Most childhood coughs are caused by common colds and will clear up on their own within a week or two. In the meantime, a few simple home strategies can make a real difference, especially at night when coughing tends to be worst. Over-the-counter cough medicines, on the other hand, are not recommended for young children and have not been shown to work much better than doing nothing at all.
Why OTC Cough Medicine Isn’t the Answer
The FDA warns that children under 2 should never be given cough and cold products containing decongestants or antihistamines because of the risk of serious, potentially life-threatening side effects. Manufacturers have voluntarily extended that warning to children under 4. Even beyond age 4, the evidence for these products is weak. A Penn State study of 105 children found that dextromethorphan, the cough suppressant in most OTC cold medicines, was no better at reducing nighttime cough than giving no treatment at all.
Honey Before Bed
For children over 12 months old, a small dose of honey about 30 minutes before bedtime is one of the most effective options available. That same Penn State study found honey outperformed both the OTC cough suppressant and no treatment for reducing the severity, frequency, and bothersome nature of nighttime cough. Parents across the board rated it significantly better for helping their children sleep. Half a teaspoon for toddlers and up to a full teaspoon for older children is a reasonable amount. Buckwheat honey was used in the study, but any pure honey will coat and soothe the throat.
One critical rule: never give honey to a baby under 1 year old, not even a tiny amount on a pacifier. Honey can contain spores of Clostridium botulinum bacteria, and an infant’s immature digestive system can’t fight them off. This can lead to infant botulism, a serious illness. Wait until after your child’s first birthday.
Clear the Nose With Saline and Suction
A lot of childhood coughing, particularly in babies and toddlers, comes from mucus dripping down the back of the throat. Clearing the nose can reduce or stop this type of cough entirely. The process is straightforward: put 3 to 4 drops of saline solution into each nostril while the child is lying on their back, wait about a minute to let the saline thin the mucus, then suction it out with a bulb syringe.
To use the bulb syringe, squeeze all the air out first, gently place the tip into one nostril, then release the bulb so it pulls mucus in. Squeeze the contents onto a tissue and repeat on the other side. Limit suctioning to four times a day to avoid irritating the nasal lining, and always do it before meals rather than after, since suctioning on a full stomach can trigger vomiting.
You can buy pre-made saline drops at any pharmacy, or make your own by dissolving a quarter teaspoon of table salt in one cup of warm water. Make a fresh batch each day.
Add Moisture to the Air
Dry air irritates inflamed airways and makes coughing worse. A cool-mist humidifier in your child’s bedroom can help ease coughing and congestion, especially overnight. Always use a cool-mist model rather than a warm-mist vaporizer for children. Hot water or steam can cause burns if a child gets too close or knocks it over.
The tradeoff with humidifiers is maintenance. Standing water breeds bacteria and mold, which the humidifier then sprays into the air your child is breathing. Empty the tank and dry all surfaces daily. Use distilled or purified water instead of tap water to reduce mineral buildup inside the machine.
Keep Your Child Hydrated and Upright
Fluids thin mucus, making it easier for the body to clear. Water, broth, warm apple juice, and popsicles all count. For babies under 6 months, breast milk or formula is sufficient. Warm liquids in particular can soothe an irritated throat in older children.
Propping your child up slightly can also help, since lying flat lets mucus pool in the back of the throat and trigger coughing. For older children, an extra pillow works. For babies, holding them upright on your lap or in an infant seat is safer than placing anything in the crib.
If the Cough Sounds Like a Bark
A harsh, seal-like barking cough usually means croup, a viral infection that causes swelling around the vocal cords. It tends to be worst at night and can sound alarming. Comfort is key here: crying and distress actually worsen airway swelling, so holding your child, speaking in a calm voice, and offering a favorite blanket or toy all help more than you might expect.
Many parents find that cool night air helps. If the weather is cool, opening a window and letting your child breathe the outside air for a few minutes can ease the cough. Sitting in a steamy bathroom (with hot water running in the shower, not the child) is another common approach. The scientific evidence for both is limited, but they remain widely used because many families find them effective in the moment. A doctor may prescribe a corticosteroid to reduce airway swelling, which typically starts working within a few hours. OTC cough medicines do not help croup.
Signs That Need Medical Attention
Most coughs are harmless, but a few warning signs call for prompt evaluation. Watch for skin or lips turning bluish, a high-pitched whistling sound when your child breathes in (called stridor), visible pulling in of the skin between or below the ribs with each breath, drooling combined with difficulty swallowing, or your child looking unusually sick or anxious. Any of these suggest the airway is significantly narrowed and your child needs to be seen right away.
A cough that lasts more than two to three weeks, keeps coming back, or is accompanied by a persistent fever also warrants a visit to your child’s pediatrician to rule out something beyond a simple cold.