A hysteria-free explanation of the newborn cough

It starts with one sneeze and a tiny (cute) cough."Bless you!" you say, taking a break from the mountains of laundry and dirty dishes, to capture the moment on your phone.

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Then there’s a little sniffle, another cough coupled with a baby fart, which startles your little man and makes you gush with pride.

A few hours later, you hear multiple sneezes or a series of small cough sounds that cause the alarm bells in your head to go off. Before you know it, you’ve strapped your baby in his car seat and are racing off to the emergency department with your child’s doctor on speed dial.

Could it be allergies? A sinus infection? Respiratory distress—whatever that is?

What if it’s a dangerous viral infection he caught from the grocery run last week?

By the time Dr. Raj picks up his phone, you’ve scared yourself.

It takes a minute for him to calm you down and it is only when you inform him of your child’s symptoms that you realize you may have ‘overreacted’ a bit. Okay, a lot!

He tells you to go back, and you thank him for your time and make a mental note to send him a generous gift basket so he thinks it’s worth putting up with your crazy.

You take his advice, observe your baby’s symptoms, and start to understand your baby’s cough.

Understanding your baby's cough

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Having healthy children is a blessing and as parents, we tend to panic when our children fall ill. But younger babies are still developing their immune systems, and sickness is part of the learning process for their bodies.

The same is true for coughs and colds. Each time a child falls ill or contracts a virus or any other germ, their immune system starts to work; making antibodies that strengthen their immunity, thus protecting them from virus and bacterial infection now and in the future.

While catching a cold may cause a week of runny or blocked noses, a sore throat, and sleepless nights for you, it’s part of growing up and is important in building immunity.

However, it’s important to know the different types of coughs to know when it’s just a blocked nose or one of the warning signs of a respiratory illness.

 

 

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Causes and types of baby coughs

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Newborns can experience various types of coughs, each with distinct causes and characteristics:

• Viral infections: The most common cause, such as the common cold or flu, can lead to frequent coughs in newborns. Other cold-like symptoms include runny or blocked nose.
• Bacterial infections: Though less common, bacterial infections like pneumonia can also cause a dry cough or one with wet mucus.
• Allergies: Newborns can react to allergens by coughing, although this is less common in young children.
• Asthma: Rare in newborns but possible, asthma can cause a persistent cough.
• Gastroesophageal reflux: This can irritate the throat and lungs, leading to coughing.
• Environmental irritants: Smoke or pollution can trigger coughing even in very young children.
• Foreign objects: If a newborn suddenly starts coughing, they may have inhaled something.
• Anatomical issues: Problems with the throat or windpipe structure can cause coughing.
• Croup: Recognisable by a barking, hoarse cough, indicating inflammation around the vocal cords.

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Trouble breathing, whooping cough, runny nose and other symptoms

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Here are some more not-so-fun facts about the other symptoms of coughs:

• Wet coughs are common after a viral infection, and become worse at night due to mucus dripping down the throat (be prepared to spend a few sleepless nights).
• Asthma-related coughs can worsen at night and after exercise, accompanied by wheezing and shortness of breath.
• Croup presents a barking cough and is more common when a child has a cold.
• Inhaled objects cause sudden coughing and wheezing. So if it’s a sudden cough, check for a foreign body, like a small toy. This is especially important for curious children.
• Whooping cough is characterized by severe coughing spells followed by a “whooping” sound on inhalation, persisting long after other cold symptoms have subsided.
• Bronchiolitis is likely if a baby under 12 months has a cough with breathing difficulties. You’ll need to make an appointment with your pediatrician for a proper diagnosis.
• Bacterial bronchitis produces a persistent, wet cough that lasts more than four weeks.

Recognising baby's cough symptoms

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A child’s cough, often part of a cold known as viral bronchitis, manifests with persistent coughing fits lasting over five minutes. Newborns exhibit distinct symptoms like difficulty breathing, which may include struggling for breath, inability to cry loudly, rib retractions, and noisy or rapid breathing. 

Blue coloring on the lips or face is a severe sign of oxygen deprivation. Exposure to irritants like tobacco smoke can also trigger coughs. Serious conditions such as pneumonia or whooping cough demand immediate medical attention. Recognizing these signs early is crucial for effective treatment. 

Here's when to seek medical help

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While most coughs may not require you to race to the hospital emergency department, there are some situations where you need to act fast and seek medical attention. Here’s a quick breakdown to help:

Difficulty breathing: Immediate medical attention (call 000)

• Severe breathing difficulties: If your baby struggles for each breath, can barely cry, or has stopped breathing.
• Color changes: If the lips or face turn blue, especially when not coughing.
• Signs of severe distress: If your baby is grunting, unable to catch their breath, or shows rapid stomach movements while breathing.

Urgent medical consultation (call your doctor)

• Persistent or severe symptoms: Any cough in babies younger than 4 months or a cough associated with a fever of 100°F or higher requires a doctor’s visit.
• Respiratory symptoms: Mild wheezing, nonstop coughing spells, or a harsh sound when breathing in (stridor).
• Worrying signs with fever: If your baby has a high-risk condition like cystic fibrosis, a weakened immune system, or a fever over 104°F, see a doctor immediately.

