Coughs and Colds in Children: What Helps and When to Worry

What a Normal Cold Looks Like

A cold is a viral infection of the nose and throat. There are hundreds of cold viruses, so children cannot become immune to them all. Young children commonly have six to ten colds a year, more in their first years at crèche, nursery or school. This is normal and does not mean your child's immunity is weak.

A typical cold:

• starts with a sore or scratchy throat, sneezing and a runny nose (catarrh);
• may bring a mild fever for the first two or three days;
• turns the mucus thick, yellow or green after a few days — this is normal and does not mean a bacterial infection or a need for antibiotics;
• is at its worst around days two to four, then slowly improves over 7 to 10 days;
• leaves a cough, often worse at night and in the morning, that can last up to three weeks as the airways heal.

A child with a cold often eats less and is cranky. Between spells of coughing they should still be drinking, passing urine, and playing at least some of the time.

When to Come In

Pneumonia — an infection of the lungs — is a major cause of death in young children in Nigeria, and most of those deaths can be prevented with early treatment. The signs below come from the World Health Organization's guidance for sick children. If your child has any one of the "come in now" signs, come to Limi Children's Hospital now, day or night. If you cannot get here quickly, go to the nearest emergency department. Have someone else drive if you can, so you can watch your child, and call 0813 408 5400 on the way so the team can prepare.

Counting Breaths and Looking at the Chest

Two checks tell a doctor, and you, most of what matters about a cough. Do them while your child is calm or asleep — crying and fever make children breathe faster.

1. Lift or open the top so you can see the chest and tummy. Good light helps.
2. Count each rise of the chest or tummy for a full 60 seconds. Use a phone timer or our breathing counter, which also tells you what the number means for your child's age.
3. Compare with the table below. If the count is at or above the number for your child's age, that is fast breathing. Fast breathing in a baby under 2 months, or 60 or more at any age, means come in now.
4. Watch the lower chest, just below the ribs, as your child breathes in. Does the skin suck in? Do the nostrils flare? Is there a grunt at the end of each breath?

Chest indrawing means the lungs are stiff or the airway is narrowed, and the child is working hard to breathe. It is easiest to see in babies and thin children. In an older child you may also see the skin sucking in between the ribs or at the base of the neck.

What Helps

• Fluids, little and often. Breast milk for babies — feed more often, for shorter times, if a blocked nose makes feeding hard. Water, warm drinks, pap and soups for older children.
• Saline nose drops or spray. Salt-water drops from a pharmacy loosen mucus. For babies, a few drops before feeds and sleep, then gently wipe or use a soft bulb sucker at the nostril. Do not push anything inside the nose.
• Honey for children over one year. A spoonful of honey, alone or in a warm drink, can ease a cough, and it is recommended by NICE for children over one. Never give honey to a baby under one year — it can cause infant botulism.
• Paracetamol or ibuprofen for fever or a sore throat if your child is uncomfortable, using the dose on the pack for your child's age, measured with the syringe or spoon that comes with it. Do not give ibuprofen to a child who is dehydrated or vomiting.
• Rest and comfort. Keep babies on their back to sleep on a flat, firm surface, even with a cold — see safe sleep. Older children may be more comfortable propped up on a pillow.
• Keep them home while they have a fever. A child can return to school once the fever has gone and they feel well enough, even if they still cough.

What Does Not Help

Coughs That Need a Closer Look

Pneumonia

A child with pneumonia usually has a cough, fever and fast breathing, and may have chest indrawing, grunting, or look unwell and tired. Pneumonia can be caused by bacteria or viruses, and a doctor decides whether antibiotics are needed after examining your child, and sometimes after a chest X-ray or a blood oxygen check with a finger clip. Children with low oxygen or chest indrawing are treated in hospital. At Limi, the inpatient paediatric team cares for them day and night, and children who need intensive care go to our paediatric intensive care unit (PICU).

Croup

Croup is a viral infection that swells the voice box and windpipe. It usually affects children between six months and three years. It causes a barking cough like a seal, a hoarse voice, and sometimes a harsh noise breathing in (stridor). It is often worse at night and usually lasts two or three days.

