by Pediatric Experts

Cough Talk: What Does All That Hacking Mean?

Nov 01, 2023

Right now, there is probably at least one person in your household with a cough. Coughs are often associated with the common cold and will get better with time, but sometimes there are other causes that do require treatment. A lot of coughing could be a sign of a serious illness. Here are some things to consider.

Barking Cough

The distinctive ‘seal bark’ cough of croup is caused by inflammation of the voice box and throat. This cough is usually worse at night. It is caused by a virus and does not require antibiotics. If it is mild, try to keep your baby or child calm and run a cool mist humidifier by the bedside. 

If the cough continues, encourage them to breath cool, damp air. If it is 50 degrees or cooler you can take them outside to breath the night air or if you want to stay inside, open the freezer and have them breath the freezer mist. 

If you prefer staying warm, turn on hot water until it steams up the bathroom and have your child sit in the bathroom with you. Be careful to keep your child away from the hot water. If the water is hot enough to steam the bathroom it is too hot to touch.

If your child is making hoarse noises when they breath, having difficulty speaking or the barking cough is very loud and continuous, they need to go directly to the urgent care or emergency room. They may need medicine to reduce airway inflammation and make them more comfortable.   

Follow up is always important. If your child had a croupy cough of any kind overnight, contact your child’s care team the next morning to make a plan with them.

Loud Whoop

This could be Pertussis, also known as “whooping cough.” A vaccine for this illness is part of every child’s recommended immunization series, however outbreaks of this illness still pop up every few years as not all children are immunized.  

In most cases, a baby will have no cold symptoms or fever, but will suddenly develop coughing fits where they cannot catch a breath. It will sound like long chains of very short dry coughs. The “whoop” comes at the end of the coughing fit when they take a large breath in. Some children will also choke or vomit after coughing.  

People of any age can catch pertussis. Immunization is the best form of protection to prevent this illness. Pertussis can be treated with an antibiotic to fight the infection, but the cough may hang around for up to six weeks. Pertussis can be a serious infection requiring hospital admission, especially in unvaccinated babies.

Wet, Nighttime Coughs

Coughs usually get worse at night, especially when mucous drains from the sinuses down the back of the throat. Reducing nasal congestion and drainage will help decrease throat irritation and coughing. Suggestions include a warm bath to help loosen the mucus, a cool mist humidifier by the bedside, nose blowing and taking a drink to help clear mucus from the back of the throat.

The American Academy of Pediatrics does not recommend over the counter cough and cold medications for children. Studies have shown that they are not effective at improving symptoms and they can have side effects.

Dry, Daytime Coughs

This type of cough can be caused by infection, but also by physical irritation to the throat and lungs. Cold air, increased activity, fragrances and indoor dust (stirred up by the furnace) can all trigger a dry cough. A persistent dry cough could mean allergies or asthma. 

If the cough is persistent, you should contact your child’s primary care team. They will help you determine the cause and possible treatment. If your child is having difficulty catching their breath or is breathing very fast, they should go directly to the urgent care or emergency room.

COVID-19 and RSV

COVID-19 and RSV are two viruses that have had a lot of attention in the past few years. These are both respiratory viruses that have the potential to cause nasal congestion, runny nose, cough and fever. If your child is healthy and does not have underlying medical problems, these viruses will look like any other cold. Provide care for symptoms and keep them away from others to prevent spread until they are fever-free with improving symptoms. 

Home COVID-19 tests are available and accurate. If your child tests positive on a home test they have COVID-19 and need to follow the guidelines posted on the Centers for Disease Control and Prevention website.

As with any illness, if your child is breathing very fast, having difficulty catching their breath, coughing uncontrollably, has excessive fatigue or you feel concerned that this is not their usual cold, then contact your child’s care team. If they are not available, go to your local urgent care of emergency room immediately. 

If your pediatrician has advised you that your child is at risk for a complication from viral illness then you should contact them any time your child develops symptoms; they will help you determine next steps, including viral testing.

Cold and Cough Care

Cough and cold medications are not recommended for children. Teenagers and children should not take prescription or over the counter products that contain codeine, including cough syrup.  

Home remedies to try:

  • Cold humidifier to hydrate the air and help soothe irritated throats.
  • A warm bath before bed to loosen mucus. A warm bath (or shower) in the morning will also help loosen mucus that has built up overnight.
  • In the middle of the night, encourage your child to sit up, blow their nose and take a drink; this will help clear mucus from the nose and throat.
  • For children too young to blow their nose you can use a children’s nasal saline spray. Give 1-2 sprays in each nostril, wait 5-10 minutes then use a nose suction bulb to help remove mucus.
  • Warm tea with lemon juice and pasteurized honey can sooth the throat and help with cough for children over 12 months.
  • If they do not like tea, a little pasteurized honey may help.
    • For children over 12 months you can give a teaspoon of pasteurized honey straight or dissolved in a little warm water to help sooth the throat.
    •  Do NOT give honey to children under the age of 1.

No matter what kind of cough your child has – if it is accompanied by a fever of more than 102˚F, or goes on longer than two weeks, it is time to see a doctor or nurse practitioner.

If your child turns blue with an coughing spell or is having difficulty breathing, or very rapid breathing, go to an urgent care or emergency room immediately.

Check Out Our Guide to Respiratory Season
Download Your Free Symptom Checker Now

Featured Expert

Cynthia Zimm
Cynthia Zimm, MD
Urgent Care

Cynthia S. Zimm, MD, is chief of the Division of Urgent Care at Nationwide Children's Hospital.

All Topics

Browse by Author

About this Blog

Pediatric News You Can Use From America’s Largest Pediatric Hospital and Research Center

700 Children’s® features the most current pediatric health care information and research from our pediatric experts – physicians and specialists who have seen it all. Many of them are parents and bring a special understanding to what our patients and families experience. If you have a child – or care for a child – 700 Children’s was created especially for you.