How Long Is Too Long For A Cough?
This sick season has been SO hard - if you’re in it with your little ones, I feel you and am sending so many warm thoughts your way. Having sick kids at home, especially when they feel like they’ve been sick forever, can feel so hard. One of the most common questions parents have is “My child has been coughing for weeks, when should I see the doctor?” Let me help walk you through it step-by-step.
What To Know
We’re seeing a lot of viral illnesses this season - flu, RSV, you name it. Though we sometimes think of colds as these quick things we get past, but they can actually take a lot longer. Most viral upper respiratory infections can take 7-10 days before your child feels better. And RSV/Bronchiolitis can take almost 2 weeks.
What Should I Do If My Child Has Had a Prolonged Cough?
Here are a few things to think about if your child has had symptoms for longer than 10 days:
Take Notes. I don’t want tracking to stress you out in any way. But the most important thing is the history - what you tell your care team. For those of you with my Baby’s Health Journal, there’s a whole triage sheet in there just for coughs - like I’m right there with you asking you questions. Some things to note:
when is the cough worse (daytime, nighttime, waking up, with activity)
do they have a really runny nose
when exactly did it start
do you hear wheezing
how has it changed over time (sound, wet/dry, better/worse/same)
is there any fever (secondary infections)
Talk With Your Care Team. I’ve listed out some things we think about in our differential when kids have prolonged coughs.
What We Think About (and What to Try)
Secondary Infections. We consider secondary bacterial infections like sinusitis (thick nasal discharge, facial pain), pneumonia (new fever after cough starts, fast breathing, fatigue), or ear infections (potentially fever, ear pain).
Back-to-Back Infections. We want to track when the cough started, if there was ever a day without cough or with improvement, and exposures (childcare, other sick family members, etc.)
Post-Viral Bronchospasm/Wheezing. Some viruses this year have a lot of inflammation causing wheezing that can last for weeks after an acute illness - this often sounds like a prolonged cough (i.e. you might not hear audible wheezing, but instead a cough). You might hear a persistent cough, cough that’s worse at night, or coughing spasms.
Postnasal Drip. Runny noses irritate the vocal cords, which can cause a lingering cough. This might be worse at night or right when waking up, with position changes. You might also see clearing of the throat or rubbing the nose.
Allergies. Babies and toddlers can get non-allergic rhinitis - i.e. irritation in the nasal passages that comes with inflammation after a cold, environmental triggers (carpet, dust, etc.). This is sometimes worse at night and may vary by room/environment.
Reflux. Babies with reflux can often have prolonged cough, without other clear symptoms. The milk comes back up, irritates the back of the throat, causing cough. It may be worse after feeds or when lying down. There may also be other symptoms of reflux (see my IG highlight).
When Should I Seek Medical Help?
You should seek medical assistance if your child is/has:
Trouble breathing or increased work of breathing (respiratory distress, see my “breathing” highlight on Instagram)
Wheezing
Change of color (pale, blue/purple, etc. around the mouth)
Drooling or trouble swallowing
Lethargy (very tired or hard to arouse)
Dehydration
Fever for more than 3 days
Symptoms that are worsening after 10 days
Other medical conditions
With any questions or concerns
Let’s talk more this week about how to care for your child at home and what to discuss with your care team. Knowing what to do at home and when to seek help will help you feel confident caring for your sick child. You’re doing so great.