Coughing Newborns: Safe To Feed Or A Concern?

Coughing in newborns is less common, but it can be a cause for concern. While coughing is usually a natural reflex to protect your baby's airways from getting blocked, it could also be a sign of something more serious. In this article, we will explore the different causes of coughing in newborns, when to worry, and how to treat your baby's cough.

Home remedies to ease the cough

It is indeed distressing to hear your baby cough, especially while feeding. While coughing is one of the body's most important defences against respiratory tract illness, there are some instances where you should seek medical attention.

If your baby is coughing while feeding, it is recommended that you consult a doctor. If your baby is coughing and has any of the following symptoms, consider heading to your local emergency room (ER):

• Troubled or laboured breathing
• A fever higher than 100.4 °F (38 °C) for children under 3 months or a fever higher than 102.2 °F (39 °C) for children over 3 months
• Difficulty opening their mouth fully
• Significant tonsil swelling on just one side

If your baby is exhibiting any of the following symptoms, it is also recommended that you contact your doctor:

• Any cough in newborns within the first couple of weeks
• A cough that lasts 8 weeks or longer
• A cough that worsens with time, especially after 3 weeks
• A cough with night sweats or weight loss
• Any cough—wet or dry—with wheezing or rapid breathing

If your baby is exhibiting any of the above symptoms, or if you are concerned about your baby's health, it is always best to consult a doctor.

If your baby's symptoms are mild and they do not require medical attention, there are several home remedies you can try to help ease their cough:

• Keep your baby hydrated: Breastfeed or offer formula as frequently as your baby needs. Stick to breast milk and formula for younger babies, and for older babies, fluids can include water and unsweetened juices. Keeping your baby hydrated will help to keep their mucus flowing so that it can be coughed up more easily.
• Use saline drops in your baby's nose: Over-the-counter (OTC) saline drops can be used in your baby's nose to help moisten secretions and prevent postnasal drip, which can irritate the throat and cause a cough. Use 2-3 saline drops per nostril a few times throughout the day.
• Use a bulb syringe to clear mucus: After using saline drops, a bulb syringe can be used to gently suck the mucus out of your baby's nose. This will help to prevent nasal and sinus congestion, which can impair breathing and make coughing worse.
• Use a humidifier: Adding moisture to the air with a humidifier can help to keep your baby's mucus flowing and prevent dryness, which can increase mucus production. Alternatively, you can run hot water in the shower and close the bathroom door to create a steam room effect. Just 10-15 minutes should help to loosen mucus.
• Offer honey (for babies over 1 year): For babies 12 months or older, a small amount of honey before bedtime or naps can help to coat the throat and relieve soreness. Honey may be as effective as over-the-counter cough suppressants. However, honey is not appropriate for younger babies due to the risk of botulism, a rare form of food poisoning.
• Address irritants: Try to rid your home of any irritants that might trigger asthma or allergies, such as tobacco smoke, dust, or mould. Keep the humidity level of your home between 40% and 50%, and use a room air purifier with a HEPA filter.
• Gargle with warm salt water (for children over 6): For older children, gargling with warm salt water can help to relieve a sore throat and reduce mucus and congestion.
• Elevate your child's head while sleeping (for children over 2 years): Propping up your child's head with an extra pillow may help reduce their cough at night by allowing congestion to drain and easing a cough related to postnasal drip.
• Drink warm liquids: Encourage your child to drink warm liquids such as caffeine-free tea, broth, or hot water with lemon. These can help to loosen mucus and soothe a sore throat.
• Offer cold treats: Give your child cold treats such as popsicles or ice cream to help soothe a sore throat.

While these home remedies can help ease your baby's cough, it is important to monitor their symptoms and seek medical attention if their condition worsens or does not improve.

When to be worried about your newborn coughing

Coughing is one of the body's defences against respiratory tract illness. It helps to clear mucus that is secreted into the airways during infections. While coughing is common in newborns and babies, and often not serious, there are some instances where you should seek medical advice or attention.

When to call your doctor:

• Any cough in newborns within the first couple of weeks.
• A dry cough related to a cold (a runny nose but no fever) that lasts more than five to seven days.
• Coughs that persist for more than 10 to 14 days.
• A fever for more than three days. (Babies under 2 months need to be seen immediately for any fever over 100.4°F/38°C).
• Coughing frequently during the night.
• Coughing persistently after eating.
• Noisy breathing like rattling or whistling.
• A dry or wet cough with a cold and a fever of 100°F/38°C or more.
• Mild, light wheezing.

When to call 911 or head to the ER:

• Skin retractions (skin pulling in) at the neck and chest area with breathing.
• Dizziness, excessive sleepiness, refusal to eat or drink, or trouble crying.
• A cough that sounds like barking or “whooping”.
• Inability to catch their breath.
• Rapidly retracting and expanding their stomach.

Other signs of respiratory distress:

• Count how many times your child breathes in 60 seconds. If it's 50 breaths per minute or more, your child is in respiratory distress.
• Determine if your baby is working harder to breathe than usual. See if their skin is pulling in at any of these places when they breathe in: right above the collar bone, at the neck right between the collar bones, between the ribs, and on the belly right below the ribs.
• Observe your child's nostrils to see if they are flaring, which also indicates they are working harder to breathe.
• Look to see if they can't nurse or take a bottle as usual and instead frequently pause to stop and catch their breath.

Types of baby coughs

Dry Cough

A dry cough in babies is typically unproductive, meaning it doesn't clear mucus from the airways. It may be caused by a cold or allergies and can help clear post-nasal drip or irritation from a sore throat. Dry coughs can also be a symptom of asthma.

