Infant coughing at night is most often a cold, and a cold cough resolves in 90% of children within 25 days. Teething is the popular explanation, but in a prospective study of 125 infants followed for 19,422 child-days, cough was not significantly associated with tooth emergence (drooling, biting and irritability were). A cough that lasts longer than three weeks, is wet and brings up purulent mucus, comes with wheeze or breathlessness, or follows sudden choking needs a doctor, and so does any cough in a very young infant that comes with pauses in breathing or trouble feeding. A recording of the night gives a pediatrician something countable to work with.
Most parents come to this question at night, with a sleeping child making the same dry sound every ten minutes, and a half-remembered rule that teething causes everything. Here is what the studies say about infant coughing at night, what a cold does to the calendar, and where the line to a doctor sits. It is general information for parents and does not replace a pediatrician's exam. For adults, the companion piece is only coughing at night.
What counts as normal for infant coughing at night
There is almost no recording data on infants. The nearest thing is from 1996: 41 healthy school children, free of respiratory infection for a month, wore a cough recorder for 24 hours. Cough frequency was 11.3 cough episodes per 24 hours, with a range of 1 to 34. Nocturnal and prolonged coughing was unusual in these children. It describes older, healthy kids, but it says something useful about the pattern: a child who coughs repeatedly through the night is outside the usual picture.
Munyard P, Bush A. How much coughing is normal? Arch Dis Child 1996. PMID 8758131
Parents are also not the most reliable counters. In 40 children with recurrent cough, parent- and child-recorded cough scores correlated only moderately with objectively counted cough frequency (r of about 0.32), though more consistently than lab measures of cough sensitivity did. A tired adult at 3 a.m. remembers the worst stretch, and that skews the count.
Chang AB, Phelan PD, Robertson CF, Roberts RG, Sawyer SM. Relation between measurements of cough severity. Arch Dis Child 2003. PMID 12495964
Teething and coughing at night: what 19,422 child-days show
The teething question has two good answers. The larger one is a prospective cohort of 125 healthy infants of employees at a US clinic. Parents recorded temperatures and the presence of 18 symptoms every day from the 4-month visit to the first birthday, and noted every tooth that came through. That produced 19,422 child-days of symptoms and 475 tooth eruptions. Symptoms were more frequent only in an 8-day window around a tooth coming through (four days before, the day itself and three days after). In that window, biting, drooling, gum-rubbing, sucking, irritability, wakefulness, ear-rubbing, facial rash, less appetite for solid food and a mild rise in temperature were all associated with teething. Congestion, sleep disturbance, loose stools, cough, rashes other than on the face, a fever over 102 °F and vomiting were not.
The authors add two cautions. No single symptom appeared in more than 35% of teething infants, and none occurred more than 20% more often than in infants who were not teething. And before caregivers blame teething for signs of a potentially serious illness, other possible causes must be ruled out.
Macknin ML, Piedmonte M, Jacobs J, Skibinski C. Symptoms associated with infant teething: a prospective study. Pediatrics 2000. PMID 10742315
A second, much smaller study of 21 children aged 6 to 24 months in day care did not find tooth eruption linked to temperature or to most reported symptoms. Yet all of the parents reported afterwards that their own child had suffered teething symptoms. Its authors say weak associations cannot be ruled out. The summary of all this is a 2016 meta-analysis of 16 observational studies with 3,506 children from 0 to 36 months, which found an overall prevalence of signs during eruption of 70.5%. The most frequent were gingival irritation, irritability and drooling. Temperature could rise during eruption, but not to the level of a fever.
Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics 2000. PMID 11099591
Massignan C, Cardoso M, Porporatti AL, Aydinoz S, Canto Gde L, Mezzomo LA, Bolan M. Signs and Symptoms of Primary Tooth Eruption: A Meta-analysis. Pediatrics 2016. PMID 26908659
So drooling is genuinely part of teething, and some parents suspect the drool as a cause of throat-clearing at night. That route is plausible and untested. What the data do not support is treating a real, repeated cough as a teething sign.
