Should Your Child See a Doctor?


This Care Guide Covers

  • A cough is the sound made when the cough reflex clears the lungs
  • A coughing fit or spell is over 5 minutes of nonstop coughing
  • Coughs can be dry (no mucus) or wet (with white, yellow or green mucus)

See Other Care Guide If

  • Stridor (harsh sound with breathing in). See CROUP.
  • Barky cough and hoarse voice. See CROUP.
  • Your child has asthma. See ASTHMA ATTACK.
  • Wheezing but no past diagnosis of asthma. See WHEEZING.

Health Information

Causes of Cough

  • Common Cold. Most coughs are part of a cold that includes the lower airway. The medical name is viral bronchitis. The bronchi are the lower part of the airway that go to the lungs. Bronchitis in children is always caused by a virus. This includes cold viruses, influenza and croup. Bacteria do not cause bronchitis in healthy children.
  • Sinus Infection. The exact mechanism is unknown. It may be that post-nasal drip irritates the lower throat. Or pressure within the sinus may trigger the cough reflex.
  • Allergic Cough. Some children get a cough from breathing in an allergic substance. Examples are pollens or cats. Allergic coughs can be controlled with allergy medicines, such as Benadryl.
  • Asthma. Asthma is the most common cause of chronic coughs in children. In adults it's smoking.
  • Air Pollution Cough. Fumes of any kind can irritate the airway and cause a cough. Tobacco smoke is the most common example. Others are auto exhaust, smog and paint fumes.
  • Exercise Induced Cough. Running will make most coughs worse. If the air is cold or polluted, coughing is even more likely.
  • Serious Causes. Pneumonia, bronchiolitis, whooping cough and airway foreign body (object).

Phlegm or Sputum: What's Normal?

  • Yellow or green phlegm is a normal part of the healing of viral bronchitis.
  • This means the lining of the trachea (windpipe) was damaged by the virus. It's part of the phlegm your child coughs up.
  • Bacteria do not cause bronchitis in healthy children. Antibiotics are not helpful for the yellow or green phlegm seen with colds.
  • The main treatment of a cough with phlegm is to drink lots of fluids. Also, if the air is dry, using a humidifier will help. Sipping warm clear fluids will also help coughing fits.

Return to School  

  • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Passed out or stopped breathing
  • Lips or face are bluish when not coughing
  • You think your child has a life-threatening emergency

Go to ER Now If

  • Choked on a small object that could be caught in the throat

Call Your Doctor Now (night or day) If

  • Trouble breathing (Exception: present only when coughing)
  • Lips or face have turned bluish during coughing
  • Ribs are pulling in with each breath (called retractions)
  • Can't take a deep breath because of chest pain
  • Harsh sound with breathing in (called stridor)
  • Wheezing (purring or whistling sound during breathing out)
  • Severe chest pain
  • Coughed up blood
  • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
  • High-risk child (such as cystic fibrosis or other chronic lung disease)
  • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
  • Fever over 104° F (40° C)
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

Call Your Doctor Within 24 Hours If

  • Nonstop coughing spells
  • Age under 6 months old
  • Earache or sinus pain (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after gone for more than 24 hours
  • Chest pain even when not coughing
  • You think your child needs to be seen, but the problem is not urgent

Call Your Doctor During Weekday Office Hours If

  • Coughing causes vomiting 3 or more times
  • Coughing has kept home from school for 3 or more days
  • Allergy symptoms (such as runny nose and itchy eyes) also present
  • Runny nose lasts more than 14 days
  • Cough lasts more than 3 weeks
  • You have other questions or concerns

