A cough in a child is almost always a cold clearing the airways, and it can go on for three to four weeks without anything being wrong. What decides whether you should seek care is not how much your child coughs but how they breathe and how they are between the coughing fits. A barking cough at night is croup, a wheezing out-breath suggests narrowed airways, and a cough with breathing difficulty, high fever or drowsiness should always be assessed by a doctor or nurse.
At half past two in the morning the two-year-old starts coughing in the next room, and you lie there listening: is it the usual cough, or does it sound different? Being able to tell coughs apart is one of the most useful skills of the toddler years, because it decides whether you roll over and go back to sleep, go in and sit your child up, or make a call. Here are the common kinds, what they usually mean and what to do.
The different kinds of cough
| What it sounds like | What it usually is | What you do |
|---|---|---|
| Rattling, chesty cough, mostly in the morning and at bedtime | A cold, with mucus running down the back of the throat | Saline drops in the nose, head end raised, fluids. Passes with the cold. |
| Dry, tickly, after a cold | Irritated airways that are healing | Honey from age one, humid air. Can linger for a few weeks. |
| Barking, hoarse, often sudden and at night | Croup | Calm, sit upright, cold air. Call 112 if breathing is laboured at rest. |
| Whistling or wheezing when breathing out | Narrowed airways: obstructive bronchitis or asthma | A doctor should assess. If breathing is difficult, urgently. |
| Whooping, the child goes red and vomits after the fit | Whooping cough | Call 1177 the same day, especially for a baby. |
| Cough with high fever, fast breathing, a child who is clearly unwell | Pneumonia or another infection | Seek care the same day. |
Chesty cough and dry cough: the usual ones
The most common cough in preschool children comes from mucus running back from the nose when the child lies down. That is why it is worst in the evening and morning, and why rinsing the nose helps a cough even though the cough sits in the throat. After the cold there is often a dry, tickly cough that can linger for weeks. The child is well, plays, eats and sleeps reasonably, but coughs on exertion and in cold air. It heals by itself. If your child coughs for more than six to eight weeks without a break, or coughs at night without having a cold, the vårdcentral (local health centre) should take a look, partly to rule out asthma.
Barking cough: croup
Croup (falsk krupp in Swedish) comes on suddenly, almost always at night, in children between about six months and three years. The child wakes with a cough that sounds like a seal, is hoarse and gasps for breath with a whistling sound when breathing in. It looks frightening. What helps is calm, sitting upright on your lap and cool air: open the window, go out on the balcony wrapped in a blanket. It usually eases within a quarter of an hour. If it doesn't improve, if your child is breathing with effort even at rest, goes blue around the mouth or becomes drowsy, call 112 (the emergency number). We have a separate guide to Croup.
Wheezy cough: narrowed airways
A whistle or wheeze when your child breathes out, and a cough that sits deeper, suggest that the small airways are swollen. In children under two it is often called obstructive bronchitis and comes with a cold. If it comes back several times it may be asthma, which is common and treats well. The first time you hear the wheeze, a doctor should listen to your child's chest. If your child is breathing fast, with the skin pulling in between the ribs or at the base of the throat, or cannot manage to talk or drink, it is an emergency.
Whooping cough
Whooping cough starts like an ordinary cold and turns into coughing fits where the child coughs until they run out of air, gasps with a whooping sound and sometimes vomits. The whooping cough vaccine is part of the childhood vaccination programme and is given by BVC (the child health clinic every family is enrolled in), but protection is not complete before the first doses, and babies under six months can become seriously ill. If you suspect whooping cough, especially if there is a baby in the home, call 1177 the same day.
What helps, and what doesn't
- Raise the head end. A towel under the mattress instead of a pillow for small children.
- Saline drops in the nose before sleep, so the mucus doesn't run backwards.
- Honey, a teaspoon at bedtime, for children over one. Works as well as cough medicine in studies, and tastes better.
- Fluids, often and a little at a time. A warm drink can calm a tickly cough.
- Humid, cool air. Air the room, turn the radiator down, or sit in the bathroom with the hot shower running if your child has a dry, tickly cough.
- Cough medicine: no, not for small children. No proven effect, and the apotek (pharmacy) often advises against it. Always ask before giving anything.
- A smoke-free home and smoke-free clothes. Children in homes where someone smokes cough more, even if the smoking happens on the balcony.
When to seek care
| Seek care | Wait at home |
|---|---|
| Trouble breathing, fast breathing, skin pulling in between the ribs | Coughs but breathes calmly between the fits |
| Blue lips or a drowsy child: call 112 | Tired but awake and responsive |
| A baby under three months with a cough and fever | A child over one who coughs with a cold |
| Whooping, vomiting after coughing | Coughs up a little mucus |
| A cough lasting more than six to eight weeks | A cough three weeks after a cold that is easing off |
| High fever and a child who is clearly unwell | Mild fever that is coming down, good spirits |
How we do it with our families
Nike looks after a two-year-old who coughs every autumn, and she can hear the difference between his usual chesty cough and the hoarse sound that came one evening in November. She rang the parents before doing anything else, sat him upright on her lap and went out onto the balcony wrapped in a blanket. It eased within ten minutes, and there was no trip to A&E. Her note recorded exactly when the cough started and what it sounded like. The same nanny every week hears when a cough changes character, because she knows how it usually sounds.
This article is general information and does not replace advice from BVC, your vårdcentral or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows what is normal for them and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Colds in children · Croup · Laboured breathing while your child sleeps · Fever in children
Frequently asked questions
How long is it normal for a child to cough?
Three to four weeks after a cold is common, and a preschooler who catches several colds in a row can cough more or less all autumn. A cough that goes on for more than six to eight weeks without a break, or that keeps coming back at night without a cold, should be assessed by a doctor or nurse.
What does a barking cough mean?
A cough that sounds like a seal or a dog, often at night, with hoarseness and sometimes a whistling sound on breathing in, is croup. It is common in children between six months and three years and usually passes within half an hour in cold air, but call 112 if your child has trouble breathing at rest.
What does a wheezy cough mean?
A whistling or wheezing sound when your child breathes out, together with a cough, suggests narrowed airways, as in asthma or obstructive bronchitis. Small children often get it with a cold. It should be assessed by a doctor the first time, and immediately if there is any breathing difficulty.
Should we give cough medicine?
No, not to small children. Cough medicines have no proven effect in children, and the apotek often advises against them. Honey for children over one, a raised head end, fluids and humid air help more. Never give honey to a child under one, and always ask the apotek before giving any medicine.
Can my child go to förskola with a cough?
Yes, if your child is free of fever and has the energy to join in. A cough can linger for weeks after a child is well again, and that is no reason to stay at home from förskola (municipal preschool, from age one). If your child coughs so much that they cannot sleep or play, that is a different matter.