A reflex that forces air from the lungs with a sudden noise. It is a symptom for a wide group of diseases.

• The main concern is in watching for signs of difficult breathing:

  Mild difficulty breathing is noted when a child is breathing a little faster than usual, but is able to eat and talk normally. Babies are able to take a bottle or nurse comfortably and are able to smile and coo. The stomach muscles may be moving in and out very slightly when the child breathes. This visible movement of extra muscles to breathe is called retractions. Places to look for retractions include the muscles in the neck, the muscles in between or below the ribs and the stomach muscles.

  Moderate difficulty breathing is noted when a child is breathing with more effort than normal, has retractions of the muscles of the stomach and possibly between the ribs. He may appear pale, but not blue. He will interact and talk in short phrases, but maybe not in complete sentences and may play for brief periods. A baby taking the bottle or nursing may need to pause more frequently, but is able to feed.

  Severe difficulty breathing is noted when a child is struggling to take each breath. Retractions are seen of the stomach muscles, the muscles between the ribs and those above the collarbone. Audible grunting may be noted. He may need to sit up and lean forward just to breathe. The child will appear agitated or frantic. The child will not make good eye contact, interact and there is obvious difficulty getting a word out. A baby may appear listless and is unable to suck a bottle or nurse effectively.   The tongue, lips and possibly nailbeds will appear blue. This is a real emergency and it must be decided if it is quicker to take the child immediately to the emergency room or call 911.

• Coughs may be dry and hacking or wet and productive. This does not really help to tell you the cause of the cough.
• Coughs help protect the lungs and do not necessarily need to be suppressed with medications.
• Coughs are usually the last symptom to resolve during the course of a cold and may last up to 2 weeks.
• Coughs may cause a child to vomit immediately after a coughing episode.

Causes of cough can include:

• Cold viruses often causes a postnasal drip and that causes a cough. This is the most common cause for a cough.
• Croup is characterized by a barking, "seal-like" cough caused by a virus.
• Pneumonia, which is an infection in the lungs. It may be caused by viruses or bacteria. There is also an unusual organism called mycoplasma, which causes the classic "walking pneumonia". Children with pneumonia can barely appear sick with low-grade fever and a mild cough or be very ill with high fevers and labored breathing.
• Asthma may cause coughing and wheezing.  This may be triggered by viruses, exercise or an allergic trigger like dust, smoke, mold or pets.
• Foreign body aspiration should be suspected if there is a history of a coughing or choking episode with eating, especially with small hard foods like nuts or popcorn.
• Sinusitis may cause a cough especially at night or in the mornings.  (See colds for information on sinusitis).
• "Spitting up" or gastroesophageal reflux in babies under a year may trigger coughing because of small amounts of aspiration of food into the lungs. Wheezing or recurrent pneumonia may be associated with reflux.
• Pertussis or whooping cough is an infection that is characterized by a severe cough where the child has difficulty catching his breath with the coughing episodes and may turn blue with coughing.
• Bronchitis is a debated issue in pediatrics. Some researchers feel that children don’t really develop true bronchitis. The very deep cough, "bronchitis type cough" is sometimes from a postnasal drip or may be due to pneumonia.

• Signs of severe or moderate difficulty breathing
• Breathing is fast and/or labored in between coughing episodes
• Appears agitated, gasping for breath
• Lips or tongue or nailbeds turn blue or purple with the coughing episodes
• Blood tinged secretions being coughed up
• Chest pain that is continuous
• Listless, lethargic or difficult to arouse or acting sick
• Suspicion of aspiration of a foreign body, household chemicals or powders

• Fever more than 48 hours
• Cough more than 2 weeks
• Coughing episodes associated with chest pain
• Less than 2 months old
• Coughing episodes that cause lack of sleep
• Coughing associated with significant vomiting

Medications. Coughs may be a helpful mechanism for the body to protect the lungs, they do not necessarily need to be suppressed. If the cough interferes with a child’s sleep or school or work, a cough suppressant may be helpful. They should not be used under one year of age without discussing with your physician. Dextromethorphan (DM) is an over-the-counter medicine available in many of the cold remedies. Codeine cough suppressants are available only by prescription and should not be used without the approval from a physician. Cough drops are not recommended in young children because of a choking risk.

Humidifiers. These are helpful, especially if a dry cough is present. If a child is having a coughing spasm that is difficult to stop, a session in a steamy bathroom with the shower running may be helpful. Humidifiers must be kept clean and if possible, distilled water is recommended. Cool mist humidifiers are safer than steam vaporizers because of the risk of a curious toddler burning himself with the steam.

Diet. Milk does not need to be eliminated with a cough or cold, unless milk allergy is suspected. Fluids do need to be encouraged, solid foods are not as important. Make sure the child is staying well-hydrated (see dehydration).

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