Parent Care at Home If

  • Cough with no complications

Care Advice for Cough

  1. What You Should Know About Coughs:
    • Coughs are a normal part of a cold.
    • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
    • A cough can be a good thing. We don't want to fully turn off your child's ability to cough.
    • Here is some care advice that should help.
  2. Homemade Cough Medicine:
    • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
    • Age 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
    • Age 1 year and older: Use Honey ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don't have any honey, you can use corn syrup.
    • Age 6 years and older: Use Cough Drops to coat the sore throat. If you don't have any, you can use hard candy.
  3. Non-Prescription Cough Medicine:
    • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 4 years old. (FDA 2008.)
    • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
    • If age over 4 years old, you might decide to use a cough medicine. Choose one with Dextromethorphan (DM), such as Robitussin Cough. It's present in most non-prescription cough syrups.
    • When to Use: Give only for severe coughs that interfere with sleep or school.
    • DM Dose: See Dose Table. Give every 6 to 8 hours as needed.
  4. Coughing Fits or Spells - Warm Mist:
    • Breathe warm mist (such as with shower running in a closed bathroom).
    • Give warm clear fluids to drink. Examples are apple juice and lemonade.
    • Age under 3 months. Don't use.
    • Age 3 - 12 months of age. Give 1 ounce (30 ml) each time. Limit to 4 times per day.
    • Age over 1 year of age. Give as much as needed.
    • Reason: Both relax the airway and loosen up any phlegm.
  5. Vomiting from Coughing:
    • For vomiting that occurs with hard coughing, give smaller amounts per feeding.
    • In infants, give 2 ounces (60 ml) less formula.
    • Reason: Vomiting from coughing is more common with a full stomach.
  6. Encourage Fluids:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
    • It also will thin out the mucus discharge from the nose.
  7. Humidifier:
    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.
  8. Fever Medicine:
    • For fevers above 102° F (39° C), give an acetaminophen product (such as Tylenol) or. Another choice is an ibuprofen product (such as Advil). See Dose Table.
    • Note: Fevers less than 102° F (39° C) are important for fighting infections.
    • For all fevers: Keep your child well hydrated. Give lots of cold fluids.
  9. Avoid Tobacco Smoke:
    • Tobacco smoke makes coughs much worse.
  10. Return to School:
    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of coughs and colds cannot be prevented.
  11. Extra Advice - Allergy Medicine for Allergic Cough:
    • Allergy medicine can bring an allergic cough under control within 1 hour. The same is true for nasal allergy symptoms.
    • A short-acting allergy medicine (such as Benadryl) is helpful. No prescription is needed.
    • Give every 6 to 8 hours until the cough is gone. See Dose Table.
  12. What to Expect:
    • Viral bronchitis causes a cough for 2 to 3 weeks.
    • Sometimes, your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow or green.
    • Antibiotics are not helpful.
  13. Call Your Doctor If:
    • Trouble breathing occurs
    • Wheezing occurs
    • Cough lasts more than 3 weeks
    • Your child becomes worse

Remember! Contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.


  1. American Academy of Pediatrics, Committee on Drugs Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99:918-919
  2. Cromer BA, Goydos J, Hackell J, et al. Unrecognized pertussis infections in adolescents. Am J Dis Child. 1993;147:575.
  3. Guilbert TW, Taussig LM. "Doctor, he's been coughing for a month. Is it serious?" Contemp Pediatr. 1998;15 (3):155-172.
  4. Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25 (4):115-123.
  5. Margolis P and Gadomski A. Does this infant have pneumonia? JAMA. 1998; 279:308-314.
  6. Olsen SJ, Swerdlow DL. Risk of infant botulism from corn syrup. Pediatr Infect Dis J. 2000;19:584.
  7. Paul IM; Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161 (12):1140-1144.
  8. Paul, IM, Yoder KE, Crowell KR, et al. Effect of Dextromethorphan, Diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114:e85-e90.
  9. Schaefer MK, Shehab N, Cohen AL, et al. Adverse events from cough and cold medications in children. Pediatrics. 2008;121 (4):783-787.
  10. Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr. 1993;122:799-802.
  11. Woods C. Acute bacterial pneumonia in childhood in the current era. Pediatr Ann. 2008;37 (10):694-702.


This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information

Copyright 1994-2015 Barton D. Schmitt, MD. All rights reserved.