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