• Keep your child calm and sitting up on your lap. Crying makes the swelling and the noise worse.
• Do not look in the throat or put anything in the mouth.
• Come in now if there is stridor while your child is calm or asleep, if the skin sucks in, if your child is drooling or cannot swallow, is pale, agitated or unusually sleepy.
• Even mild croup is worth a same-day visit. A single dose of steroid medicine prescribed by a doctor reduces the swelling.

Bronchiolitis in Babies

Bronchiolitis is a viral chest infection of babies, mostly under one year and especially under six months. It starts like a cold, then over two or three days the baby develops a cough, faster breathing and sometimes wheeze. It is usually worst around days three to five, and the cough can last three weeks. Antibiotics and inhalers do not help most babies. Watch feeding and breathing: come in now if your baby has pauses in breathing, chest indrawing or grunting, looks blue, or has had no wet nappy for 12 hours. See a doctor today if your baby is taking less than half their usual feeds or has had no wet nappy for 8 hours. Babies born early, or with heart or lung conditions, need to be seen sooner.

Wheezing

Wheeze is a high whistling sound when breathing out. Many young children wheeze with colds, and most outgrow it. Wheeze that keeps coming back, or wheeze and cough at night, with exercise or with dust, may be asthma. Read our guide to asthma.

Whooping Cough (Pertussis)

Whooping cough begins like a cold, then after a week or two brings long fits of coughing that leave the child red-faced, gasping with a "whoop", and often vomiting. It can last up to three months. Babies may not whoop at all: they may simply stop breathing or go blue after coughing, which is an emergency. The pentavalent vaccine given at 6, 10 and 14 weeks protects against it — keep your child's vaccines up to date. Antibiotics help if given early and protect others in the home.

A Cough That Started Suddenly with Choking

If a cough began suddenly while your child was eating (groundnuts, corn, beans) or playing with small objects, something may have gone into the airway. Even if the cough settles, see a doctor today. If your child cannot breathe, cough or cry, start first aid — see first aid for choking.

A Cough That Lasts: Could It Be TB?

Tuberculosis (TB) is common in Nigeria and children usually catch it from an adult they live with or spend time with. TB in children is easy to miss. Ask a doctor to check for TB if your child has:

• a cough that has lasted more than two weeks and is not getting better;
• weight loss, or not gaining weight despite eating;
• fever, often in the evenings, and night sweats;
• tiredness, less playfulness;
• swollen glands in the neck;
• contact with anyone who has TB or a long cough.

TB can be cured with a full course of treatment. Testing and treatment for TB are available free through Nigeria's national TB programme. If an adult in the home is diagnosed with TB, all children in the home should be checked, even if they are well, because young children may need preventive treatment.

Harmattan, Dust and Smoke

Harmattan

From about November to March, the dry, dusty harmattan wind brings dry coughs, blocked or bleeding noses, cracked lips, and more asthma attacks. It helps to:

• give plenty of fluids;
• use saline drops for dry noses and a little petroleum jelly on the skin around the nostrils and lips;
• keep windows closed on very dusty days, and damp-dust rather than sweep;
• keep children with asthma on their preventer inhaler as prescribed.

Smoke in the Home

Smoke from cigarettes, firewood, charcoal and kerosene stoves damages children's lungs and makes pneumonia, asthma and ear infections more likely.

• Do not allow smoking in the house or car.
• Cook outside or in a well-ventilated space, keep babies and toddlers away from the cooking fire, and use cleaner fuels such as gas where you can.
• Keep generators outside, far from windows and doors. Generator fumes contain carbon monoxide, which can kill without warning.
• Avoid burning mosquito coils or rubbish near where children sleep and play.

Preventing Chest Infections

• Vaccines. The routine vaccines protect against the main causes of serious pneumonia: pneumococcus (PCV), Hib and whooping cough (in the pentavalent vaccine) and measles. Check your child is up to date with our vaccine schedule tool.
• Breastfeeding, exclusively for six months, protects babies from chest infections.
• Good nutrition. Underweight children get pneumonia more often and more severely.
• Handwashing with soap, and teaching children to cough into a tissue or elbow.
• Keep young babies away from people with coughs and colds.
• Clean air at home: no smoke, and generators outside.

Questions Parents Ask