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Coughing Children: When Not to Worry

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We asked Dr. Schmitt, a board-certified pediatrician at Children’s Hospital Colorado, when to worry about coughing, especially during the cold and flu season.

What should I know about coughing?
“Coughs in children are almost always part of a cold caused by a virus, and coughs are not helped by antibiotics,” Dr. Schmitt said. “Yellow or green phlegm tells us the child is getting better, not that the infection has become a bacterial one. Finally, make sure your children’s whooping cough shots are up to date.”

What are “normal” coughs?
Most coughs are part of a cold and are called a lower respiratory infection (LRI) or viral bronchitis. The average child gets four to six periods of cough per year. Parents often worry if the cough is not gone after 10 days. However, coughs with viral infections can last up to three weeks (sometimes six weeks) – it takes that long for the lining of the trachea to heal itself.

Also, a cough that worsens in the evening or at night does not necessarily mean your child has a sinus infection. Most coughs worsen at night.

Why is coughing a good thing?
• The cough reflex has value. It clears out secretions and protects the lungs from pneumonia.
• Noisy breathing (without wheezing or stridor) is also usually normal. Noisy sounds are often due to vibrations from mucus in the nose or secretions pooling in the lower throat. It can be eliminated by coughing, throat clearing, swallowing or suctioning the nose.
• A wet or productive cough means the infection is starting to break up, and your child is coughing up the damaged cells. Productive coughs should be encouraged, not suppressed.
• Coughing up yellow or green sputum (phlegm) is also part of the normal healing phase of a viral bronchitis. It does not mean a bacterial infection has set in.

When should I worry about a cough?
“We ask to see your child for: respiratory distress (trouble breathing), wheezing (as seen with bronchiolitis) or stridor (as seen with a croupy cough),” Dr. Schmitt said. “We also want to see your child if the lips or face turn bluish during coughing. This suggests borderline oxygen levels and possible pneumonia. Most children with a cough, however, don’t have trouble breathing.”

Get more cold and flu resources from Children’s Colorado.

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