Why Does My Toddler Cough at Night?

A toddler coughing at night is usually due to something minor, such as the common cold. When your toddler is lying down, mucus can run down the back of the throat causing them to cough.

Sometimes, however, your child may have a condition that needs to be diagnosed and treated by a healthcare provider, such as asthma. Less commonly, it may be something that requires emergency treatment. The deciding factor is often the type of cough—frequent, persistent, dry, wet, barking, whooping, or more.

This article explains the most common types of childhood coughs. You'll also learn how to tell if your child's cough means you need to make an appointment with their pediatrician or go to the ER.

Frequent and Persistent Cough

A frequent, persistent cough in kids can be caused by something fairly simple, like throat irritation from mucus. However, a child's cough that doesn't go away can also be a sign that they're having breathing trouble.

A child who is coughing a lot may have asthma, a chronic condition where the airways of the lungs become inflamed and narrow. Although the reasons aren't well understood, many people with asthma experience worsening symptoms at night, which can lead to nocturnal coughing.

Some additional symptoms of asthma in children include:

• Wheezing
• Shortness of breath
• Tightness in the chest

If your child has asthma, their healthcare provider can diagnose the condition and recommend treatment, like an inhaler or nebulizer.

If your child's cough is frequent—more than every five minutes for more than two hours—call your pediatrician.

Whooping Cough

Whooping cough is a bacterial infection that causes a particular type of cough. Also called pertussis, the infection causes a fast cough and a "whoop" sound when a child takes a breath.

People of any age can get whooping cough, but it is most serious for children younger than 1-year-old. Infants can die from whooping cough.

However, infants with pertussis do not always have a cough. Instead, they may briefly stop breathing (apnea) and their skin can turn blue (cyanosis). Severe whooping cough can also cause vomiting.

The best way to prevent whooping cough is to ensure your baby gets a pertussis vaccine. It is usually given as a combination vaccination called the DTaP, which includes protection against two other serious bacterial diseases: diphtheria and tetanus.

The combination vaccine can be given starting at 2 months old. Adults should get a booster (Tdap)—especially if they are pregnant or have young children at home.

Whooping cough is generally treated with antibiotics. Your child's healthcare provider may also recommend antibiotics for family members who have been in close contact with your child.

Your child should get plenty of fluids and eat small meals spaced a few hours apart to help prevent vomiting. Don't give your child cough medications; they aren't recommended for children under 4 and are unlikely to help improve an older child's symptoms.

Coughing With Vomiting

Sometimes coughing is accompanied by vomiting. This can happen when a severe cough triggers the gag reflex. It can also happen when your child swallows too much mucus, causing nausea. 

Some of the conditions that can cause coughing with vomiting include:

• Whooping cough
• Pneumonia
• Asthma

A cough with vomiting isn't usually serious unless the vomiting is frequent, prevents them from keeping fluids down, or continues for more than 24 hours. 

Coughing With Fever

Many of the conditions that cause a cough also cause a fever. A mild fever is common in children who have the common cold, for example. If your child has a cough with a high fever (more than 102 F), it can be a sign of a serious illness such as pneumonia. Influenza and COVID-19 can also cause a cough with fever. 

Your child's healthcare provider may recommend a fever-reducing medication such as Advil (ibuprofen) or Tylenol (acetaminophen) to help make them more comfortable. Ask your child's healthcare provider before giving one of these medications to a child younger than 2.  

If your child has a high fever and other symptoms such as weakness and rapid breathing, call their healthcare provider right away.

Productive (Wet) Cough

A child's cough that's productive or "wet" brings up fluid like mucus. When your child coughs, you'll be able to hear the fluid moving in their airways. Usually, the fluid has drained from the head or is phlegm that's being made in the respiratory tract.

The common cold and the flu are common causes of wet coughs in kids. These illnesses are usually not serious, and your child can be cared for at home.

While having a productive cough is no fun, it has an important purpose: it helps clear the lungs and prevent infection. That's why healthcare providers don't usually recommend trying to suppress a child's cough unless it's making it hard for them to rest or breathe.

Infection

Sometimes, a loud, wet cough is a warning sign that your child has an illness or condition that needs medical treatment.

If your child's cough is bringing up green or yellow mucus, and they have to sneeze or blow their nose a lot, they might have a sinus infection.

You'll want to take them to the pediatrician, as they might need antibiotics or allergy medication to help clear up the infection and ease their symptoms.

