Why does your child keep coughing?

Parents search this at 2 a.m., which is reasonable. A child who coughs until the household is awake feels seriously ill, even when the cause is ordinary. The useful question is not how to silence the cough. It is why the cough is there.

Why the cough is worse at night

When a child has a cold or allergies, the nose makes extra mucus. During the day that mucus runs forward, or it is swallowed without much notice. Lying down changes the direction. Mucus slides onto the back of the throat. Doctors call this post-nasal drip. The throat is not built to ignore it, so it coughs.

That is why a child can seem manageable in the afternoon and relentless after lights-out. The lungs are not necessarily the part that started it. The nose handed the throat a problem, and the cough is the throat’s answer. A saline rinse or drops before bed, used the way a doctor has shown you, can thin that mucus. It does not cure the cold. It gives the throat less to argue with.

For an older child, a doctor may suggest raising the head of the bed a little. Do not do this for a baby. Infants sleep on a flat, firm surface, on their back, with no pillow, no wedge, and no extra bedding. A blocked nose in a baby is helped with saline and gentle suction, not with a tilted cot.

How long a viral cough can last

Most of these coughs are viral. A virus irritates the airway, and the irritation outlasts the fever and the runny nose. Two to three weeks is a familiar course. Some coughs linger a little longer while they fade. Fading is the point. A cough that is quieter each few days is a different story from a cough that is harsher, more frequent, or newly paired with fever.

Colour is a poor guide. Yellow or green mucus does not prove a bacterial infection, in the nose or in the chest. It often means the immune system is clearing a virus. Antibiotics do not treat viruses. They do not shorten an ordinary viral cough, and they carry their own harms, including diarrhoea, rash and the slow loss of antibiotics that still work.

When the night cough is not a cold

A cough with repeated sneezing, itchy eyes and a watery nose, especially in dust or at a change of season, fits allergy more than a chest infection. Allergy care is about the nose and the trigger. It is described on the allergic rhinitis page, and in the guide to allergy, a cold, and sinusitis.

A cough that returns for weeks, wakes the child most nights, and comes with a wheeze or with breathlessness on running, can be asthma, including the kind that coughs more than it wheezes. A family history of asthma or eczema makes that more worth examining. This page cannot make that diagnosis. A repeating pattern can.

Reflux is the other night visitor. Acid reaches the throat when a child lies flat, the throat coughs to clear it, and the cough itself can bring more acid up. It is one possibility among several, not a reason to start medicine from a pharmacy shelf.

Cough syrup, honey, and what not to reach for

Over-the-counter cough syrup is a weak answer to a strong question. It does not treat the cause. In young children it is not recommended at all, and combination cold medicines are a common way for a child to receive more than one drug by accident. Ask a doctor before any cough or cold medicine, and do not borrow a dose meant for an adult.

For a child older than one year, a doctor sometimes suggests a little honey at night. There is modest evidence that it soothes a cough better than some syrups. Honey is not safe under one year, because of the risk of infant botulism. It is a kitchen remedy with an age limit, not a treatment for a child who is working to breathe.

• Offer fluids, and keep smoke away from the child.
• Saline drops or a spray can thin the mucus that sets off the night cough. A baby may need gentle suction before sleep.
• Do not tilt a baby’s cot, and do not add a pillow or a wedge.
• Ask a doctor before any cough or cold medicine. Do not borrow a dose meant for an adult.
• Honey is only for a child older than one year.

What should be seen the same day

The cough itself is common. The company it keeps is what matters. Fast breathing, a ribcage that pulls in, a wheeze, a noise when breathing in, blue or grey lips, or a child who is too tired to drink, needs medical attention now. Difficulty breathing is an emergency. Do not wait for a reply to the website form. Call the clinic’s emergency line if you already have it, or go to an emergency department.

See a doctor, rather than waiting another night, if any of these are true.

• The cough is still going after two to three weeks.
• It had started to settle, then came back with a fever.
• There is blood in what the child coughs up.
• The cough began as a sudden choke on a small object.
• The child is a young infant, or will not drink.

Children’s ear, nose and throat problems are seen in children’s ENT consultations at Apricity. Bring the list of what you have already tried, including syrups. The visit is to find the reason, which may be the nose, and to say clearly if it is not.