How Long is Too Long for a Cough?
This sick season has been so hard! If you’re in it with your kids, I’m sending so many warm thoughts your way. Having sick kids at home can be overwhelming, and those never-ending coughs can leave you wondering when to seek help. Prolonged coughs can stem from various causes, some harmless and self-limiting, while others may require medical attention. In this post, I’ll guide you through what to observe in your child’s cough—its duration, sound, and associated symptoms—and share insights into how pediatricians approach these situations. Together, we’ll explore the clinical clues that help differentiate between common and more concerning causes, so you can feel confident in supporting your child’s health.
what to know
Here are a few things to think about if your child has had a cough for more than 10 days. I don’t want to stress you out by having you add one more thing to your to-do list, but taking notes (or even videos) can help a lot with collecting data. A thorough history can help us with 90% of diagnoses in medicine, so I want you to have this data on hand when you’re chatting with your care team.
when is the cough worse: daytime, nighttime, waking up at night, with activity
when exactly did it start: was there ever even a day that your child didn’t have a cough, or has it been every day for the duration of that time
do you hear wheezing: or any additional sounds
how has it changed over time: better/worse/same over time, is it productive (coughing mucous/phlegm up), does it sound dry or hacking, etc.
do they have other symptoms: runny nose, increased work of breathing, fever, fatigue, headache, vomiting, etc.
if they have a fever, did it start before or after the cough?
is it disrupting their daily lives?
what we think about
Based on your child’s history, your care team will likely think about a few things on their differential diagnosis:
Secondary infections. we consider secondary bacterial infections like sinusitis (thick nasal discharge, facial pain), pneumonia (new fever after cough starts, fast breathing, fatigue, pneumonia contacts), or ear infections (potentially fever, ear tugging, pain when lying down).
Back-to-back infections. we want to track when the cough started, if there was ever a day when the cough went away or improved, and exposures (childcare, other sick family members, etc.)
Postnasal drip. Runny noses irritate the vocal cords, which can cause a lingering cough. this might be worse at night or right when waking up, with position changes. You might also notice clearing of the throat or rubbing of the nose or even coughing spasms that cause gagging/vomiting.
Post-viral bronchospasm or wheezing. Some viruses have inflammation that can trigger bronchospasm - or spasms in the airways of the lungs. This can sound like audible wheezing, wheezing by stethoscope, or sometimes prolonged cough only (cough-variant). This can sometimes last for weeks after the virus. You might hear persistent cough, nighttime cough, coughing spasms, or coughing so hard that your child is vomiting.
Allergies. Babies and toddlers don’t typically get seasonal allergies, but they can get non-allergic rhinitis (irritation in the nasal passages) after a cold, from environmental triggers (like dust, carpet, smoke). This is sometimes worse at night and might vary by the room or environment.
Reflux. Children with reflux can often have prolonged cough without other clear symptoms. For younger kids, milk can come back up from the stomach, irritate the back of the throat and vocal cords, and cause cough. It might be worse after feeds or when lying down. You might also notice other signs of reflux.
Pertussis (Whooping Cough). We always keep this on the differential—not because it’s common in fully vaccinated kids (though immunity can wane over time), but because its early symptoms can look deceptively mild. If we see a persistent paroxysmal cough, post-tussive vomiting, or nighttime-worsening cough, especially during community outbreaks or known exposures, we may test for this.
when to seek help
LONGER THAN 10 DAYS. Many kids this season have had lingering coughs - coughs that feel like they've lasted forever. Most viral coughs can last almost 7-10 days, and some longer. But if your child has a cough that has been going on every single day (without a day free) for more than 10 days, it's good to make sure there is no other reason (i.e. a secondary infection - ear infection, pneumonia), wheezing, postnasal drip, etc.).
COUGH AND THEN NEW FEVER. Many viral infections start with a fever and a cough - the fever eventually goes away, and the cough lingers for a while. But if your child has had a cough for a few days and THEN gets a fever after that, it can sometimes signal a secondary or new infection.
COUGH THAT IS GETTING WORSE INSTEAD OF BETTER OVER TIME. Most coughs should be steady or getting better slowly over time - if your child has a cough that is progressively getting worse instead, it's good to check in with your care team. (Note: With RSV and bronchiolitis, symptoms do get worse on days 4-6 of illness and then slowly improve.)
RESPIRATORY DISTRESS. Respiratory distress means a few things - if your child has any of these, it's important to seek medical attention. See my breathing reel for real-life examples of these.
Increased "work of breathing" — subcostal retractions (tugging at the bottom of the ribs), intercostal retractions (tugging between the ribs), suprasternal retractions (tugging above the ribs at the collarbone), or nasal flaring.
Extra sounds — wheezing, stridor, or grunting.
TRUST YOUR GUT. You know your child best - if something feels off or doesn't seem right, trust that instinct. Parents have the best sense of their kids - we trust you in the care process.
what to have
I believe in being intentional about things you keep at home when your children are sick. You don’t need a million products, but these are a few items that can help when your kids have coughs.
and just remember…
I know it can be a lot, and at times even scary, to navigate a prolonged cough in your child. But remember, you’re not alone in this journey. By keeping track of key details—like how long the cough has lasted, what it sounds like, and any other symptoms—you’ll be better prepared to have clear and productive conversations with your care team. These observations are invaluable in helping to diagnose the cause of your child’s cough and guiding the best treatment plan. Your attentiveness plays a vital role in getting your little one the relief they need, and with the right support, they’ll be on the road to feeling better soon. You’re doing so great - just take it one step at a time.