Coughing In Newborns: When To Be Concerned As A Parent

Coughing is a natural reflex that helps protect a newborn's airways from getting blocked. While it is not uncommon for newborns to cough occasionally, it could be a sign of something serious.

Newborns may cough due to various reasons, such as the common cold, respiratory syncytial virus (RSV), influenza, pneumonia, bronchitis, croup, or gastroesophageal reflux disease (GERD). In some cases, a newborn's cough can also be caused by allergies, asthma, or the ingestion of a foreign object.

If your newborn is coughing, it is important to monitor them for any other symptoms and seek medical advice if necessary. While occasional coughing is usually not a cause for concern, persistent or chronic coughing (lasting for more than three weeks) may require medical attention.

When to worry about a newborn's cough

It is normal for newborns to cough occasionally, but 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 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.
• Coughs 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 go 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.

What to do for a baby with a cough

Coughing is a natural reflex that helps protect and clear the airways. However, it can be distressing to hear a baby cough, and it's important to know when to treat it at home or seek medical advice. Here are some things you can do to help ease your baby's cough:

• Keep nasal passages clear: Babies under four months are "obligate nose breathers", meaning they breathe mainly through their nose. Congestion and post-nasal drip can worsen a cough, so use nasal saline drops and a bulb syringe to help clear mucus.
• Use a humidifier: A cool-mist humidifier in your baby's room can moisten airways, reducing coughing caused by post-nasal drip.
• Offer fluids: Keeping your baby hydrated is important to thin out mucus, making it easier to cough up. For younger babies, stick to breast milk or formula. For older babies, water, juice, or warm decaf tea can help ease the tickle that triggers coughing.
• Try honey: For babies over one year, a spoonful of honey before bed can coat and soothe a sore throat. Do not give honey to younger babies due to the risk of botulism.
• Address irritants: Remove potential triggers for asthma or allergies, such as tobacco smoke, dust, or mould.
• See a doctor if concerned: If your baby is under three months old, has a fever, or is experiencing breathing difficulties, contact your doctor or seek emergency care.

When to worry:

• Onset of cough within the first few weeks of life
• Cough with fever lasting more than five days
• Cough lasting for eight weeks or more
• Cough worsening after the third week
• Difficulty breathing
• Night sweats, weight loss, coughing up blood
• Persistent cough without wheezing or fast breathing
• Any cough in newborns within the first couple of weeks

Home remedies for a baby's cough

It can be distressing to hear your little one cough, but it is a common wintertime symptom and often sounds worse than it is. Coughing is one of the body's defences against respiratory tract illness, helping to clear mucus from the airways.

If your baby is under 3 months old and has a cough, you should seek medical advice. For older babies, there are a number of home remedies you can try to ease their coughing:

• Keep their nasal passages clear: Use a few drops of saline solution in each nostril a few times a day to thin mucus and relieve congestion. You can then use a bulb syringe to suck the mucus out of your baby's nose.
• Keep them hydrated: Breast milk, formula, water and unsweetened juice will all help to keep your baby's mucus flowing and easy to cough up.
• Add moisture to the air: Use a cool-mist humidifier in your baby's room to reduce coughing caused by postnasal drip.
• Try some honey: For babies over 12 months, a teaspoon of honey before bed can help to coat and soothe their throat. Do not give honey to younger babies.
• Give them extra fluids: Warm, clear fluids like apple juice or lemonade can help to soothe a sore throat.
• Try chicken soup: The warm broth can help to clear the upper respiratory tract.
• Try a warm shower: Let your baby breathe in the steam from a warm shower to help loosen mucus.
• Try decongestants: Warm, decaffeinated tea, or a popsicle can help to ease the tickle that sets off a cough.
• Try over-the-counter medicines: For babies over 6 months, you can try children's Tylenol or ibuprofen to keep them comfortable if they have a fever.

When to seek medical advice for a baby's cough

While coughing is one of the body's defences against respiratory tract illness, there are times when a persistent cough in a newborn may be cause for concern. Here are some signs that you should seek medical advice:

• Onset of cough within the first few weeks of life: If a newborn starts coughing within the first few weeks of their life, it could be a sign of a serious respiratory issue and should be assessed by a doctor.
• Cough with a fever: A cough accompanied by a fever, especially if the fever lasts for more than three days in babies under 2 months or five days in babies over 3 months, could indicate a bacterial infection and should be evaluated by a medical professional.
• Prolonged cough: A cough that lasts for eight weeks or longer could be a sign of an underlying medical condition and should be checked by a doctor.
• Worsening cough: If the cough worsens over time, especially after the third week, it could indicate a developing respiratory or other illness and should be medically assessed.
• Difficulty breathing: Any signs of breathing difficulties, such as rapid breathing, wheezing, or laboured breathing, along with a cough, warrant immediate medical attention.
• Other concerning symptoms: Night sweats, weight loss, coughing up blood, or a persistent dry or wet cough without wheezing or fast breathing can be indicative of a serious condition and should be evaluated by a doctor.
• Persistent cough and stuffy nose: If your child's cough and stuffy nose persist for more than 10 days without improvement, it could be a sign of acid reflux, allergies, asthma, or enlarged adenoids, and you should consult a doctor.
• Winter cough: In the winter, a persistent and severe cough could be a sign of respiratory syncytial virus (RSV) or whooping cough, both of which are dangerous for infants, and you should seek immediate medical advice.
• COVID-19: Although babies usually experience mild or no symptoms with COVID-19, if you suspect your child has COVID-19 and they are experiencing difficulty breathing, unresponsiveness, or an inability to eat or drink, seek immediate medical care.

In general, it is always better to err on the side of caution when it comes to your child's health. If you are concerned about your baby's cough, consult your paediatrician or healthcare provider for advice and guidance.

What causes a baby's cough

Coughing is one of the body's defence mechanisms against respiratory tract illness. When a baby coughs, they are trying to clear their airways of mucus, phlegm, postnasal drip or a lodged piece of food.

Common causes of a baby's cough

• Respiratory tract infections: Coughing is the body's way of clearing mucus from the airways during respiratory tract infections.
• Viral or bacterial illness: Respiratory viruses like a cold, flu, or croup, and bacterial infections such as bronchitis and pneumonia can trigger coughing in babies.
• Allergies: Your baby could be allergic to something in their environment, such as pet dander, dust, or mould.
• Gastroesophageal reflux disease (GERD): Babies are prone to 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 and adults.
• Asthma: A baby with asthma may experience coughing fits while trying to fall asleep at night.
• Foreign object: A baby may cough if they have inhaled a small object or piece of food.

When to seek medical advice

It is always distressing to hear your baby cough, but it is important to remember that it often sounds worse than it is. However, there are some warning signs that you should seek medical help:

• Any cough in newborns within the first few weeks.
• A cough with a fever lasting more than five days.
• A cough lasting for eight weeks or longer.
• A cough that worsens after three weeks.
• Associated difficulty or laboured breathing.
• Night sweats, weight loss, or coughing up blood.
• A persistent cough without wheezing or fast breathing.
• A cough that persists for more than 10 days without improving.

If you are concerned about your baby's cough, it is always best to consult your paediatrician for a proper diagnosis and treatment plan.

Frequently asked questions