Why can’t my kid stop hacking?

Q: My toddler’s been coughing for five days, mostly in the morning and at night, but has no other symptoms. Why? 

A: Coughing is the end result of many clinical situations — infection fallout, anatomic concerns, allergic/reactive processes or a combination of these issues. 

For toddlers, the most common reason is undoubtedly infectious. Toddlers explore their environments through touching and inadvertently tasting everything by putting their fingers in their mouths. 

Hand washing cannot occur frequently enough to compensate for the number of exposures to viruses or bacteria that occur with this normal inquisitiveness. Additionally, toddlers’ immune systems are often experiencing illnesses for the first time. Their bodies are learning immune responses to more quickly react to illnesses in the future.  

Often these first exposures result in more protracted symptoms as their bodies are learning to fight off infection. Furthermore, toddlers’ interactions with other toddlers, in daycare or other child environments, are also a source of infection propagation. 

Toddlers of course don’t always cover their noses and mouths when coughing. Indeed, toddlers have little regard for personal space, frequently coughing on top of one another or holding hands and inadvertently sharing mucus. They often use the back of their hands to wipe their runny noses and mucus off their faces and then touch surfaces.  

As respiratory infections create mucus day and night, pooling at the back of the nose and mouth occurs when kids are sleeping. Coughing helps clear the pooled mucus and can sound deep or coarse, but clears readily. 

Gastroesophageal reflux (stomach acid that comes up toward the mouth with heartburn) can happen to toddlers, too. 

This often leads to coughing when lying down, in the morning and at night, but is typically a more longstanding issue, not a five-day problem. 

From an allergic/reactive standpoint, mucus production from seasonal allergies can come on quickly and persist over five days, but toddlers rarely experience this. Seasonal allergies usually need multiple seasons of exposure to generate an immune response of runny nose, pooling of mucus and cough.  

Because coughing is so often an infectious issue, coughing children should be out of daycare as much as possible to prevent spread of illness. 

Q: What's the deal with e-cigarettes?

A: E-cigarette use, such as JUULing, has unfortunately gained popularity with teenagers. There are many factors contributing to this popularity, including fruity flavors, social media positioning e-cigarettes in a glamorous light and the ease of secretly hiding them due to the lack of smoke and the discreet design of the devices. 

Also known as vaping, using e-cigarettes produces visible vapor, but no smelly smoke. Though e-cigarettes don’t have tar or carbon monoxide, which have been implicated in cancers of the mouth, throat and lungs, they represent a gateway to cigarette use. 

The nicotine in these devices is highly addictive and under-recognized. For example, the amount of nicotine in a full pack of 20 cigarettes is equivalent to one pod of some brands of e-cigarettes. Nicotine causes increases in heart rate and blood pressure, suppresses appetite and affects the brain’s biochemical system to induce craving and addiction. The addictive potential of nicotine has been compared to heroin. Since children and teenagers are still growing and developing, exposing their growing bodies and brains to the effects of nicotine has lifelong implications. 

It is critically important that parents talk with kids about e-cigarettes and the risk of experimental use quickly becoming an addiction due to the powerful nature of nicotine. 


Dr. Gigi Chawla is a board-certified pediatrician and the chief of general pediatrics at Children’s Minnesota.