Why is My Child Coughing at Night But Not Sick?
Is your child’s persistent nighttime cough keeping you, and them, up? Children who cough at night, especially when they seem perfectly healthy, can have a variety of things going on. Kathleen Gradoville, ARNP and pediatric pulmonologist, UnityPoint Health, dives into the reasons behind your child’s nagging bedtime cough, what’s normal and what’s a concern as well as practical tips to help both you and your little one get a better night’s rest.
What Does a Persistent Cough in a Child with No Other Symptoms Mean?
If your child is coughing at night without other signs of illness, there could be a few cruddy culprits, such as:
Post-Infectious Cough
It’s one of the most common reasons a child coughs at night without other signs of illness. While cold symptoms take one or two weeks to clear, coughs can stick around longer.
“Your child could have had respiratory syncytial virus (RSV), or another virus where the cough lingers. Sometimes, we watch and wait as long as it’s not disruptive to your child. Usually, if a cough lasts more than three weeks, it should be addressed,” Gradoville says.
Antibiotics aren’t typically helpful for coughs that stem from a virus. However, Gradoville says they’re warranted if there’s a different underlying infection, such as an ear infection, sinus infection or pneumonia.
Acid Reflux
Acid reflux may be cough-inducing.
“The more acid that comes up your throat, the more you cough to clear it, and the more you cough, the more acid comes up. It’s a vicious cycle,” she says.
However, when an infant or young child lays down and starts coughing, acid reflux is a possibility.
Allergies
Post-nasal drip from allergies can trigger a cough in children. Excess mucus drips down the back of the throat and irritates the airways. Additionally, pollen or dust may cause inflammation in the immune system and lead to a cough as the body tries to clear the irritants.
If your child can’t stop coughing at night, and it’s interfering with their sleep and healthy growth, always talk to your doctor.
Asthma
This common lung disorder is another reason your child might cough after bedtime.
“There are specific things we look for to determine if it’s asthma,” Gradoville says. “Asthma has a recurrent pattern. Children may cough for weeks or months. If the cough gets better with albuterol (a medication used to treat trouble breathing) or oral or inhaled steroids, that’s a good indicator it’s asthma.”
Doctors also evaluate your child for allergies or eczema. Along with a family history, these are considered red flags for an asthma diagnosis.
“Around age five or six, we use a spirometry test to potentially verify asthma,” Gradoville says. “A normal test doesn’t exclude asthma. It may mean your child was fine at that time, but a virus or exposure to cold a week later can trigger their asthma symptoms.”
Other symptoms that can accompany asthma include:
- Wheezing (sometimes, but not always)
- Chest tightness
- Shortness of breath
How to Calm an Asthma Cough in a Child
Asthma coughs are often worse at night, because the steroid your body produces drops in the evening. It’s the lowest between midnight and 3 a.m. and then goes back up. So, your body’s normal mechanisms that help control a cough are their lowest at night,” Gradoville says.
The body's immune system is also at work and may cause more congestion and increased cough, especially first thing in the morning.
If you, and your child’s doctor, suspect they’re coughing because of asthma, make sure they’re taking their inhaled medications, like albuterol and inhaled corticosteroid (controller medication), if prescribed.
In addition to using a prescribed inhaler, parents can try the following to calm their child’s asthma cough:
- Remove triggers: Ensure there aren’t any strong odors, dust or pet dander in your child’s room. If you’re able, room air purifiers are helpful for removing allergens. Allergen mattress and pillow covers are also helpful.
- Set the thermostat: Temperature changes can trigger asthma symptoms. Keep your child’s space comfortably cool.
- Practice relaxation techniques: Asthma attacks can cause anxiety in some children, which worsens symptoms. Try deep breathing or other calming methods before bed.
Gradoville writes out plans that explain what parents can do if their child has an asthma attack.
“At the start of a cough, I recommend children use their albuterol every four to six hours to calm their lungs and reduce inflammation from causing additional symptoms. What’s most important is to keep asthma controlled, so when they encounter a trigger, they have less difficulty,” she says.
Home Remedies to Stop a Cough at Night
Gradoville says if your child doesn’t have an asthma diagnosis, supportive care is the best way to help them get relief from their cough.
She suggests the following at-home remedies for nighttime coughs:
- Allergy medication: If your child has allergies, ensure they’re taking their allergy medication. Avoid using over-the-counter cough and cold medications as they aren’t recommended for children under six years old.
- Fluids: Ensure your child drinks plenty of fluids throughout the day. This helps thin mucus and relieve congestion. Warm water is good for easing coughs, too.
- Honey: Try a teaspoon of honey before bed to coat the throat, soothe irritation and suppress coughing reflexes. (Don’t give honey to children less than a year old.)
- Nasal suction: Suction your child’s nose using a nasal saline and bulb suction before they lay down for bed. This clears nasal passages and reduces postnasal drip, which can trigger a cough.
- Raise their pillow: If they’re old enough, prop their pillow up so your child sleeps in an elevated position. This helps with drainage.
- Steam: Humidifiers can be used, but they may make asthma symptoms worse in some children. Make sure you clean the humidifier regularly as they harbor mold.
Persistent Wet/Dry Cough in Child
An asthma cough can be wet or dry.
Gradoville says, “It may start out as a dry cough. Then, there’s so much inflammation that mucus secretions start to occur, and it becomes a wet cough.”
In addition to asthma, these are some other common reasons for a wet cough in a child:
- Allergies
- Bronchitis
- Common cold
- Environmental allergens
- Gastroesophageal reflux disease (GERD)
- Pneumonia
- Respiratory syncytial virus (RSV)
- Secondhand smoke exposure
- Sinus infection
In addition to several of the conditions above, a dry cough in a child may signal the following:
- Croup
- Post-infectious cough
- Sinus drainage
- Viral infection
- Whooping cough
When to Call Your Doctor if Your Child is Coughing at Night
Call your doctor if your child’s cough hasn’t resolved within a few weeks.
“If they’ve had a cough and low-grade temperature for a few days, and all of a sudden, they spike a high fever — or a fever or cough that get worse — these kids need to be seen,” Gradoville says.
If your child has trouble breathing or coughs up blood, seek medical attention right away.