Cough in babies: causes, care and when to consult

The newborn's cough is the main reason for paediatric consultations in primary care centres. So many mums and dads come along asking about this that we simply had to bring you the latest evidence from our Happymami midwives, with everything you need to know about the newborn's cough and how to treat a cough in babies.

Why does your baby cough?

Your baby's cough, like yours, is a reflex caused by the forced contraction of the chest wall, the diaphragm and the abdominal muscles against a closed glottis. This innate action is designed to clear secretions and foreign material from your baby's airway. It is triggered by receptors located in the upper and middle respiratory tract, and also in the external auditory canal, the pharynx and the stomach.

Will all babies get a cough?

It is estimated that babies, and especially children of nursery age, suffer an average of 6 respiratory infections a year, concentrated in the winter months. And more than 50% of babies and children suffer some episode of coughing with wheezing in the first years of life, and a third of them will develop bronchial asthma by the age of 6.

What type of cough does your baby have?

In general, we can tell the newborn's cough and that of an older child apart.

• Asthmatic cough: a dry cough accompanied by breathing difficulty, which bothers the baby
• Barking cough: a dry cough that irritates the throat, very characteristic of laryngitis
• Whooping cough: it consists of several rapid bursts of coughing, followed by a sharp intake of breath.
• Loose or productive cough: it is called this because it comes with phlegm. It doesn't hurt, but it is uncomfortable.
• Dry cough: this cough leaves the throat dry, with no phlegm, irritating the area and causing discomfort and even pain.

What should you do if your baby coughs?

As we mentioned earlier, your baby's cough, like yours, is a defence mechanism of the body. So it seems logical that stopping the baby from coughing would not be entirely justified. What is more, the usual medicines used for a cough in children are not advisable because of the lack of evidence.

If your baby has a coughing fit with no other apparent symptom of breathing difficulty, the treatment is symptomatic, based on humidity, plenty of fluids and nasal rinses with saline solution.

If your baby is over one year old, honey can be beneficial if they are suffering from a dry cough, as at the start of a cold. That said, do not dip the dummy in honey, and do not forget to brush their teeth.

To achieve that humidity for a cough, you can use humidifiers, but bear in mind that whether it is advisable to use them depends on the type of cough. Because there are cases in which they do more harm than good.

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When should I see a doctor about a cough?

The Spanish Association of Paediatrics tells us that we should go to hospital if our baby has a cough in the following cases

• Cough with difficulty breathing.
• Inspiratory stridor (a noise when taking air in), especially if it causes tiredness or when it appears in a baby.
• Suspected aspiration of a foreign body.
• Persistent cough (more than 3 weeks).
• Cough and prolonged fever.
• Cough in fits with colour changes (bluish/cyanotic lips or face).

What will the paediatrician assess at the appointment if you go because of a cough?

First of all, they will distinguish between a cough of recent onset and a prolonged or chronic cough (when it lasts more than 3 weeks). They will then look for the cause of the cough, which varies depending on your baby's age. But the most common causes are respiratory infections and reactive airway disease.

To get this information, they will ask you some key questions: how long has your baby had the cough? Is it worse at a particular time of day? What are the characteristics of the cough? Is it accompanied by any other symptom?

In addition, after this appointment your paediatrician may request a chest X-ray and a basic blood test for your baby. Even, if necessary and depending on the baby's history, this could be extended with an allergy and immunity study.

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Types of cough in babies and their treatment

The treatment for your baby's cough that the paediatrician prescribes will depend on the suspected cause. Most cases are due to viral infections of the upper respiratory tract and will only need symptomatic treatment. If mild laryngitis has been diagnosed, your baby may be given a dose of oral corticosteroids together with an inhaler. If it is an asthma attack, your baby will be prescribed a bronchodilator treatment (an inhaler), and sometimes also an oral corticosteroid. And if, on the other hand, it were pneumonia, they will give antibiotic treatment, just as they would for sinusitis.

