What should you know about infant barking cough at night?

A harsh, seal-like cough is often associated with swelling near the voice box, commonly during a viral illness. A cold, bronchiolitis, asthma, allergic rhinitis or acid reflux can also cause nighttime coughing, although the sound and accompanying symptoms differ. The cough itself does not identify one diagnosis.

Listen for a high-pitched noise when breathing in, called stridor, and watch the skin between the ribs, under the ribs or at the neck. Changes in colour, alertness, feeding or breathing effort are more concerning than a cough that is loud but comfortable.

Keep your baby calm and upright while awake, because distress can increase noisy breathing. Offer usual feeds in small, frequent amounts if comfortable and keep the air free from smoke or strong scents. Stay nearby and observe breathing rather than forcing fluids or food. Do not give cough medicine, honey or steam treatments to an infant unless a clinician specifically advises it.

If a clinician has given an action plan, follow it. A short recording of the cough and notes about fever, feeding and breathing can help during assessment.

Call emergency services if your baby struggles to breathe, has persistent stridor while resting, pulls in around the ribs or neck, pauses breathing, turns blue or grey, drools and cannot swallow, or becomes floppy or difficult to wake. Seek prompt medical advice for worsening symptoms, poor feeding, fewer wet nappies or a cough after choking. Keep the baby upright and calm while help is arranged.

Ask whether the sound fits croup or another cause, how to recognise stridor, what to do during the next night and whether your baby needs examination or follow-up. Confirm which medicines, if any, are appropriate for your baby’s age.