Chest Congestion in Toddlers

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Chest congestion is a common symptom of a number of conditions that affect toddlers, from a virus such as a common cold to a genetic condition such as cystic fibrosis.

The additional symptoms that come with chest congestion and the course of treatment depend on the cause of the congestion and the characteristics of the child. Your child's healthcare provider can help find a diagnosis and suggest treatment options.

A toddler girl has her right hand on her chest as she coughs into the inside of her left elbow.

StephanieFrey / Getty Images

Symptoms and Causes

Chest congestion is a symptom of a condition, not a condition unto itself. It can have several different causes and is usually accompanied by other symptoms like a cough.

Cold

As the name states, the common cold is common. Colds are caused by respiratory viruses and are the number one reason for doctor calls and visits.

Healthy children experience about six colds per year, and colds are rarely serious. In the 5 to 10% of children who develop a secondary health problem due to a cold, the condition is usually an ear or sinus infection.

Normal symptoms of colds include:

  • Runny nose and congestion (up to two weeks)
  • Sore throat (up to five days)
  • Hoarse voice
  • Cough (up to three weeks)
  • Fever under 104° F/40° C (up to three days)

Symptoms of a secondary problem that prompt a visit to a healthcare provider include:

  • Trouble breathing
  • Rapid breathing
  • Earache
  • Ear discharge
  • Pus in the eyes ("gunky" eyes, eyelids stuck together, especially after sleeping)
  • Fever for more than three days
  • Sinus pain that is not helped by nasal washes
  • Fever that goes away for 24 hours and then returns
  • Sore throat for more than five days
  • Nasal discharge for more than two weeks
  • Cough lasting more than three weeks

What Kind of Cough Is It?

Coughs are a common symptom of many illnesses, but the type of cough makes a difference. Your toddler's healthcare provider is likely to ask you to describe the cough. Does it sound:

  • Barky: Sounds like a seal bark. Associated with swelling in the upper airway. Often signals croup.
  • Whooping: A deep breath in that makes a "whooping" sound at the end of the coughing
  • Wheezing: A wheezing, whistling sound when exhaling (breathing out)
  • Stridor: High-pitched whistling sound on inhalation (breathing in)
  • Wet: Produces mucus. Comes from the chest. Can be forceful, trigger the gag reflex, and/or cause vomiting

Acute Bronchitis

Often called a "chest cold", acute bronchitis is an inflammation of the bronchi (large breathing tubes in the lungs). In contrast to chronic bronchitis, acute bronchitis is short-lasting. Symptoms usually develop and go away quickly, and most cases are mild.

In children, acute bronchitis is usually caused by a viral infection, sometimes after a cold or other viral upper respiratory infection. It can also be caused by bacteria or as a result of exposure to irritants such as dust, allergens, strong fumes, or tobacco smoke.

Symptoms of acute bronchitis usually last one to two weeks and include:

  • Dry or mucus-filled cough
  • Wheezing
  • Sore throat
  • Vomiting or gagging
  • Runny nose (often before the cough starts)
  • Chest congestion
  • Chest soreness
  • Fatigue
  • General feelings of discomfort or unwell
  • Slight fever (under 100.4° F/38° C)
  • Chills
  • Mild muscle/back pain

Take your toddler to a healthcare provider right away if:

  • There is a fever of 100.4° F/38° C or higher
  • There bloody mucus with the cough
  • The child has trouble breathing/shortness of breath
  • The symptoms last more than three weeks
  • Episodes of bronchitis are repeated/reoccurring
  • You are concerned

Bronchiolitis

Bronchiolitis is an infection in which swelling occurs in the bronchioles (smaller airways) of the lungs, blocking airflow in and out of the lungs.

Bronchiolitis is usually caused by an infection in the upper respiratory tract which spreads down into the windpipe and lungs. This infection is often a viral infection, most frequently respiratory syncytial virus (RSV).

It occurs most often in winter and early spring, and usually affects children under two years old.

