What should you know about a barking cough in an infant?

A harsh, seal-like cough may occur with a viral upper-airway illness, while bronchiolitis can cause cough with fast or laboured breathing and feeding difficulty. A cold, reflux, or irritated throat may also provoke coughing. The sound alone cannot name the cause. Watch the infant when calm: look for pulling in around the ribs or neck, noisy breathing, pauses, unusual sleepiness, fewer wet nappies, or difficulty taking feeds. A sudden cough after food or a small object may signal choking and needs immediate attention.

Keep the infant calm and upright in your arms, offer usual feeds in smaller, more frequent amounts if feeding is tiring, and keep the air free from smoke and scented products. Do not give honey to an infant, use steam near the child, or give cough and cold medicine unless a clinician specifically advises it. Listen to the breathing between coughs and keep track of feeds, wet nappies, temperature, and changes in behaviour.

Call emergency services if the infant struggles for each breath, has blue or grey lips, pauses breathing, becomes floppy or difficult to wake, cannot swallow, or has a harsh noise while resting. Seek urgent assessment for worsening chest pulling, poor feeding, dehydration signs, or a cough that started suddenly during choking. Babies can worsen quickly, so do not wait for a routine appointment when breathing is affected.

Does the breathing pattern suggest an upper-airway illness or bronchiolitis? How can I judge whether feeding is becoming unsafe? Which medicines, if any, are suitable for this infant? What breathing changes should prompt emergency help?