Most infant coughs are caused by common viral infections and will clear up on their own within one to two weeks. You can’t speed up the virus itself, but you can make your baby more comfortable by keeping their airways clear, their body hydrated, and their environment moist. Importantly, over-the-counter cough medicines are not safe for infants and should never be given to children under 2.
Why You Can’t Use Cough Medicine
The FDA does not recommend over-the-counter cough and cold medicines for children younger than 2 because they can cause serious, potentially life-threatening side effects. Most manufacturers now voluntarily label these products with a warning not to use them in children under 4. That includes homeopathic cough and cold products, which the FDA says have no proven benefits and should not be given to young children either. This means the tools you have are all non-medication strategies, and they work well for the vast majority of infant coughs.
Honey is a common cough remedy for older children, but never give honey in any form to a baby under 12 months. An infant’s digestive system can’t fight off the spores that cause botulism. In babies, those spores can multiply and produce a toxin that enters the bloodstream and disrupts the nervous system. After age 1, healthy gut bacteria keep botulism-causing bacteria from surviving long enough to cause harm.
Clear the Nose With Saline and Suction
Babies breathe almost exclusively through their noses, so a stuffy nose often triggers coughing. Saline nasal drops are the single most effective tool you have. Place a few drops in each nostril, then hold your baby with their head tilted back for about a minute to give the saline time to thin the mucus. After that, use a bulb syringe or nasal aspirator to gently suction out the loosened mucus.
Limit suctioning to no more than four times a day. Doing it more frequently can irritate the nasal lining and actually make congestion worse. Good times to suction are before feedings and before sleep, since clear nasal passages make both easier.
Keep Your Baby Well Hydrated
Fluids thin mucus from the inside, making it easier for your baby to clear their airways naturally. For babies under 12 months, stick with breast milk, formula, or an oral rehydration solution if your doctor recommends one. Do not dilute formula, and do not stop breastfeeding. Babies older than 6 months who have started solids can also have small sips of water between feedings.
If your baby seems reluctant to feed or is vomiting, offer small, frequent amounts instead of full feedings. Start with about 1 teaspoon (5 mL) of liquid every 5 to 10 minutes and gradually increase as your baby tolerates it. Shorter, more frequent nursing or bottle sessions are easier for a congested baby who needs to pause to breathe.
Use a Cool Mist Humidifier
Dry air irritates inflamed airways and thickens mucus. A cool mist humidifier in your baby’s room adds moisture to the air and can noticeably reduce coughing, especially at night. The American Academy of Pediatrics recommends cool mist over warm steam vaporizers because vaporizers pose a burn risk if a child gets too close or knocks the device over.
A humidifier that’s too large for the room can create condensation that breeds bacteria and mold, so choose an appropriately sized unit. Use filtered or distilled water rather than tap water, which contains minerals that encourage microbial growth inside the tank. Clean the humidifier every two to three days by soaking the tank and all water-exposed parts in a solution of one part bleach to nine parts water. Empty the tank and dry the interior surfaces each time you turn the machine off, and refill with fresh water daily.
Safe Sleep for a Congested Baby
It’s tempting to prop up your baby’s mattress or place them in a swing to help with breathing, but the AAP is clear: infants should sleep on their backs on a firm, flat mattress with no pillows, blankets, or inclined surfaces. Elevating one end of a crib mattress is not recommended because it can cause a baby to slide into a position that restricts breathing. Avoid letting your baby sleep in a swing, car seat, or bouncer, even if they seem to breathe more easily upright.
What you can do is run the humidifier in the sleep area and suction your baby’s nose right before laying them down. A clear nose at bedtime goes a long way toward reducing overnight coughing.
What the Cough Sound Tells You
Not all coughs are the same, and the sound can point to different causes. A wet, phlegmy cough usually means mucus is draining from the nose into the throat, which is the most common scenario during a cold. A dry, tight cough may signal irritation from dry air or mild inflammation in the lower airways.
A barking cough that sounds like a seal is the hallmark of croup, an infection that causes swelling around the voice box and windpipe. When a cough forces air through that narrowed passage, the swollen vocal cords produce the distinctive bark. Croup often worsens at night. Taking your baby into a steamy bathroom for 10 to 15 minutes or stepping outside into cool night air can sometimes ease the swelling temporarily, but a barking cough warrants a call to your pediatrician, especially if it’s accompanied by a high-pitched sound when your baby breathes in.
A whooping or gasping cough, where your baby coughs in rapid bursts and then struggles to inhale, can indicate whooping cough (pertussis) and needs prompt medical attention.
Signs That Need Medical Attention
Most infant coughs resolve without any medical treatment, but certain signs mean your baby needs to be seen right away. Watch for these specific indicators of breathing difficulty:
- Nostril flaring: The openings of the nose spread wide with each breath, a sign your baby is working harder than normal to get air.
- Chest retractions: The skin pulls inward just below the neck, under the breastbone, or between the ribs with each breath. This means your baby is using extra effort to inflate the lungs.
- Fast breathing: A noticeable increase in the number of breaths per minute, especially at rest, suggests your baby isn’t getting enough oxygen with each breath.
Fever combined with a cough also changes the urgency. Call your pediatrician for any fever in a baby younger than 3 months, no matter how mild. For babies 3 to 6 months old, call if the temperature reaches 100.4°F (38°C) or if your baby seems unusually sluggish or fussy even with a lower temperature. A cough that lasts longer than two weeks, produces blood-tinged mucus, or makes it difficult for your baby to eat or sleep also warrants a call.
Blue or gray discoloration around the lips or fingernails means your baby isn’t getting enough oxygen. That’s an emergency requiring immediate care.