The sounds of coughing…

Parents often bring in kids with a cough but can’t describe what it sounds like. I sometimes get to hear it if they cough, but Murphy’s Law also says that a child who coughs often throughout the night and frequently during the day will have a 15 minute period of no cough at the exact time the doctor is in the exam room.

cough wheeze stridorIn all seriousness — coughs, regardless of the source — are usually worse at night, which means your doctor won’t usually get to hear the worst of it.

They can also change over time. For instance, croup often starts as a sudden barky cough that over days turns into a wet cough.

I often wish there was one place I could refer parents to so they could see what various coughs sound like, so I decided to put a list together. The internet is ripe with videos, but I have spent many hours watching videos that weren’t very helpful in order to find these. I’m sure I missed some of the best ones, so if you have one that you really like, please post in the comments below.

Regardless of how the cough sounds, if you’re worried about your child’s breathing or the sound of the cough, bring your child in to be seen.

Disclaimer: I have no ties to any of the videos below and am not responsible for any of the opinions or errors within them. Some are professionally done and others are videos parents uploaded. Some have advertisements which I do not endorse.

Croup

The initial seconds of this baby with croup stridor video show the typical croupy cough. At about 0:55 it shows the stridor that many kids with croup have. Stridor is a whistling sound as the baby breathes in (often confused with wheezing, which happens when you breathe out). It is common in croup and is caused by the swelling near the voice box. (Older kids and adults who get the same viruses that cause croup in younger kids often get laryngitis from the swelling near the voice box in a larger neck.)

This ER physician of TheEDExitVideo spends the first couple of minutes discussing what causes croup. At 2:27 sounds of stridor in an otherwise happy looking baby are shown. At 3:44 is a picture showing intercostal retractions (also seen with wheezing or other types of respiratory distress).

TheKidsDr also has a great informational video on croup.

Dry Cough

Dry cough can be from an irritation in the throat, asthma, acid reflux, or any common cold. It can also come from a habit cough (often seen after an illness and goes away with sleep only to return when awake).

If you’re sitting here reading this and not sick, make yourself cough. That’s what a dry cough sounds like.

Laryngomalacia

Laryngomalacia wasn’t on my original list because it isn’t from a virus or bacteria causing illness, but it is a cause of noisy breathing in infants. It is caused by floppy tissues near the voice box (i.e. larynx). Linden’s Laryngomalacia – 3 Months shows this breathing. It is often worst when baby is excited or fussy.

For more information on this (even a video of a scope into the airway), check out Children’s Hospital of Philidelphia’s Laryngomalacia page.

Pneumonia

The cough with pneumonia can sound like a wet cough or dry cough, so no specific videos are for this cause of cough.

The clues to pneumonia include a fever with cough, difficulty breathing between coughs, shallow breathing, shortness of breath with brief exertion, pain in the chest, rapid breathing, or vomiting after cough.

Pneumonia can be caused from viruses and bacteria and can range in severity. Walking pneumonia generally means that the person is not sick enough to require hospitalization.

Some pneumonias lead to severe difficulty breathing and require oxygen support.

Wet Cough

Wet cough can be from pneumonia or bronchitis, but also from postnasal drip with a common cold or allergies.

When kids “cough stuff up” it is usually the postnasal drip being coughed up, not mucus from the lungs coming up. The same is true if they “cough up blood”. This blood is usually from a bloody nose draining into the throat, not from lung tissue. (Note: bloody mucus can be from more serious causes and if your child has no signs of blood in the nose or is otherwise ill, he should be properly assessed by a physician.)

Wheezing

Wheezing is typical in asthma (and bronchiolitis). Many parents mistake the upper airway congestion sound that many kids make with postnasal drip as wheezing.

Wheezing can sound like a whistle as a child breathes out. Ethan’s wheezing shows a baby with noisy breathing without distress. This Wheezing – Lung Sounds Collection video has the sounds one would hear with a stethoscope, but if you put your ear against your child’s back (without a shirt) you might be able to hear them.

If you don’t hear wheezing, but your child is struggling to breathe, it does not mean there is no wheezing! Treat like you would if you hear the wheeze.

Asthma

Asthma Attack in a child starts with information on asthma, then at 1:50 video of what retractions look like.

Asthma attack shows the typical short breathing in phase with long exhale seen with an asthma attack. Also you can see the airway pulling in at the neck (retractions).

Bronchiolitis, often simply called RSV, but caused by many viruses

Bronchiolitis Cough, 3.5 months old shows a baby with a wet sounding cough, typical of bronchiolitis.

Bronchiolitis is a video from the ER physician Dr Oller. He reviews causes of bronchiolitis, how it’s spread, and how it affects the body. At 1:40 he discusses the natural progression of the simple cold into bronchiolitis. At 3:04 there is a picture of how we collect a nasal swab to help with diagnose of any viral illness.

Sick with Bronchilitis shows an infant with suprasternal retractions (sucking in at the base of the neck) and the typical cough associated with bronchiolitis. The man erroneously says “croupy”, see below for croup.

RSV and Infant Treatment shows the best treatment for babies with RSV (or any bronchitis): suctioning. Some babies need this deep suctioning in the doctor’s office or hospital. Others can get by with nasal aspirating at home. I’m not a fan of the bulb syringe for this. Here’s a good review of various aspirators.

Whooping Cough

Pertussis – Whooping Cough: A Family’s Story is an informational video on pertussis with the classic whooping cough in a child and pictures of a newborn with pertussis.

Silence the Sounds of Pertussis – Whooping Cough is a commercial for vaccinating, but it starts with the typical whooping cough sound.

Pertussis (whooping cough) shows a young infant with a cough from pertussis. Young infants do not always whoop, they stop breathing.

8 Year Old With Pertussis (Whooping Cough) shows a typical cough for an older child. Her positioning in front of the toilet shows that these kids often vomit from the force of the cough. The 2nd video from this same girl shows how normal and healthy kids can appear between episodes.

Final words…

Regardless of the sound of the cough or the ability to feel rattling in the chest, how kids are breathing is most important.

Coughs can often sound just awful but if the child is breathing comfortably and well appearing otherwise, it is probably not serious.

Conversely, some kids have a minimal cough but are suffering from difficulty breathing. If they are unable to talk and breathe or eat and breathe they should be seen. If the ribs suck in and out or the breathing is continuously more rapid than normal, they should be seen.

Don’t rely on the cough alone to decide how sick your child is. If they seem uncomfortable breathing it’s time for them to be evaluated.

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