A cold is the usual answer, and it lasts longer than you think
Take a 9-month-old coughing at night, with a runny nose that started four days ago and a normal appetite. This is the commonest scene by a wide margin, and the usual answer is a viral cold. The surprise is the calendar. A systematic review of 23 trials and 25 observational studies of children in primary and emergency care found that in 90% of children, acute cough had resolved by 25 days, a common cold by 15 days and bronchiolitis by 21 days. Croup was done by two days in 90% of the children studied. The authors point out that the actual duration of colds is longer than the guidance parents are usually given.
Thompson M, Vodicka TA, Blair PS, Buckley DI, Heneghan C, Hay AD, TARGET Programme Team. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013. PMID 24335668
A Belgian primary care guideline draws the practical conclusion: in the absence of signs of a specific underlying illness, coughing in children is generally self-limiting, and symptomatic treatments have not been proven effective while many may cause serious side effects, so their use should be limited. It defines prolonged cough as a daily cough that lasts more than three weeks. Whatever you decide to give or not to give, talk to a pediatrician or pharmacist first, particularly with a baby.
Leconte S, Paulus D, Degryse J. Prolonged cough in children: a summary of the Belgian primary care clinical guideline. Prim Care Respir J 2008. PMID 18418499
Wheeze and asthma: the preschooler coughing at night
Asthma enters the conversation with older children, and it is easy to over-diagnose. A review of asthma under age five notes that cough and wheeze are common in childhood but mostly do not signify a serious illness, and that in a community setting an isolated cough with no wheeze or breathlessness is most unlikely to be asthma. Wheeze, breathlessness and a family history change that.
Bush A. Diagnosis of asthma in children under five. Prim Care Respir J 2007. PMID 17297521
Night-time recordings can separate patterns. In 49 children with either acute wheezing or an upper respiratory infection, a portable cough monitor in the child's room found that the wheezing children coughed more per night, had more coughing bouts and coughed faster within a bout. The wheezing group coughed most between 11 p.m. and 1 a.m. (23.00 to 01.00 in the paper); between 1 and 6 a.m. the two groups did not differ. The study could be useful in clinical practice, the authors say, which is a modest claim for a 49-child sample.
Urkin J, Ishay Y, Bilenko N, Bar-David Y, Gazala E, Mijalovsky A, Lapidus V. Night-time cough in children with acute wheezing and with upper respiratory tract infection. Prim Care Respir J 2008. PMID 18633556
Asthma has a twist here. In 32 children with stable asthma (median age 12), the median number of cough episodes was 14, higher than in normal children (6.7), and the coughing was greater during the day than at night. A child with controlled asthma does not necessarily cough in the night.
Li AM, Lex C, Zacharasiewicz A, Wong E, Erin E, Hansel T, Wilson NM, Bush A. Cough frequency in children with stable asthma: correlation with lung function, exhaled nitric oxide, and sputum eosinophil count. Thorax 2003. PMID 14586052
The cough that will not leave
Now take an 18-month-old coughing at night for six weeks, with a rattly, wet sound and no real cold. That is a different case. The Belgian guideline summary reports that prolonged cough affects 4.8% to 10.4% of school children, says doctors should look for signs of any serious underlying condition, and says a chronic productive cough with purulent mucus should always be investigated. A review of chronic cough in children adds that viral infections are the most prevalent cause, that passive smoking is an important contributor, and that the younger the child, the more reason to exclude underlying disease early.
de Jongste JC, Shields MD. Cough . 2: Chronic cough in children. Thorax 2003. PMID 14586058
One diagnosis that is recognized more and more is persistent (protracted) bacterial bronchitis, a bacterial infection of the airways that causes a chronic wet cough. Specialists describe impaired clearance of mucus as the common risk factor, and note that asthma is often misdiagnosed in these children. It is a diagnosis for a doctor to make, and it is the reason a wet cough that outlasts a cold should not be left to fade.
