Cough and Cold in Children: Home Care, Danger Signs and When to See a Doctor

Children catch an average of six to eight colds each year, more if they attend nursery or school. These are annoying but normally harmless illnesses caused by viruses. Most coughs and colds get better on their own with rest, fluids and comfort measures. The key skill for parents is to tell a simple cold from a chest infection or other serious illness.

Typical symptoms of a cold

• Runny or blocked nose, sneezing
• Sore throat, hoarse voice
• Mild fever (often under 38.5 °C) for a day or two
• Dry or wet cough
• Reduced appetite, mild tiredness
• Watery eyes

Symptoms peak around days 2-3, and then improve over a week. A runny nose that turns yellow or green is normal and does not mean antibiotics are needed.

Home care

1. Fluids: offer breast milk, formula, water, soups and diluted juice often. Fluids loosen mucus and prevent dehydration.
2. Rest, and let the child set the activity level.
3. Saline nose drops or spray to clear blocked noses, especially before feeds and sleep. For babies, gently suck out mucus with a bulb syringe.
4. Honey (1 teaspoon) at bedtime for children over 1 year can ease night cough. Never give honey to babies under 12 months, because of the risk of botulism.
5. Raise the head of the bed slightly for older children (with a pillow under the mattress, not for babies under 1 due to suffocation risk).
6. Steamy bathroom or warm moist air may help comfort, but hot steam inhalation carries a burn risk and is not recommended.
7. Keep the air clean: avoid cigarette smoke, mosquito coils and wood smoke, which worsen cough.
8. Paracetamol for fever or discomfort, as per weight and the product label. Use our paracetamol dose calculator. Do not give aspirin.
9. Keep the child at home while feverish, and teach them to cough into the elbow and wash hands.

Medicines to avoid

• Cough and cold syrups with antihistamines, decongestants, codeine or dextromethorphan are not advised for children under 6 (and some countries advise under 12). They can cause drowsiness, heart rhythm problems and overdose.
• Antibiotics unless a doctor diagnoses bacterial infection.
• Herbal remedies or vapour rubs in babies and young children, without medical advice. Some contain camphor or menthol, which are unsafe for under 2-year-olds.

How to count your child's breathing

Count the breaths for one full minute while the child is quiet or asleep. Fast breathing suggests pneumonia or a serious chest problem:

• Under 2 months: 60 or more breaths per minute
• 2 to 11 months: 50 or more
• 1 to 5 years: 40 or more

Danger signs: seek urgent care

• Fast or laboured breathing, as above
• Chest indrawing, where the lower chest wall sucks in when breathing
• Noisy breathing: wheeze, grunting, or a high-pitched sound when breathing in (stridor)
• Blue or grey lips or face
• Unable to drink or feed, repeated vomiting
• Unusually sleepy, floppy, difficult to wake or irritable
• Fever lasting more than 3 days, or fever of 38 °C or higher in a baby under 3 months
• Signs of dehydration: dry mouth, no tears, fewer wet nappies
• Child with a long-term illness (heart, lung, immune problems) and a new chest illness

Read about fever in children.

Common causes of cough

• Common cold: runny nose, mild cough
• Bronchiolitis (babies under 2): cough, wheeze and fast breathing, with feeding difficulty, usually from RSV virus. Some need hospital care.
• Croup: barking "seal-like" cough, hoarse voice, noisy breathing, worse at night, usually in children 6 months to 3 years. See a doctor urgently if there is breathing difficulty.
• Pneumonia: fever, fast breathing and chest indrawing
• Asthma: recurring cough or wheeze, especially at night or with exercise or colds, and a family history of allergy or asthma
• Whooping cough (pertussis): long bouts of coughing with a "whoop" or vomiting afterwards, especially in babies and incompletely vaccinated children
• Allergies and reflux, or a cough lasting weeks
• Foreign body: sudden choking and coughing in a toddler who has been eating or playing with small objects, which needs emergency care
• Tuberculosis: persistent cough with weight loss and fever, particularly after contact with a TB patient

Prevention

• Wash hands often and teach children to do the same.
• Keep up to date with vaccinations, including DPT (against whooping cough), measles and pneumococcal vaccines where available. See childhood vaccination.
• Breastfeed in the first six months.
• Avoid smoke in the home.
• Keep sick children away from babies.

When to see a doctor

See a doctor if the cough lasts more than 3 weeks, wakes the child most nights, comes with weight loss or poor growth, or recurs often. Go to hospital at once for any danger sign above.

References

• World Health Organization: Integrated Management of Childhood Illness, cough or difficult breathing
• NICE guideline NG120: cough (acute) with chest infection in under 5s, and NG84 on antimicrobial prescribing
• American Academy of Pediatrics: cough and cold medicines in children
• Sri Lanka Ministry of Health, Family Health Bureau: child health guidance