Consult within 24 hours

• If symptoms persist: For babies younger than 6 months with any cough, or if there’s an earache, drainage, or a fever that lasts more than 3 days.
• Recurring symptoms: If the fever returns after being absent for more than 24 hours.

Doctor’s visit during office hours

• Ongoing issues: If coughing causes vomiting three or more times, a runny nose lasts more than 14 days, or the cough itself persists for more than 3 weeks.
• General concerns: Whenever you have other questions or concerns that do not require immediate attention.

Diagnosing and treating baby cough

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Tests and examinations

When diagnosing a child’s cough, doctors typically start with a review of the baby’s medical history and a physical examination to assess symptoms and look for signs of respiratory issues.

If pneumonia is suspected or there’s concern about the inhalation of a foreign body, a chest X-ray may be ordered. 

For suspected serious infections, blood tests can help identify infection markers, while a swab from the back of the nose may be used to test for whooping cough.

In cases where the cough persists beyond four weeks or is accompanied by issues like poor weight gain, a referral to a pediatrician or respiratory specialist might be necessary for further evaluation and possibly more specialized tests. 

Effective treatments for mild cough

When treating a child’s cough, it’s essential to use safe methods.

There is no such thing as baby cough medicine. Full stop.

For common colds, ensure the baby is well-hydrated and rested. Utilise saline drops for nasal congestion and a cool-mist humidifier to soothe the cough. Honey is effective for babies over one year. 

For croup, exposing the child to steam in a closed bathroom or cool, damp air can help ease breathing. Treat bronchiolitis at home by monitoring the baby’s hydration and rest, but seek immediate medical attention if the respiratory rate exceeds 50 breaths per minute. If whooping cough is suspected, hospitalisation is necessary to provide oxygen during severe coughing fits. 

For asthma symptoms like wheezing, consult a doctor who may prescribe treatments and asthma medication such as nebulized albuterol.

Always monitor the baby closely for any signs of worsening or severe symptoms and consult healthcare providers promptly.

Preventing baby cough

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To prevent newborn coughing, it’s important to adopt effective hygiene and vaccination strategies. Regular hand washing with warm, soapy water can significantly reduce the transmission of germs. Encourage sneezing or coughing into a tissue or the elbow to prevent spreading airborne pathogens. 

Vaccination plays a crucial role; flu immunisation is recommended for all children over 6 months annuallyto lessen the risk of flu-related coughs. Additionally, vaccinating your child against pneumococcal disease as part of the National Immunization Program can help prevent coughs caused by pneumococcal infections. 

For children with asthma, adherence to an asthma action plan and regular medical reviews are essential to prevent coughs triggered by asthma. Also, prevent the risk of inhaling foreign objects by ensuring small items like nuts or tiny toys are out of reach for babies and toddlers.

Care advice and tips for baby cough

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So with cough syrup being a no-no, and your Dr. Raj telling you it’ll go away on its own, is there anything you can do to help your baby feel better?

Well, actually, yes!

Tip 1: Sip on warm clear fluids

For babies aged 6 months to 1 year, offering warm, clear fluids like apple juice or lemonade can help reduce throat irritation. Administer 1-2 teaspoons (5–10 mL) up to four times a day when coughing.

For infants under 6 months, stick to breast milk or formula, or sip on some apple juice yourself so they’ll get some of its goodness too!

Tip 2: Humidity and warm mist are your new BFF’s

Using a humidifier can add moisture to dry air, making it easier for your baby to breathe and soothing any cough irritation. Sitting in a bathroom with the shower running to create a steamy environment can also help relax the airways.

Tip 3: Avoid honey and strong medicines

Avoid giving honey to children younger than 12 months due to the risk of botulism. Also, no over-the-counter cold and cough medicines for children under six years old, as they can cause serious side effects and are often ineffective.

Listen to your pediatrician!

Tip 4: Handling coughing fits and vomiting

During episodes of hard coughing that lead to vomiting, try feeding smaller amounts more frequently.

Tip 5: Fever management

If your child’s having other symptoms like fevers above 39°C, your doctor may suggest acetaminophen (such as Tylenol) to help reduce the fever. Avoid ibuprofen in babies under 6 months.

Tip 6: Smoke-free environment:

Keep the air around your baby free from tobacco smoke, as it can exacerbate coughing and respiratory difficulties. Use an air purifier and humidifier to tackle impurities and dryness.

Tip 7: Returning to child care:

Your child can return to child care once the fever has resolved, but be aware that coughs and colds are highly contagious.

Wrapping it up

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And that’s it. So if your newborn or young child is coughing, stay calm but be vigilant and observe their breathing and other symptoms.

I’d like to think of this as a way of making up to Dr. Raj. I may or may not have sent him photos of dirty diapers at 3 a.m in the morning with long, hysterical voice notes, only to be told it was the color green because of the broccoli I had for lunch.

Yeah, I know. It was awkward.

Also, side note: if they’re not already teaching, ‘Hysterical Mom 101’ in medical school, I think it’s time they added it to the course!

Sources

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https://www.seattlechildrens.org/conditions/a-z/cough-0-12-months/

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/coughing-and-wheezing-in-children

https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/whooping-cough

https://www.chla.org/blog/advice-experts/decoding-your-babys-cough