Your daughter seems to be coming down with the "bug" that is going around, so you put her to bed half an hour early. After some grumbling, she finally falls asleep, and you tackle the dishes, catch up on a little reading, then head off to bed yourself. But at 3:30 AM, you wake up to a burst of loud coughing. What should you do?

Coughs are one of the most frequent symptoms of childhood illness, and although they can sound awful at times, they usually are not a symptom of anything dangerous. Actually, coughing is a healthy reflex that helps clear the airways in the throat and chest. Occasionally, though, coughs can be cause for a visit to your child's doctor. If you learn to recognize certain types of coughs, you will know how to handle them and when you should seek medical help.

Types of Coughs and What They Mean

"Barking" Cough

These coughs are usually caused by croup, an inflammation of the larynx (voice box) and trachea (windpipe) brought on by allergies, change in temperature at night, or most commonly a viral upper respiratory infection. When a young child's airway becomes inflamed, it swells up, making it harder to breathe. Children under 3 years of age have croup most often because their windpipes are narrow - some children have it practically every time they have a respiratory illness.

Croup can occur suddenly in the middle of the night, which can be frightening for both you and your child. Although most cases can be managed at home, if you suspect your child has croup, call your child's doctor to determine whether your child needs to visit him or her.

"Whooping" Cough

 The "whooping" sound actually occurs after the cough, when the child tries to take in a deep breath.

If your child makes a "whooping" noise (which actually sounds like "hoop") after severe bouts of rapid coughing, it is most likely a symptom of pertussis (whooping cough) - particularly if your child has not received her diphtheria/tetanus/pertussis (DTaP) vaccinations.

Infants with pertussis usually do not "whoop" after the prolonged episodes of coughing, but they may not get enough oxygen or they may even stop breathing with this disease. In infants and very young children, pertussis can be deadly, so call your child's doctor right away.

Cough With Wheezing

When coughing is accompanied by a wheezing sound as your child exhales (breathes out), it is a sign that something may be partially blocking the lower airway. This might be caused by swelling from a respiratory infection (such as bronchiolitis or pneumonia), asthma, or an object stuck in her airway. Call your child's doctor unless your child has this problem often and you have medicine, such as an inhaler or nebulizer, with instructions on how to use the medicine for home treatment of your child's asthma. If the cough and wheezing do not improve with medication, call your child's doctor.

Stridor

Although wheezing usually during exhalation, stridor (pronunced: stry-door) is noisy, harsh breathing (some doctors describe it as a coarse, musical sound) that's heard when a child inhales (breathes in). Most often, it's caused by swelling of the upper airway, usually from viral croup. However, it's sometimes caused by a more serious infection called epiglottitis or a foreign object stuck in the child's airway. If your child has stridor, call your child's doctor immediately.

Sudden Cough

When a child suddenly starts coughing, it may mean she has swallowed some food or liquid "the wrong way" (into the airway) or something (a bit of food, vomit, or perhaps even a small toy or coin) is caught in her throat or airway. Coughing helps clear the airway and may even continue for a minute or so simply because the throat or airway is irritated. But if the coughing does not seem to improve or your child has trouble breathing, call your child's doctor. Do not try to clear the throat with your finger because you might push the obstruction even farther down the windpipe.

Nighttime Cough

Lots of coughs get worse at night because the congestion in a child's nose and sinuses drains down the throat and causes irritation while the child lies in bed. This is only a problem if your child is unable to sleep. Asthma can also trigger nighttime coughs because the airways tend to be more sensitive and become more irritable at night.

Daytime Cough

Allergies, asthma, colds, and other respiratory infections are the usual culprits. Cold air or activity can make these coughs worse, and they often subside at night or when the child is resting. You should make sure that nothing in your house, like air freshener, pets, or smoke, is making your child cough.

Cough With a Cold

Because most colds are accompanied by a cough, it's perfectly normal for your child to develop either a wet or dry cough when she has a cold. The cough usually lasts about a week, often after all other symptoms of the cold have disappeared.

Cough With a Fever

If your child has a cough, mild fever, and runny nose, chances are she has a simple cold. But coughs with a fever of 102 degrees Fahrenheit (39 degrees Celsius) or higher can mean pneumonia, particularly if your child is listless and breathing fast. In this case, call your child's doctor immediately.

