Nighttime and Morning Cough in Young Children

Coughing at midnight / Coughing in the morning

Hello Doctor, my child is one year and one month old.
On December 18 of last year, he contracted enterovirus and was recovering when he returned for a follow-up visit, where he had a cough and runny nose.
The doctor prescribed medication.
On January 8, during a vaccination appointment, I mentioned that my child coughs at night and in the morning, but not much during the day.
The doctor indicated that the cough could be due to weather changes, dust, etc.
After January 8, the coughing persisted but seemed to have lessened.
However, as of yesterday, January 20, it seems to have worsened again, with coughing severe enough to wake him up at night.
This coughing issue has been ongoing for nearly a month, and although I have been encouraging him to drink water for relief, he is reluctant to do so.
Could it be that his throat hurts, causing him to avoid drinking? Before contracting enterovirus, he did not have issues with coughing at night or in the morning.
Is this a sign that he is still unwell, or could there be another underlying cause? He was tested for allergens at birth, and the results were normal.
Could you please clarify this for me? Additionally, which specialty should I consult for a detailed examination? Thank you.

Snady, 20~29 year old female. Ask Date: 2016/01/21

Dr. Xiao Kaiwen reply Pediatrics

If a sore throat is so severe that one cannot even drink water, it is likely that eating food would also be painful.
The most common causes of persistent coughing in young children are respiratory allergies, post-nasal drip, and gastroesophageal reflux, while less common causes include bacterial infections and foreign body aspiration, among others.
The allergy index tested at birth is merely a reference and does not guarantee that the child will not develop allergic conditions later on.
Children often cough more during temperature changes (such as upon waking and at night), which is more likely to be allergic cough.
It is recommended to consult a pediatric allergist at a major hospital for further evaluation.

Reply Date: 2016/01/21

More Info

Understanding nighttime and morning cough in young children can be quite complex, as it often involves multiple factors that can contribute to respiratory symptoms. In your case, the one-year-old child has experienced a persistent cough that seems to worsen at night and in the morning, which can be concerning for parents.

From the information provided, it appears that the child had a history of enterovirus infection, which can sometimes lead to lingering respiratory symptoms even after the acute phase of the illness has resolved. Coughing at night and in the morning can be attributed to several potential causes:
1. Postnasal Drip: This is one of the most common causes of nighttime cough in children. When a child has a cold or respiratory infection, mucus can accumulate in the nasal passages and drip down the back of the throat while they are lying down, leading to irritation and coughing. This can be particularly pronounced in the morning after a night of sleep.

2. Allergies: Even though the child was tested for allergens at birth and found to be negative, it is possible for allergies to develop later in life. Common allergens include dust mites, pet dander, pollen, and mold. If the child is exposed to any of these allergens, it could trigger a cough, especially at night when the child is in bed.

3. Asthma: Another possibility is that the child may have asthma or reactive airway disease. Asthma can present with nighttime cough, especially if there are triggers such as cold air, exercise, or allergens. The fact that the cough is worse at night and in the morning could suggest that the airways are becoming constricted or inflamed during sleep.

4. Environmental Factors: Changes in weather, exposure to cold air, or irritants such as smoke or strong odors can exacerbate coughing. If the child is sleeping in a room with dry air, this can also lead to throat irritation and coughing.

5. Infection: While the child may have recovered from the initial viral infection, it is possible that there is a secondary infection, such as a bacterial sinus infection or bronchitis, that is causing the cough to persist.

Given that the cough has been ongoing for almost a month and has worsened recently, it is advisable to seek further evaluation. A pediatrician would be the most appropriate specialist to assess the child’s condition. They can perform a thorough examination, review the child’s medical history, and possibly recommend further tests, such as allergy testing or pulmonary function tests, if asthma is suspected.

In the meantime, here are a few suggestions to help manage the cough:
- Hydration: Encourage the child to drink fluids, as staying hydrated can help thin mucus and soothe the throat. If the child is reluctant to drink, try offering fluids in different forms, such as soups or popsicles.

- Humidifier: Using a cool-mist humidifier in the child’s room can help keep the air moist, which may alleviate coughing caused by dry air.

- Nasal Saline Drops: Saline nasal drops can help clear nasal congestion, which may reduce postnasal drip and coughing.

- Elevate the Head: If possible, try elevating the head of the child’s bed slightly to help reduce coughing during the night.

In conclusion, while there are several potential causes for the nighttime and morning cough, a thorough evaluation by a pediatrician is essential to determine the underlying issue and appropriate treatment. Early intervention can help alleviate symptoms and improve the child's comfort and quality of sleep.

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