Why Babies Cough and How To Help Them

A coughing baby is a sad sight. It can be tough to witness those big, scary sounds coming from your baby’s little body.

Rest assured that, most of the time, your baby’s cough isn’t something to worry about.

Pediatrician Shannon Thompson, DO, explains why babies cough, how to help them feel better and when to get help.

Types of baby coughs

It’s normal to worry when your baby starts coughing — but coughs are part of life with an infant.

“Babies catch viruses easily because their immune systems are immature,” Dr. Thompson explains. “And their airways are small, so it’s easy for them to get congested.”

Let’s take a look at what your baby’s cough might be telling you.

Barky or ‘croupy’ cough

Croup is a viral respiratory infection that’s most common in babies and toddlers. A croupy cough is pretty easy to recognize because it sounds like a barking seal. That’s because it causes inflammation in their voice box.

“Once you hear it, it’s easy to place,” Dr. Thompson acknowledges.

Babies with croup usually cough more in the morning and at night. Your baby may also make a high-pitched noise when they breathe in (stridor). Croup may also cause a fever.

Croup usually isn’t serious, but it’s very contagious. So, it’s best to keep your baby away from other kids while they’re symptomatic and for at least 24 hours after their fever breaks.

Wet cough

A wet cough is one that brings up mucus (phlegm), which babies and toddlers can’t clear out very well. It’s also called a “productive” cough.

“Wet coughs are a result of excess mucus,” Dr. Thompson explains. “We all swallow a lot of mucus during the day without realizing it. When we have too much, it can cause a wet cough.”

A wet cough is a sign that your baby has more snot than they can easily manage. That’s pretty common. Babies’ nasal passages are tiny, after all. And they can’t exactly blow their noses to clear things out. So, when they have some extra phlegm, things can get gunked up pretty quickly.

Productive coughs are usually a sign of a respiratory infection, like:

• Colds
• Flu
• RSV
• Bronchitis
• Pneumonia (less common)

Dry, hacking cough

Unlike a wet cough, a dry cough doesn’t come from mucus. Instead, it’s a sign that your baby’s airways are irritated by something else.

Dry coughs aren’t as common as wet or croupy coughs in babies. They can be an early sign of environmental allergies or asthma, though neither of those conditions is typically diagnosed until toddlerhood or later.

Why babies cough more at night

Sometimes, your baby will have a rough night — up coughing and hacking and feeling generally miserable — only to make it through the next day like nothing happened. Then, the sun goes down, and the cycle starts again.

Sound familiar?

“When they lie flat, everything settles, which causes a cough,” Dr. Thompson explains. “When they’re up during the day, their airways open up and allow them to breathe more easily.”

Other reasons for the overnight cough sessions include:

• Shallow breathing: When your baby lies down, they can't breathe as deeply. That makes it harder to clear mucus.
• Air quality: Air tends to be drier at night, which can irritate airways.
• Mouth breathing: After babies hit about 3 months old, they can start using their mouths to breathe. That can help them catch their breath even when their nose is stuffed up. But breathing through their mouth can dry out their airways and make a cough worse.

Cough remedies for babies

Just because coughs are common in babies doesn’t mean that you’re defenseless against them. Dr. Thompson shares some dos and don’ts for treating a baby’s cough.

Do

• Do use sterile saline drops (baby nasal drops).
• Do try gentle suction to remove excess mucus, like a bulb syringe or nasal aspirator.
• Do run a cool mist humidifier in their bedroom to keep the air moist.
• For croup, take your baby briefly into cool night air to help reduce swelling.
• Do use steam to loosen mucus. That can be as simple as running a hot shower and closing the door. Bring your baby into the bathroom to breathe in the steam.
• Do ensure your baby is staying hydrated by providing extra breast milk or formula. But do not give water to babies under the age of 6 months.
• Do use fever-reducing medications, like acetaminophen (Tylenol®), as needed. Ibuprofen (Advil®) shouldn’t be given to babies until they are 6 months or older. Follow instructions carefully, including proper dosage for their age and weight.

Don’t

• Don’t use cough medicine in kids under 6 years old, unless recommended by a healthcare provider. It can cause dangerous side effects.
• Don’t use menthol rubs (Vicks®) in babies under 2 years old.
• Don’t give honey to babies before their first birthday. Honey can cause infant botulism. It‘s a common ingredient in “natural” cough relief products for babies and kids. Check labels thoroughly on those products.

When to get help for your baby’s cough

Most coughs can be managed at home, but some can be a sign of a bigger problem.

Get emergency medical attention if:

• Your baby is struggling to breathe at rest. You may see their nose flaring or their head bobbing.
• They’re panting or breathing very quickly (more than 60 breaths per minute).
• They make a high-pitched sound when they inhale when they’re not coughing or crying.
• They’re under 2 months old and have a fever.
• They’re under 3 months old and not eating well or their cough is getting worse.

Talk with a children’s health professional if:

• Your baby has a fever for more than two days.
• Your baby isn’t making as many wet diapers as usual.
• They’re excessively sleepy or not eating well.
• Their cough doesn’t go away after several days.

Above all, Dr. Thompson says to trust your instincts: “If you feel like something’s not right, you’re probably right. If it’s not getting better or you’re worried, just call. That’s what we’re here for.”