Pneumonia

You should also watch for signs of pneumonia, an infection caused by viruses or bacteria that get into the lungs and cause them to fill with fluid.

Even if you've already seen your child's healthcare provider about their cough, call them again if your child has:

• A cold lasts for more than a week
• A cough that's wet, loud, and phlegmy
• Breathing that seems faster than normal

Bacterial pneumonia is treated with antibiotics, but viral pneumonia needs to run its course. If your child gets severe pneumonia, they might need to be treated in the hospital.

Dry Nighttime Cough

If your child's cough is an annoying "on-and-off" cough that gets worse at night and with activity, call your pediatrician. A dry cough at night can also mean your child's body is making too much mucus. It can also be a sign of asthma.

Barking Cough (Croup)

A child's cough that sounds like a seal or small dog barking is a sign of an upper airway infection called croup.

Croup is most common in younger children. Each year, between 2% and 6% of children will develop croup, and between 10% and 16% will get croup at least once during their childhood.

Croup usually starts or gets worse at night. A child may wake up with a barking cough and make a loud whistling sound when they breathe (stridor).

In a child, a cough that sounds like this can be scary for kids and parents, but they don't always mean you have to go to the ER.

If your child wakes up with a barking cough, there are a few ways to help them at home. First, take them to the bathroom and turn on the hot water in the shower. Let the room steam up, and sit in it for about 15 minutes. You may want to try reading to them to help pass the time.

Often, sitting in a humid bathroom for a while is enough to help with the coughing and stridor from croup—at least enough to get through the rest of the night. If it does help, you can go back to sleep and call your pediatrician in the morning.

Cool air can also help ease a croup cough. If the weather is cool, bundle your child up and bring them outside to see if it helps their cough.

If it doesn't help and your child is still coughing and having trouble breathing, go to the ER right away. Depending on the severity of your child's condition, they may be given medications such as dexamethasone and epinephrine. The ER staff may also want to observe them for a short time before you can return home.

Wheezing Cough

A child's cough is not always wheezing, even if it sounds like it. People often confuse the term "wheezing" with the normal sounds a congested child makes when they breathe.

If you can hear mucus when your child is breathing, it probably is not a cause for concern. True wheezing is a high-pitched whistling sound a child makes when they're breathing out.

If your child is coughing and wheezing, you'll want to call your pediatrician. If your child is having a hard time breathing, take them to the ER.

If your child has asthma and is coughing and wheezing, follow your family's asthma action plan.

Comfort Care for a Child's Cough

There are some things that you can do at home to help with your child's cough.

• Use a cool-mist humidifier at night to put extra moisture in the air which can soothe airway irritation
• Give children 12 and up cough drops (do not give them to younger children because they are a choking hazard
• Give your child plenty of cool drinks or popsicles to ease throat pain and help them stay hydrated; avoid giving carbonated drinks or drinks like orange juice that could cause additional coughing
• Give children over the age of 12 months honey to help soothe the throat
• Elevate their head
• Make sure they get plenty of rest
• If your child has asthma, follow your family's asthma action plan
  

When to See a Healthcare Provider for a Child's Cough

A child's cough is not always a reason to panic. With time and experience, caregivers learn when it's time to call their child's healthcare provider or head to the ER.

Some warning signs mean a child's cough is not something you can handle at home. If your child is coughing and has these symptoms, you'll need to get them medical care right away:

• A fever of 100.4 F or higher in an infant 2 months old or younger
• A fever of 102 F or higher in a child of any age
• Blue lips
• Excessive crankiness or sleepiness
• Labored breathing (e.g., nostrils widening with each breath, wheezing, fast breathing, or shortness of breath)
• Loss of appetite or thirst, with signs of dehydration (such as urinating less often)
• Persistent ear pain
• Severe headache
• Worsening general health

Summary

A child's cough can be a common symptom of an illness that isn't serious, but it can also be a sign of a more pressing problem. If in doubt, call your child's healthcare provider. They will ask you to describe what the cough sounds like—or may even have you hold your phone up so they can hear your child's cough.

There are different types of coughs that kids can get. You may need to take your child to the pediatrician to figure out what is causing their cough and get them a treatment that will help.

Even if your child's cough can be managed at home at first, if they are not getting better, develop new or concerning symptoms, or are having trouble breathing, they need medical care right away.