Baby coughing at night: causes, safe relief and when to worry

A cough that seems fine by day can sound alarming at 2 am. Many night coughs come with an ordinary cold and ease on their own, but a few causes are typically worse overnight: croup, whooping cough and, in toddlers, asthma. What matters most is not the cough itself but your baby's breathing, colour, feeding and alertness. Those tell you whether to soothe and watch, see a doctor today, or call 999.

Why does my baby's cough get worse at night?

There isn't one reason, but several common causes have a night-time pattern:

• Croup. The NHS croup page says symptoms are often worse at night, and the Royal Children's Hospital Melbourne (RCH) says the noisy breathing of croup often starts suddenly in the evening or overnight.
• Whooping cough. The NHS whooping cough page describes coughing bouts lasting a few minutes that are worse at night.
• Asthma. The RCH asthma fact sheet says an asthma cough usually happens at night or in the early hours of the morning.
• Post-nasal drip. The AAP's cough guide says mucus dripping down the back of the throat, such as from a sinus infection, can irritate the throat and trigger a cough.
• Dry air. The AAP says dry air makes coughs worse, which many parents notice when the heating is on overnight.

Night is also when you're listening closely in a quiet house. The RCH cough fact sheet says it's common for a dry cough to carry on for weeks after a cold. See colds and congestion for the cold itself.

Is it a cold, croup or whooping cough?

Croup: the barking cough

The NHS describes a barking cough that may sound like a seal, a hoarse voice and a high-pitched rasping sound when breathing in. That rasping sound is called stridor. The RCH says croup is most likely between 6 months and 6 years, usually lasts 2 to 4 days and nights, and is often worst on the second or third night. The barking cough itself can hang on for up to a month.

When your child wakes with croup, keep them calm, because the RCH says breathing is usually harder when they're upset. The NHS suggests sitting them upright, comforting them, giving plenty of fluids and checking on them regularly, including at night. The NHS also says to get an urgent GP appointment or call NHS 111 if you think your child has croup, because a doctor may prescribe medicine to shorten it.

Stridor at rest is the key warning sign. The RCH says to call an ambulance if your child is struggling to breathe or has stridor, and to go to hospital if they have stridor while resting and calm, or skin sucking in between the ribs or under the neck at rest. Stridor only when crying or upset still needs a doctor today.

Whooping cough: fits, a whoop and pauses

Whooping cough (pertussis) starts like a cold. The RCH whooping cough fact sheet says the cold-like stage usually lasts about a week, then the cough comes in long spells and may last for 10 weeks or more. Some children cough so much they vomit, and the NHS says the cough may last for several weeks or months.

Young babies often don't follow the textbook pattern:

• The NHS says babies under 3 months may not whoop, and young babies may turn blue or grey after a coughing bout.
• The RCH says babies under 6 months may have pauses in breathing (apnoeas) instead of a cough.
• The CDC says many babies with whooping cough don't cough at all, and that these pauses are life-threatening and may turn a baby blue.

The RCH calls whooping cough especially dangerous in babies under 6 months, and the NHS says to get urgent advice if a baby under 6 months has symptoms. Any pause in breathing, or blue or grey colour, means calling 999.

Vaccination protects babies

Whooping cough vaccine is offered in pregnancy, so your baby is born with some protection, and then as part of your baby's routine vaccines. Timing differs by country:

The CDC's pregnancy vaccine page explains that babies don't start building their own protection until their first dose. The RCH also recommends a booster for parents of newborns and other carers of babies under 6 months. Our vaccinations guide has the full schedules.

Could reflux or asthma be behind the cough?

Reflux. The NHS reflux page lists coughing or hiccupping during feeds among reflux symptoms, along with bringing up milk and being unsettled at feeds. It says reflux usually starts before 8 weeks and gets better by 1 year. The NHS advises holding your baby upright during feeds and for as long as possible afterwards, then putting them to sleep flat on their back without raising the head of the cot. See reflux and spit-up.

Asthma in older toddlers. The RCH says the most common asthma trigger is a viral infection such as a cold, and that asthma can cause a cough at night or early morning along with a wheeze, a high-pitched whistle usually heard when breathing out. Doctors can diagnose asthma from the first birthday, but the RCH notes that not all children who wheeze have asthma. A night cough that keeps coming back, or wheezing, is worth discussing with your GP.

How can I ease my baby's cough at night?

1. Keep feeds and fluids going. The AAP suggests extra breast milk or formula for babies under 1, and the RCH and NHS both suggest plenty of fluids.
2. Clear a blocked nose. Saline drops and gentle suction before feeds and sleep can help. See helping a baby with a stuffy nose sleep.
3. Comfort them upright while they're awake. Holding your baby upright during a coughing bout is comforting. Once they're asleep, put them back on their back in their cot.
4. Keep the air smoke-free. The AAP says tobacco smoke makes coughs much worse.
5. Honey only from 12 months. The RCH says honey may ease a cough in children over 12 months, but never give honey to a baby under 12 months because of the risk of botulism. The AAP says the same.
6. Stay close. For croup, the RCH suggests staying close at night so you can hear your child.