Cough With Vomiting

Children often cough so much that it triggers their gag reflex, making them throw up. Usually, this is not cause for alarm unless the vomiting persists. Also, if your child has a cough with a cold or an asthma flare-up, she may throw up if lots of mucus drains into her stomach and causes nausea.

Persistent Cough

Coughs caused by colds can last weeks, even up to 3 weeks, especially if your child has one cold right after another. Asthma, allergies, or a chronic infection in the sinuses or breathing passages might also be responsible for long-term coughs. If your child's cough lasts for more than a month, you should schedule a visit with your child's doctor.

Coughs in Young Infants

Coughing can wear out babies younger than 6 months, so keep a close eye on any cough your infant develops. These infants are also the population that is most at risk for complications from respiratory syncytial virus (RSV), which is most common in the winter. RSV causes colds and ear infections in older children and adults, but in young babies, it can cause bronchiolitis and pneumonia and lead to severe respiratory problems. The disease starts out like a normal cold but becomes worse until the child has wheezing, a cough, and difficulty breathing. Some children may have to be admitted to the hospital to receive oxygen and fluids.

When to Call Your Child's Doctor
Most childhood coughs are nothing to be concerned about. However, in some instances you should consult a doctor, just to be safe. Call your child's doctor if your child:

• has trouble breathing or is working hard to breathe
• has a blue or dusky color to the lips, face, or tongue
• has a high fever (particularly in a young infant or in the absence of congestion or a runny nose; contact your child's doctor for any fever in an infant younger than 4 weeks of age)
• is an infant (3 months old or younger) who has been coughing for more than a few hours
• makes a "whooping" sound when she breathes after coughing
• is coughing up blood (if your child has had a nosebleed recently, this usually is not a problem)
• has stridor when inhaling
• has wheezing when exhaling (unless you already have home asthma management instructions from your child's doctor)
• is listless or cranky

Professional Treatment
One of the best ways to diagnose a cough is listening. Your child's doctor will determine how to treat your child based in part on what the cough sounds like.

Because the majority of respiratory illnesses are caused by viruses, doctors do not prescribe antibiotics for many coughs. If bacterial pneumonia or another bacterial infection is suspected, your child's doctor will probably prescribe antibiotics.

Unless your child's cough is keeping her from getting adequate sleep, cough medicines are usually unnecessary. These medicines, both prescription and over-the-counter (OTC), may have unpleasant side effects and can even be dangerous for infants and young children. It's usually best to just let the illness run its course.

Pneumonia, pertussis, RSV, and serious cases of croup may require hospitalization. Usually this is just for close observation and to make sure your child gets enough fluids, but sometimes, if your child is having a hard time breathing, oxygen may be given. A baby with croup may be placed in a "croup tent," a little plastic oxygen tent. A water mist is continuously sprayed into the tent to provide humidification to soothe the baby's irritated airway.

Home Treatment
Home treatments should never take the place of consulting your child's doctor for any of the conditions listed above, but there are several things you can do in the house to make your child more comfortable when she has an annoying cough.

If your child has asthma, make sure you have received asthma-management instructions from your child's doctor. Monitor your child's progress carefully during a flare-up and give asthma medicines according to the doctor's instructions.

If your child wakes up with a "barking" or "croupy" cough in the middle of the night, take her into the bathroom, close the door, and let the shower run on hot for several minutes. After the room steams up, sit on the bathroom floor with your child for about 20 minutes. The steam should help her breathe more easily. Try reading a book together to keep her occupied.

A cool-mist humidifier in your child's room might also help her sleep through the night. You can also soothe throats with cool beverages like juice; avoid carbonated or citrus drinks, however, because carbonation and citric acid can be painful on raw areas.

You should not give your child (especially a baby or toddler) OTC cough medicine without specific instructions to do so from your child's doctor. Many of these medicines suppress coughs, but respiratory illnesses sometimes produce a lot of secretions and coughing helps clear them out of the airway. If the cough were suppressed with medicine, it could actually be harmful to your child. In some instances, these medicines have even caused dangerous side effects when given to infants or very young children.

Cough drops, which are fine for older children, are a choking hazard for young children.

In addition, the guidelines for OTC doses for children are often derived from adult guidelines (not formulated specifically for small children), so the medicine may not work exactly as intended. It's better to leave decisions about your child's medicine to your child's doctor.