Dr. Charles Ison – Diagnosing a Child’s Cough

Children cough. It is one of the most common symptoms of childhood illnesses.

Although most coughs are not concerning, some types are. Coughs vary by the sounds they make, when they happen and how long children have them.

– Most coughs in children are dry or wet hacky coughs. When accompanied by a low-grade fever (or no fever), they are most often from viruses such as head colds.

These coughs can be worse at night or when lying down since nasal drainage often runs down the throat in that position.

Most of these coughs are gone within two weeks (acute), even though there are sometimes chronic (greater than two weeks) post-viral coughs.

– Coughs with fever, especially if the child does not have much nasal drainage, can be concerning for pneumonia.

Overall, though, pneumonia accounts for only a small percentage of coughs in children.

– A barky cough, usually worse during the night, is the hallmark of viral croup.

This is more common in young children because the infection makes their smaller larynxes (voice boxes) swell and narrow. This cough can be accompanied by fever and sometimes an inspiratory (inhale) wheeze called “stridor.”

– Whooping cough is a bacterial infection caused by pertussis. Its hallmark is a rapid-fire cough without a pause that ends with a rather scary inspiratory whooping sound.

It can be fatal for infants and young children. It is known as “the hundred-day cough” in older children. Fortunately, there is a vaccine for it.

– A cough accompanied by a wheeze or whistle on exhaling is one of the hallmarks of asthma. It is often worse during the night.

In the daytime, however, it can be triggered by allergens or irritants.

Sometimes, a child with asthma will breathe rapidly and look like he is working hard to get air in and out of the lungs.

– Children with habitual coughs often make a honking sound. The cough usually does not happen when they are asleep. It can be a form of tic.

Coughs in children are the most concerning when accompanied by certain symptoms such as:

Respiratory distress, blue or dusky coloring (especially the face, lips, or tongue), stridor, whooping, high fever, wheezing (especially if not diagnosed with asthma), increasing weakness or fatigue, or if something could have been sucked into the respiratory tract.

The advice of a healthcare practitioner should be sought in these cases.


Dr. Charles Ison is a University of Kentucky graduate who has practiced in his hometown of Lexington since 1993. He is a partner in Pediatric and Adolescent Associates.