Barking cough in a five-month-old baby

A harsh, seal-like cough can occur when the voice box and windpipe are inflamed, as happens with croup. Hoarseness and a high-pitched noise when breathing in may accompany it. Other respiratory illnesses can also cause cough in infancy, so sound alone cannot establish the cause.

Because young babies have narrow airways and may tire during breathing, observe the baby when calm. Note whether noisy breathing happens only while crying or also at rest, and check feeding, alertness, skin colour, wet nappies, fever, and pauses in breathing.

Contact a clinician promptly for assessment. Keep the baby calm and upright in your arms while awake, since crying can make noisy breathing worse. Offer usual breast or formula feeds in smaller amounts more often if needed, and check that wet nappies continue. Use saline nose drops for nasal blockage if advised.

Do not use cough and cold remedies, honey, essential oils, or steam inhalation for a baby of this age. Steam can burn and has not been shown to remove upper-airway swelling. Place the baby flat on their back in a clear cot for sleep rather than propping them up.

Call emergency services if the baby has a high-pitched breathing sound while calm, ribs or the hollow at the neck pulling in with each breath, grunting, pauses in breathing, blue or grey lips, drooling with difficulty swallowing, unusual floppiness, or difficulty waking. These signs show that breathing or oxygen delivery may be impaired.

Urgent assessment is also needed if the baby cannot feed because of breathlessness, has far fewer wet nappies, repeatedly vomits feeds, or is rapidly getting worse. Do not drive the baby yourself if severe breathing difficulty is present.

Ask whether the sound is stridor, whether the baby needs medicine to reduce airway swelling, how feeding and hydration should be monitored, and exactly which breathing changes require emergency help. Mention premature birth, previous breathing problems, and any known exposure to respiratory illness.