Causes of coughs in children and teenagers

There are many causes of coughs in children.

By far the most common cause of coughing is a viral respiratory tract infection, like a cold or the flu. Young children can get 6-12 colds a year.

Other, much less common, causes of a cough include:

• bacterial respiratory tract infections
• irritants like cold air, second-hand smoke and pollution
• inhaled foreign objects or choking
• allergies and asthma
• gastro-oesophageal reflux
• swallowing problems or structural issues with the windpipe
• psychological reasons – for example, a habit cough or a tic.

Cough symptoms

Your child’s cough and any other symptoms will vary according to the cause of the cough.

A cough that follows a cold will typically be wet. It’s often worse at night. This is because when your child lies down, mucus drips from the back of their nose and mouth into their windpipe. This kind of cough usually goes away within three weeks, but it might last for up to six weeks after the other symptoms of the cold have gone.

An asthma cough is often worse at night and after exercise. Your child might also have a wheeze and breathing difficulties like shortness of breath.

A barking, hoarse cough could mean that your child has croup.

If your child starts coughing suddenly and also wheezing following a choking episode, he might have inhaled a foreign object.

If your child has had a very heavy cold and then gets bouts of coughing for many weeks afterwards, it might be whooping cough. This kind of cough sounds like barking when your child breathes out and ‘whooping’ when they breathe in.

If your child is less than 12 months old and has breathing difficulties as well as a cough, it might be bronchiolitis.

If your child has a wet, chesty cough that produces mucus that lasts more than four weeks, it might be bacterial bronchitis.

In an older child or teenage child, a cough might become a habit. Usually these coughs are ‘honking’ coughs and don’t happen when the child is asleep.

Does your child need to see a doctor about a cough?

If your child is well except for the cough, your child probably doesn’t need to see a GP.

But you should take your child to see the GP if:

• The cough goes on for longer than two weeks with or without a cold.
• The cough is interfering a lot with your child’s sleep or daily life.
• your child has a cough and a fever.

You should take your child to a hospital emergency department if:

• The cough starts suddenly or there’s a risk your child has inhaled a foreign body.
• Your child has difficulty breathing.

You should call 000 for an ambulance if your child:

• is choking
• has significant breathing difficulties
• is drowsy or hard to wake up
• has skin that’s turning blue or is very pale.

Tests for cough

Most children with coughs don’t need any tests.

A GP can usually work out the cause of your child’s cough by checking the history of the cough and any other symptoms, and also by examining your child.

The doctor might order a chest X-ray if your child has pneumonia or the doctor wants to make sure your child hasn’t inhaled something.

If the doctor wants to check for serious infection, they might send your child for a blood test.

The doctor might take a swab of the back of your child’s nose if they think your child has whooping cough.

If your child is five years or older, your GP might send your child to have some lung function tests if the GP suspects asthma. These tests measure how much and how fast your child can blow out.

If your child’s cough has lasted longer than four weeks or your child is having problems with weight gain or growth, your GP might send your child to see a paediatrician or respiratory specialist for further investigation.

Treatment for cough

Treatment for a cough depends on the underlying cause.

The most common cough is the one that follows a cold. This kind of cough is probably caused by irritation in your child’s respiratory tract, rather than by infection. Your child doesn’t need any special treatment and the cough will improve with time.

If your child is bothered by a cough from an upper respiratory tract infection, honey might help reduce how bad the cough is and how long it lasts. But you shouldn’t give honey to children younger than 12 months because of the risk of infantile botulism, a rare but serious form of food poisoning.

If your child’s cough is caused by asthma, it can be treated with anti-asthma medication like a Ventolin® puffer with a spacer, but this treatment depends on your child’s symptoms and the age of your child. Sometimes young children who have wheezes caused by viruses will be given asthma treatments.

Tobacco smoke can make your child’s cough worse, so keep your home free of second-hand and third-hand smoke.

Ask your pharmacist or GP if you have questions about medications or treatments that might work for your child’s cough.

Cough prevention

Your child and family can take some simple precautions to prevent the spread of infections that cause coughs:

• Wash your hands regularly with warm, soapy water.
• Keep your hands away from your face as much as possible.
• Cough or sneeze into a tissue or your elbow.

It’s also a good idea to consider flu immunisation to help reduce the chances of your child developing a cough caused by the flu. It’s recommended that all children over six months be immunised against flu every year. If you want your child immunised against flu, talk to your GP.

If your child’s cough is caused by asthma, you can usually prevent it by making sure your child follows their asthma control and management plan. Your child should also see their doctor regularly to review the plan.

You can minimise the risk of inhaling foreign objects by not letting toddlers and infants eat whole nuts or trail mix, or play with small objects that they can easily inhale.