8 Reasons Your Baby Might Be Coughing

Your baby will likely cough quite a bit in their first year of life—and for good reason. Coughs are the body’s way of protecting itself. Your baby’s cough works to keep their airways clear and clear the throat of phlegm, postnasal drip (nasal mucus that drips down the back of the throat), or a lodged piece of food, explains Howard Balbi, MD, director of pediatric infectious diseases at Nassau County Medical Center.

But here’s where things get tricky: A baby’s cough can mean many different things, and it’s not as if you can ask them what’s wrong. Sometimes it’s hard to know when to worry about your baby’s cough and if you should call your health care provider for advice or head straight to the emergency room.

Here, experts break down how to tell the difference between a wait-and-see cough from one that demands immediate medical attention.

Why Your Baby Might Be Coughing

When something irritates your lungs or throat, you cough in response. Some common causes of coughing in babies include:

• Allergies: Most children don’t develop seasonal allergies until after age 2, but your baby could be allergic to something else in their environment. Pet dander, dust, mold, and other household allergens are common culprits.
• Asthma: If your baby tends to cough while trying to fall asleep at night and they aren’t otherwise sick, their cough could be due to asthma, a chronic inflammatory disease of the airways.
• Illness: Everything from respiratory viruses like a cold, flu, or croup to bacterial infections such as bronchitis, pneumonia, and whooping cough (pertussis) can trigger coughing in babies. This is usually due to an increase in mucus in the throat or lungs, or sometimes because of inflamed or irritated bronchial tissue.
• Reflux: Babies are prone to gastroesophageal reflux disease (GERD), which can cause coughing and gagging as stomach acid irritates the throat. 

Is your baby’s cough chronic, or does it only happen when they’re sleeping? Does it last for a few days, come with a runny nose or congestion, and then disappear? Does it only happen at Grandma’s house? Understanding the context is an important diagnostic tool for health care providers, and it may help to collect some “data” before calling a health care provider.

When To Worry About Your Baby’s Cough

While wait-and-see can be a good approach for some baby coughs, there are times when you should definitely not wait to seek care.

Call your health care provider about your baby’s cough if:

• They’re younger than 4 months.
• They have a fever that lasts more than three days (or have any fever under the age of 2 months).
• Their breathing is noisy (like rattling or whistling).
• They have mild, light wheezing.
• The cough lasts more than 10 to 14 days.
• They frequently cough at night.
• They frequently cough after eating.
• They show signs of dehydration.
• They have fits of severe coughing.

Call 9-1-1 about your baby’s cough if:

• They appear to be unable to catch their breath.
• They are breathing rapidly.
• They are coughing with a barking or “whooping” sound.
• They cough up blood.
• They are grunting.
• Their skin or lips are pale, bluish, purplish, or grayish.
• They have skin retractions (skin pulling in) at the neck and chest area with inhaling.
• They are having trouble crying.
• They refuse to eat or drink.
• They show signs of excessive sleepiness or lethargy.
• They are wheezing rapidly.

Types of Baby Coughs

If your baby has a cough, it’s important to break down the details for proper diagnosis and treatment. There are two main kinds of coughs that a baby might have: a dry cough or wet cough.

• Baby dry cough: A dry cough is unproductive, meaning it doesn’t produce mucus. A dry cough might occur when a baby has a cold or allergies, and it helps clear postnasal drip or irritation from a sore throat.
• Baby wet cough: A wet cough signals phlegm or mucus (which contains white blood cells to help fight germs) in the baby’s airways. It often results from a respiratory illness accompanying a bacterial infection.

Beyond being wet or dry, the cause of your baby’s cough will affect how it sounds, what other symptoms they have, and how the cough should be treated.

Baby cough from a cold

If your baby has a dry, hacking cough along with symptoms like a stuffy nose, it could indicate a cold. Coughs that accompany colds are usually dry, but depending on the severity of the cold, your baby can have rattling mucus or even a slight fever.

Although you may be eager to give your baby cough medicine or cough syrup, the American Academy of Pediatrics (AAP) advises against using these products for kids under 6 years because studies have shown that they don’t work, and they can have potentially fatal side effects in children younger than 4.

It’s better to stick to natural baby cough remedies such as honey (for babies over 1 year), saline nose drops, and a cool-mist humidifier. Tylenol (acetaminophen) is safe for reducing a fever. If your child’s temperature is 100.4 degrees or higher and they look sick, call your health care provider.

Baby cough from croup

Usually caused by a viral infection, croup makes the lining of the trachea swell up and closes the airways, which leads to breathing difficulties in babies. This will sound more like a barking cough, which is the most telling symptom of croup. The seal-like barking cough appears when your baby inhales (not on the exhale).

Croup typically affects children under age 5 and often begins with a normal cold or sniffle earlier in the day. After you first hear your baby coughing in sleep, croup should clear up in three or four days. If it doesn’t, call your health care provider.

To treat croup, run the shower, close the bathroom door, and let your child breathe in the steamy air. You can also set up a cool-mist humidifier. Cool air from the fridge or freezer can be helpful as well.

Baby cough from COVID-19

Babies usually have mild or asymptomatic cases of COVID-19, but they can also develop a wide range of symptoms like fever, a runny nose, shortness of breath, vomiting, or diarrhea. Symptoms generally appear within two to 14 days of exposure to the virus, and they often resemble a cold or flu.

You’ll likely notice a dry and continuous cough, though wet coughs are also possible. Some babies get a barking cough that resembles croup.