Do humidifiers or steam help a cough?

Sources don't fully agree, so here is what each says:

• Cool-mist humidifier: the AAP suggests one if the air is dry. Its stuffy-nose sleep guide says to place it close enough for the mist to reach your baby but out of reach, and to change the water every day. The FDA also suggests a cool-mist humidifier and says not to use warm-mist ones.
• Shower steam: the AAP suggests sitting with your baby in a steamy bathroom with the hot shower running.
• Croup: the RCH says steam is no longer recommended because evidence shows mist, steam and vaporisers don't help, and the NHS says not to put a child with croup in a steamy room or have them inhale steam.
• Scald risk: the NHS common cold page says not to let children breathe in steam from a bowl of hot water because of the risk of scalding.

If you use steam, keep your baby well away from hot water and never leave hot water or a steaming device within reach.

Can I give my baby cough medicine?

No. Regulators and children's health bodies agree that over-the-counter cough and cold medicines aren't for babies and young children:

The MHRA's advice covers cough suppressants, expectorants, decongestants and antihistamines, and the NHS common cold page says decongestants should not be used by children under 6. The AAP's medicine guide adds that many children with colds still sleep well, so treat symptoms only if they're causing discomfort. For pain or fever, ask a pharmacist about paracetamol or ibuprofen and follow the label, which gives age limits. See fever in babies.

How do I keep my coughing baby safe in their cot?

It's tempting to prop up a coughing baby, but it isn't safe and doesn't help:

• Don't raise the cot or mattress. The AAP says propping a baby on towels or pillows or inclining their mattress is not safe. The Lullaby Trust says not to incline, tilt or prop the mattress, cot or baby, and that doing so is unlikely to improve cold symptoms and doesn't help reflux.
• No pillows, wedges or rolled towels. Red Nose in Australia says an inclined surface encourages a baby's head to fall forward, which can block their airway.
• Back to sleep, flat and clear. Put your baby on their back for every sleep, on a firm, flat mattress with nothing soft in the cot, in their own cot or bassinet in your room for at least the first 6 months, day and night. These are among the Australia's Red Nose six safe sleep recommendations in Australia.
• Not in a car seat or swing. The AAP says car seats don't provide enough support for safe sleep, so move your baby to their cot as soon as you can.

See safe sleep for the full checklist.

When should I worry about my baby's night cough?

Call 999 now if your baby or toddler:

• is struggling to breathe, breathing very fast, grunting, or sucking in under the ribs, at the tummy or at the neck
• has stridor (a harsh noise when breathing in) while resting and calm
• pauses in their breathing or breathes irregularly
• has blue, grey, very pale or blotchy skin, lips or tongue, including during a coughing fit (on brown or black skin, check the lips, tongue, inside the cheeks, palms and soles)
• is floppy, much sleepier than usual, hard to wake or can't be woken
• is drooling or can't swallow
• is under 3 months and has a temperature of 38°C (100.4°F) or higher, or is 3 to 6 months old and has a temperature of 39°C (102.2°F) or higher
• has had no wet nappy or wee for 12 hours, or has a seizure
• started coughing suddenly after choking on food or a small object

These come from the RCH croup and bronchiolitis fact sheets, the NHS whooping cough page and the NHS urgent-help guide. A coughing baby is already unwell, so treat any pause in breathing as an emergency; the AAP's sleep apnoea guide also says to call an ambulance for any pause longer than 20 seconds. The RCH bronchiolitis sheet sends a baby who goes blue in the face when coughing to hospital; we use the stricter 999 tier.

Get medical help today (same-day GP, after-hours doctor or NHS 111) if:

• you think your child has croup, or they have stridor only when upset
• your baby is under 6 months and could have whooping cough, or has coughing fits that end in a whoop or vomiting
• your baby is under 6 months and has a cough (the AAP suggests contacting a doctor within 24 hours at this age)
• your baby is feeding much less than usual or has fewer wet nappies
• the cough is getting worse, or coughing spells won't stop

Talk to your GP or health visitor if:

• a cough has lasted more than 4 weeks, which the RCH says should be checked
• a toddler coughs most nights or wheezes, as this can be asthma
• coughing at feeds comes with other reflux signs that worry you

If you're unsure, call NHS 111.

What's worth noting about a night cough?

Note when the cough started, what it sounds like and what time of night it's worst, plus feeds, wet nappies and temperatures. A short video or sound recording of a coughing fit or noisy breathing can help a doctor hear what you heard. Never delay getting help to make a recording.