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Cough – Infants (0-1 year)

Thousands of babies are seen unnecessarily in the ER every year due to a newborn cough. Why? Because coughs are confusing! There are so many illnesses with ‘cough’ listed as a symptom and a baby dry cough can linger for weeks after other symptoms have gone away (it is considered a persistent or chronic cough after three weeks). So it’s only natural that we are scratching our heads, wondering when to be worried. Let’s dive into this a bit and figure out when to be concerned and how to soothe our little loves with some home remedies for a baby cough.

Why is my baby coughing?

Many illnesses can cause a baby cough, including:

  • The common cold
  • Allergies
  • Reactive airway disease
  • Influenza (Get your vaccines!)
  • Pneumonia (Get your vaccines!)
  • Whooping cough (Get your vaccines!)
  • Bronchiolitis
  • Croup (barking cough in baby)
  • RSV (Respiratory Syncytial Virus)
  • GER (Gastroesophageal Reflux)

The biggest takeaway here is that coughs are hopping on board with everything else our poor babes are suffering from. Coughing itself is actually not all bad – it’s our body’s way of protecting us, clearing irritants and secretions from our lungs. Grab your Kinsa thermometer and see if your child has a fever along with his cough. Even if he doesn’t, you can still select current symptoms and the Kinsa app will guide you from there.

Coughing day after day, besides testing the patience of our loved ones, is uncomfortable. The biggest thing we see from this is a sore throat. It can also cause vomiting. This will scare the daylights out of you but don’t panic, this can be normal. Sometimes our kiddos cough so hard they can vomit. And honestly, it’s less often from the force of the cough but from excess mucus that our body needs to get rid of.

What to do for a baby with a cough?

  • Fluids! Drink TONS of fluids. Often times, our kids are coughing because of a runny nose and it is draining in the back of the throat. The more they drink, the thinner the drainage becomes and it is easier to get it out! For our babes under 6 months old, stick with breastmilk or formula. Older than 6 months? They get the extra perks of water.
  • Suction bulbs with or without saline. Sometimes the mucus is so thick we need to thin it out with saline drops. Again, drink fluids to help this! Since our tiny babies won’t blow their nose yet, you can use a suction bulb to clear their nose. Be careful not to do this too frequently – a couple times a day should do the trick. We don’t want to cause extra irritation to the nasal passage.
  • Cool-mist humidifier. This will help moisten the dry air and can help decrease coughing from a dry, scratchy throat. The warm-mist humidifiers increase the risk of a burn, either from the hot steam or from a water spill. It is not proven to be more effective than the cool-mist humidifiers because the heat dissipates too quickly to actually make a difference by the time your kiddo is breathing it in. There’s also no reason to add anything to the water, such as essential oils.
  • Tylenol >3 months old (or Ibuprofen if >6 months old). This is to help the discomfort, not to cure the cough. It’s really not needed unless you feel your babe is in pain from the cough or their temperature is >102℉.
  • Cough suppressants or expectorants should not be used for this age group (nobody under 6 years old; cough medicine for all kids should always be avoided if possible – the risk of accidental overdose is too high).
  • You might see suggestions for honey or products that contain menthol such as vapor rubs, but these should not be used in this age range. Specifically, no honey for anyone under 1 year old and no menthol products in anyone under 2 years old as it can cause respiratory distress.

Is your baby coughing at night? Sometimes we get postnasal drip that can cause coughing in sleep. The tips above should help! Make sure they are drinking enough to thin out the mucus so you can suction them out well right before bedtime. Safe Sleep is priority in these little ones, so no propping up the head of the bed – they need to remain flat on their backs for safety!

When to worry about a baby cough?

  • For our babies <6 months old, investigate the cough early in the illness, within the first 3 days. Even the common cold can escalate in these little guys.
  • For our babies >6 months old, make an appointment with your pediatrician to see if something else is going on if the cough is lingering for more than three weeks.
  • Shortness of breath, difficulty breathing, difficulty swallowing. Don’t waste time making an appointment here –  head to the ER.
  • Wheezing cough. If the wheezing is severe and leads to difficulty breathing, head to the ER. If during office hours, you hear a slight wheeze but your child is otherwise uncompromised, it is okay to call your pediatrician and go from there.
  • Coughing up phlegm or mucus (especially yellow or green mucus), or pink/bloody phlegm. This is usually a sign that an infection is brewing and time to make an appointment with the doc.
  • Vomiting blood. Vomiting with coughing can be normal but if you see blood, we’ve crossed the line into ‘abnormal’ and it warrants a trip to the ER.
  • Fever >100.4℉ for babies under 3 months old.
  • Fever >102℉ for babies over 3 months old. Always ask your pediatrician for specific temperature guidelines, they can vary slightly depending on their preferences.
  • Signs of dehydration. Dry mouth, dry skin, decreased urination. Do your best to keep your kiddo hydrated on your own, but if it doesn’t seem to be working, see your doctor.
  • Nothing is working. If you’re doing everything you can at home to make your babe more comfortable but it isn’t working – or they seem to be getting worse – call the pediatrician.

At the end of the day, follow your gut. You are ALWAYS the expert on your own child and you are their advocate! Coughing is an aggravating symptom to deal with day after day, so hang in there, Mama. Do your part to increase comfort where you can and slowly but surely, your babe will begin to feel better. And as they battle this illness, everyone in the family should increase their hand washing! You can’t wash too much. And grab some disinfectant to get those germs out of the house so you can move on before the next thing strikes.

Blake Wageman

Blake Wageman, RN, BSN has over 14 years of nursing under her belt, primarily focused on NICU babies and, just as importantly, their worried parents.