Contact your health care provider if you suspect COVID-19. They might recommend getting your baby tested. If they have COVID-19, isolate them (and their primary caregiver) away from other household members. Seek medical help for worrisome symptoms, such as breathing or feeding difficulties, dehydration, or an inability to wake.

Baby cough from bronchiolitis

Bronchiolitis is characterized by inflammation of the small airways in your lungs. Many things can cause constriction of the airways, including environmental factors such as dust. But the vast majority of bronchiolitis cases in babies under age 1 are caused by respiratory syncytial virus (RSV).

RSV usually triggers a simple cold in kids older than 3, but it can penetrate the lungs of infants and can be potentially life-threatening, warns David Rubin, MD, chief of pediatrics at St. Barnabas Hospital in the Bronx, New York. It may also lead to a wheezing cough in babies.

Bronchiolitis comes on after what seems to be a common cold, with coughing and a runny nose. Since baby cough or wheezing is associated with both bronchiolitis and asthma, it can be hard to tell them apart. But bronchiolitis is usually seen in the fall and winter and may be accompanied by a slight fever and loss of appetite.

You can treat bronchiolitis at home once your baby’s breathing is under control. Give them lots of fluids, plenty of rest, and a cool-mist humidifier, and always keep an eye on your child’s respiratory rate. If it gets too high (50 breaths per minute or more), your child is in respiratory distress. Call 9-1-1.

Baby cough from whooping cough

Whooping cough (pertussis) is a life-threatening bacterial infection and was a leading cause of infant illness and death until the DTaP vaccine was created in the 1960s. With a dip in the vaccination rate, whooping cough has been making a comeback, and there have been outbreaks in many states in recent years.

If your baby is experiencing whooping cough, it will sound like a loud, rapid whoop. Other symptoms might include frequent, alarming coughing spasms, tongue sticking out, bulging eyes, and face discoloration.

To prevent whooping cough, make sure your baby gets immunized when they’re eligible. It’s also essential that you and all of your infants’ caregivers get vaccinated with the tetanus, diphtheria, pertussis (Tdap) booster since babies aren’t fully protected until they’ve received multiple doses of the vaccine.

If you suspect whooping cough, call 9-1-1 immediately. By the time the coughing fits develop, the infant must be hospitalized so they can receive oxygen during coughing spells and be treated with an antibiotic, says Ruffin Franklin, MD, of Capitol Pediatrics and Adolescent Center in Raleigh, North Carolina.

Baby cough from pneumonia

Pneumonia is a viral or bacterial infection of the lungs that can be brought on by a number of conditions, including the common cold. A cough that indicates pneumonia will most likely sound wet and phlegmy.

A baby with pneumonia will be very fatigued. They will also have a “productive” wet baby cough, bringing up everything imaginable in shades of green and yellow.

Treatment depends on whether the cause is viral or bacterial, so call your health care provider, especially if your baby has a fever. Bacterial pneumonia is usually more dangerous and is most commonly caused by the Streptococcus pneumonia bacteria.

Baby cough from asthma

Because asthma involves a narrowing of the airways, a baby’s cough with asthma will sound like wheezing. Health care providers generally agree that asthma is not common in children younger than 2, unless the baby has had bouts of eczema and there’s a family history of allergies and asthma. Until there’s an absolute diagnosis of asthma, a tightening of a baby’s airways resulting in wheezing is referred to as reactive airway disease.

In the case of severe asthma symptoms, your baby will have retractions (a sucking in and out of the chest and diaphragm) with breathing. Your infant might also display other symptoms like fast breathing, panting, difficulty eating or sucking, and tiredness.

Whatever the case, it’s always best to call your health care provider when you hear your infant wheezing. Even without a definitive diagnosis of asthma, providers often use asthma medication to treat a bout of wheezing.

If a young baby has a terrible cough or one that worsens after a day or two, and their breathing becomes labored, call your pediatrician immediately. As with bronchiolitis, keep an eye on your child’s respiratory rate, and if it gets too high, call 9-1-1.

Baby cough from a foreign object

Small toys and food, such as a piece of raw carrot or hot dog, are the most common causes of choking in babies and young children. If a baby starts gasping or coughing suddenly while eating or playing with small toys, look in their mouth for an obvious culprit. They can usually cough it out themselves. A cough without any noise may indicate a complete obstruction and is a medical emergency.

Since babies are always sticking things in their mouths, it’s possible to miss something that’s been stuck for days. Signs that your baby’s cough may be caused by a foreign object include:

• Coughing spell followed by chronic cough or wheezing: An initial coughing spell followed by a persistent cough or slight wheezing over a period of days after without any other cold symptoms and no recent history of cold or fever
• Pneumonia: Pneumonia can also be a result of food that got swallowed the wrong way (aspirated) and stuck in a baby’s lungs, says Catherine Dundon, MD, an associate clinical professor of pediatrics at Vanderbilt University Medical School and a pediatrician in Goodlettsville, Tennessee.

If the object has totally blocked your baby’s airway, they would exhibit the following symptoms:

• Appearing to be in obvious distress
• Making no sound at all
• Turning pale, bluish, purplish, or grayish

If you suspect a totally blocked passageway, turn the baby over and immediately deliver five back blows between their shoulder blades. If you’re unable to dislodge the foreign object, call 9-1-1.

In the case of a partially lodged object, try to help your baby cough it up by tilting their head down and giving them a few gentle pats on the back. If you suspect your baby has a partially lodged object, but they don’t appear able to cough it up, they’ll need a chest x-ray.