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When is it “just a cough?”

By Scott Hamilton, MD
February 2, 2023
Hamilton Blog Headshot Updated 12.21.21

This week's guest columnist is Cynthia Kudji-Sylvester, MD, a family practice resident at Ochsner University Hospital & Clinics.

Many moms are frightened by coughs that sound “different.” Once when my daughter was coughing, she balled up her fists, squeezed her eyes closed and jerked her head to hack up a large green ball of mucus. I rushed her to the doctor, worried that the next time she'd surely choke to death. It turned out everything was okay.

Coughs are how our bodies respond to irritants in our throats and lungs. Mucus, viral inflammation and dust can tickle the nerves lining your airways making your brain tell your chest muscles to force that irritant out. Coughing is how your body protects itself by expelling what doesn't belong. But when are coughs a sign of more serious trouble?

Most children's coughs are benign, whether they're wet and rattly or dry and hacking. Sure, they interrupt sleep, and kids will hack out mucus of various colors, but these things typically end in three to four days. Cough syrups DO NOT make them better. The ingredients in prescription or over the counter syrups do not make coughs easier or go away sooner. These preparations can also make children more restless or some so jittery that they cry all night. The “all-natural” honey-based cough syrups are safer, but not much more effective.

One cough that needs immediate medical attention is a tight, high-pitched, hacking cough accompanied by squeaky breathing. This is the hallmark of something stuck in the airway. This is when parents should call 911 and get their child to the Emergency Department immediately. It's also a good time to know CPR, particularly the Heimlich maneuver, in case that foreign body gets stuck further and all air movement ceases.

Here's another scary cough: I was rocking my daughter to sleep when she began coughing like a barking seal. “OR'! OR'! OR'!” she went, with a hooting sound when she sucked air back in. These are the sounds of croup, which often makes parents hoot too!

Croup is an occasional reaction to cold viruses. Along with the usual runny nose, cough and fever, viruses can also inflame airways below the vocal cords. Croup often attacks at night when children are lying down, and body fluid contributes to airway swelling. Nighttime air is also drier, which is sticky when children are trying to suck it through narrowed airways. The hooting sound, called stridor, is the whistling that dry air makes in those skinnier airways.

Croup treatment is two-fold. First, sit the child up. This allows gravity to help drain fluid from swollen tissue around the airway, like elevating a swollen ankle. Second, bring your child outdoors where moist air can lubricate their dry throat. If it's cold out, you can moisten the air by turning the hot water faucets on in a bathroom to fill the room with steam. Standing in the moist environment relieves most croup attacks. If kids are still producing a hooting cough after all that, bring them in. We have medication that opens airways so kids can breathe easier.

One more worrisome cough is the “staccato” cough. These dry coughs come so close together that infants can't get a breath in. They continue with cough-cough-cough-cough-cough until their lungs are empty. When they finally get a chance to breathe in, they suck it in with a big whooping sound. Staccato coughs can be the hallmark of infant pneumonias like chlamydia or pertussis, warranting an urgent visit.