Baby's short-lived cough with no breathing difficulty

This cough is characterised by being short-lived, with normal auscultation and no signs of breathing difficulty. Symptomatic treatment will be based on humidity, plenty of fluids and nasal rinses with saline solution.

This cough is a protective mechanism, so cough suppressant treatments are not indicated; their effectiveness has not been proven in children either, and they can have undesirable side effects. This also applies to antihistamines, decongestants, mucolytics and expectorants. Antibiotics are not needed either, since they do not change the clinical course, nor do they prevent bacterial superinfection, and they also increase the risk of colonisation by resistant germs.

Baby with a barking cough

This cough is called stridulous (a dry "barking" cough). It is caused by an acute inflammation of the airways. This cough, which usually gets worse at night and especially in the first two or three days, is treated with corticosteroids and a nebuliser is added. You will also be told to come back with your baby if the episode happens again. In these cases, the beneficial effect of humidity has not been proven.

Baby with bronchiolitis

In these cases, we must bear in mind that if it is the first episode and it is a baby under 2 years old, we are dealing with bronchiolitis. If they have had a previous episode of coughing with wheezing and are under six years old, it will probably be a bronchospasm due to bronchial hyperreactivity triggered by a respiratory infection. If they are over 6 years old, the cause will most likely be allergic. And we speak of asthma when there have been more than three episodes of bronchospasm.

If it is a case of bronchiolitis, nebulised adrenaline will be given, since corticosteroids have not shown any benefit. In all other situations, a bronchodilator will be used (an inhaler on demand), which may be combined with an oral corticosteroid.

Cough in a baby with pneumonia

In this case, your baby has an intense cough with a high fever and breathing difficulty or chest pain. With these symptoms, your paediatrician will suspect pneumonia, which is confirmed with an X-ray and requires antibiotic treatment for 7-10 days.

How does the paediatrician assess the type of cough?

To assess your baby's cough, the paediatrician will take 3 aspects of the cough into account.

Quality of the cough

1. A "barking" cough points the paediatrician towards a diagnosis of laryngitis, unless the clinical picture and the circumstances suggest the aspiration of a foreign body.
2. An irritative cough, intense and followed by a whoop, may indicate a pertussis-like syndrome, especially in children who have not been vaccinated against whooping cough.
3. A "tickly throat" is typical of postnasal drip.

Timing characteristics

1. A night-time cough is typical of bronchial hyperreactivity or a post-viral cough.
2. A daytime cough in babies is more characteristic of sinusitis, although it can also appear at night. Especially if it is accompanied by bad breath, headache or morning eyelid swelling.
3. A chronic morning cough that is productive in a malnourished child will suggest cystic fibrosis.
4. A seasonal cough in spring will probably have an allergic cause
5. A psychogenic cough (nervous cough) will disappear at night

Symptoms and signs that accompany the cough

1. Fever: fever is a non-specific symptom. In viral infections of the upper respiratory tract, it usually appears at the beginning of the illness. It is accompanied by general symptoms and tends to decrease as the respiratory symptoms appear. If the fever starts suddenly and is accompanied by chest pain, the possibility of pneumonia will be considered.
2. Breathing difficulty: this may show as tachypnoea, intercostal retractions or nasal flaring. If nasal flaring is present, it is more serious. If the baby has signs of breathing difficulty, it will make the paediatrician consider the possibility of a bronchospasm, laryngitis, the aspiration of a foreign body or pneumonia.
3. Dysphonia or stridor (a high-pitched sound). This will indicate laryngitis or the aspiration of a foreign body.

Conclusion: how to treat a cough in babies?

As we always tell you, every case is unique, and this information is not intended to rule out the need to see your paediatrician. We want to bring you the latest evidence so that you can understand what may be going on. And above all, in these cases, use your common sense and be patient, because, as we said at the beginning, this is something that will happen again every year during cold season.

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