Chang AB, Redding GJ, Everard ML. Chronic wet cough: Protracted bronchitis, chronic suppurative lung disease and bronchiectasis. Pediatr Pulmonol 2008. PMID 18435475
Do not wait, and do not blame teething, if: breathing is fast, hard or noisy at rest; there are pauses in breathing; lips look blue or gray; the baby cannot feed or is floppy; there is a high fever in a very young infant; the cough started with sudden choking on something; or the cough has been daily for more than three weeks. Whooping cough (pertussis) can look atypical in neonates, so a young infant with coughing fits and trouble breathing belongs in an emergency department, not at home.
Kilgore PE, Salim AM, Zervos MJ, Schmitt HJ. Pertussis: Microbiology, Disease, Treatment, and Prevention. Clin Microbiol Rev 2016. PMID 27029594
What a recording of the night can add
For a pediatrician, a cough described as "a lot" is hard to use. A recording gives a count, a time of night and the sound, which separates a barking cough from a wet one and a wheeze from a snore. Some parents also find that the cough bunches up around a feed, a bath or the first hour after bedtime, and a recording can show whether that is so.
SleepTrace listens through the phone's microphone, marks coughing and keeps short clips of it that you can play back (3 playable clips a month in the free plan). The app has to stay open and the phone should be charging. It is not validated for children's coughs, and it cannot tell a cold from asthma or whooping cough. Treat the clips as something to show a doctor, not as a diagnosis. How to set up a recording is in how to record yourself sleeping; the adult version of the cough question is in excessive coughing at night.
Frequently asked questions
The best prospective data say no. In 125 healthy infants followed from 4 months to 1 year, drooling, biting, irritability and wakefulness were associated with tooth emergence, while cough was not. A 2016 meta-analysis of 16 studies with 3,506 children found drooling in 55.72% of children during eruption but did not list cough among the frequent signs. Drool running down the throat is a plausible route to a cough, but it has not been shown.
Occasional coughing is part of being a child, but regular night coughing is not the baseline. In 41 healthy school children recorded for 24 hours, cough frequency was 11.3 cough episodes per 24 hours (range 1 to 34), and nocturnal and prolonged coughing was unusual. Those children were older than infants, so the numbers show the pattern, not an infant norm.
Longer than most parents expect. A systematic review of 48 studies found that acute cough had resolved in 90% of children by 25 days, a common cold by 15 days and bronchiolitis by 21 days. The exact day varies, which is why three weeks of daily cough is where guidelines start asking for a check-up.
Fast or hard breathing, pauses in breathing, a blue or gray color around the lips, trouble feeding, a child who is floppy or hard to wake, a high fever in a very young infant, or a cough that began with sudden choking all warrant calling emergency services or going to an emergency department. Whooping cough in particular can look atypical in neonates, according to a 2016 review.
Possible, but not the first guess. A review of asthma in children under five states that an isolated cough with no wheeze or breathlessness is most unlikely to be asthma in a community setting. Cough that comes with wheeze, breathlessness or exercise trouble is a different story and deserves a pediatrician's look.
Chronic wet cough can come from a persistent bacterial infection of the airways (protracted bacterial bronchitis), among other causes, and it is worth a diagnosis rather than waiting. Pediatricians define the pattern and decide on testing and treatment.
SleepTrace is a wellness app, not a medical device. This article is general information, not medical advice. If your symptoms are frequent, severe or worrying, please talk to a doctor.
SleepTrace is not a baby monitor and does not measure a child's breathing or wheeze. What it does is mark coughing with a time and keep clips you can play back, so you see how many fits there were and when. Show that to the pediatrician; it is your note, not a diagnosis.
Hear your own night. SleepTrace turns a night of audio into your sleep phases, the sounds you made, and how it all trends. Works without a wearable, better with one. Your phone on the nightstand is enough to start. Get it for iPhone or Android →