Wet Cough

A wet cough causes phlegm or mucus to form in the baby's airways. It often results from a respiratory illness accompanying a bacterial infection. A wet cough is usually a response to irritation in the lower airways.

Croup Cough

Croup is a viral illness that causes inflammation in the larynx (voice box) and trachea (windpipe). It typically affects children between 6 months and 3 years old and is most common during the winter months. The telltale sign of croup is a barking cough, which usually gets better during the day but returns at night. Croup can cause difficulty breathing and a high-pitched whistling sound called stridor when the child inhales.

Whooping Cough (Pertussis)

Whooping cough is a serious bacterial illness that can affect both babies and adults. It is characterised by frequent, alarming coughing spasms, which may cause the baby to briefly stop breathing and turn purple. Young babies may not have enough strength in their lungs to make the characteristic "whooping" sound, so it can be harder for parents to detect.

Asthma Cough

Asthma is a chronic condition that causes inflammation and narrowing of the airways, leading to excess mucus production. A hacking cough at night may be the only symptom of asthma in children. Other red flags include a cough triggered by exercise, allergies, colds, or cold air.

Bronchiolitis Cough

Bronchiolitis is an infection of the smallest airways in the lungs, causing them to swell and fill with mucus. It is most commonly caused by the respiratory syncytial virus (RSV) and typically affects young babies during the winter months. Symptoms include coughing, a runny nose, and a slight fever.

Pneumonia Cough

Pneumonia is a viral or bacterial infection of the lungs that can be brought on by a number of conditions, including the common cold. A cough indicating pneumonia will likely be wet and mucousy, and the baby will be very fatigued.

COVID-19 Cough

Babies with COVID-19 usually have mild or no symptoms, but they can develop a dry or wet cough. Other symptoms may include fever, runny nose, shortness of breath, decreased feeding, changes in behaviour, vomiting, and diarrhoea.

Why your baby might be coughing

It can be distressing to hear your little one cough, but it's a common symptom, especially in winter. Coughing is one of the body's most important defences against respiratory tract illness. During respiratory tract infections, mucus is secreted into the airways, and coughing helps to clear this.

Illness

Everything from respiratory viruses like a cold, flu, or croup to bacterial infections such as bronchitis and pneumonia can trigger coughing in babies. This is usually due to an increase in mucus in the throat or lungs or inflamed or irritated bronchial tissue.

Allergies

Most children don't develop seasonal allergies until at least 2 years of age, but your baby could be allergic to something else in their environment, such as pet dander, dust, or mould.

Reflux

Babies are prone to gastroesophageal reflux disease (GERD), which can cause coughing and gagging as stomach acid irritates the throat.

Whooping Cough

Also known as pertussis, this serious bacterial illness can affect babies, children, and adults. Your baby should receive their first pertussis vaccine at 2 months old.

Asthma

If your baby tends to cough while trying to fall asleep at night, their cough could be due to asthma.

Foreign Object

Small toys and food are the most common causes of choking and can result in coughing.

Bronchiolitis

This is characterised by inflammation of the small airways in the lungs and is usually caused by a respiratory syncytial virus (RSV).

Pneumonia

A bacterial or viral infection of the lungs brought on by a number of conditions, including the common cold. A cough that indicates pneumonia will likely sound wet and mucousy.

If you're concerned about your baby's cough, it's always best to consult your doctor.

When to worry about your baby's cough

It can be distressing to hear your baby cough, but it's important to know that coughing is a defence mechanism to protect the body and clear the airways of mucus. It is usually not a sign of something serious. However, there are certain instances when you should be concerned about your baby's cough and seek medical advice or attention.

When to seek medical advice:

• If your baby is younger than 3 months old and has a cough.
• If your baby has a dry cough related to a cold (a runny nose but no fever) that lasts more than five to seven days.
• If your baby has been coughing for more than 10 to 14 days.
• If your baby has a fever for more than three days. (Babies under 2 months old should be seen immediately for any fever over 100.4°F (38°C).)
• If your baby is coughing frequently at night.
• If your baby's cough persists after eating.
• If your baby has noisy breathing, such as rattling or whistling.
• If your baby has a dry or wet cough with a cold and a fever of 100°F (37.8°C) or higher.
• If your baby has mild, light wheezing.

When to seek emergency medical attention:

• If your baby is coughing and has a fever higher than 100.4°F (38°C) (children under 3 months) or higher than 102.2°F (39°C) (children over 3 months).
• If your baby has difficulty opening their mouth fully.
• If your baby has significant tonsil swelling on one side.
• If your baby has any cough in the first couple of weeks of life.
• If your baby has a cough that lasts 8 weeks or longer.
• If your baby's cough worsens after the third week.
• If your baby has a cough with night sweats or weight loss.
• If your baby has any cough—wet or dry—with wheezing or rapid breathing.
• If your baby is coughing and experiencing skin retractions (skin pulling in) at the neck and chest area with breathing.
• If your baby is dizzy, excessively sleepy, refusing to eat or drink, or having trouble crying.
• If your baby has a cough that sounds like barking or "whooping".
• If your baby is unable to catch their breath.
• If your baby is rapidly retracting and expanding their stomach.
• If your baby is turning a dusty blue colour, indicating respiratory distress.
• If your baby is having trouble breathing.
• If your newborn is breathing irregularly.
• If the area around your baby's mouth is turning blue.
• If your baby has stopped breathing.

Frequently asked questions