Bronchiolitis often looks like a common cold at first, but then the cough (and often other symptoms) get worse over time. It is important to see a healthcare provider for a diagnosis as the symptoms are similar to other conditions, especially in babies and young toddlers.

Symptoms of bronchiolitis include:

  • Runny nose
  • Congestion
  • Cough
  • Vomiting
  • Fever
  • Fast or hard breathing
  • Wheezing
  • Loss of appetite
  • Irritability

Call your child's healthcare provider right away, or seek emergency care if your child:

  • Has trouble breathing
  • Turns blue in color (especially the lips and fingertips)
  • Is breathing very fast
  • Is not eating or drinking
  • Can't keep fluids down
  • You are concerned

RSV

Respiratory syncytial virus (RSV) is a virus that is a leading cause of childhood respiratory infection.

It is very common, with nearly all children contracting an RSV infection by the age of 2 years old. Most often, RSV infection is mild but it can be serious, especially for premature infants, infants under six months, children who are immunocompromised, and children with certain disorders that put them at risk for serious RSV infections.

RSV usually causes mild, cold-like symptoms, but it can cause more severe illnesses such as bronchiolitis or pneumonia. Approximately 58,000 children younger than 5 years old in the United States are treated in hospital for RSV infections each year.

Symptoms of RSV include:

  • Runny/congested nose
  • Cough (may progress to wheezing)
  • Sore throat
  • Decreased appetite
  • Mild headache
  • Fever (not always)
  • Generally feeling unwell

An important note: Infants often show no symptoms with RSV infection beyond irritability, decreased appetite, decreased activity, and/or apnea (pauses in breathing).

What Does "Trouble Breathing" Look Like?

With a cough and/or congestion, it can be hard to tell if a child is having trouble breathing. If you notice any of these signs, your child may be experiencing breathing difficulties and you should seek immediate or emergency medical care:

Allergies

Allergies are more common in children from families that have a history of allergies, but any child can have allergies.

Children can have allergies to environmental triggers such as pollen, insect bites, or animals, to certain medications, or to foods such as peanuts or milk.

Common symptoms of allergies in children include:

  • Runny/congested nose
  • Itchy/watery eyes
  • Skin problems (rashes, eczema, hives, etc.)
  • Difficulty breathing/asthma
  • Sneezing
  • Coughing
  • Upset stomach
  • Ear problems (itching, pain, feeling blocked)

In severe cases, allergies can cause a serious and potentially life-threatening reaction called anaphylaxis which causes breathing impairment, a sudden drop in blood pressure, and possibly shock. This is a medical emergency requiring an immediate 911 call and injection of epinephrine (adrenaline), if available.

Croup

Croup is an infection in children that causes swelling in the upper part of the airway in the neck, usually seen in the winter.

Croup is usually caused by a virus, but can also be caused by bacteria, allergies, or reflux from the stomach.

Symptoms of croup are not universal, can change over time, and do not always occur at the same time. They usually last three to seven days and are often worse at night.

Symptoms of croup include:

  • "Barky" cough ("seal bark")
  • Runny nose/congestion and slight cough
  • Laryngitis ("lost voice", hoarse voice or cry)
  • Fever
  • Stridor (a high-pitched “creaking” or whistling sound when breathing in)

Croup can become an emergency situation if breathing difficulties become severe. Call 911 if your child is experiencing any of the following:

  • Has stridor that becomes louder with each breath
  • Has stridor while resting
  • Struggles to catch their breath
  • Has increased difficulty breathing
  • Is drooling, spitting, and/or has a hard time swallowing their saliva
  • Has a blue or dusky (greyish) color around the fingernails, mouth, or nose
  • Can't speak or make sounds
  • Has lost consciousness and/or stopped breathing
  • You think it is an emergency

Asthma

Asthma is a chronic inflammatory respiratory condition that causes airways to narrow, swell, and sometimes produce extra mucus.

The most common symptom of asthma in children is a chronic cough. Other symptoms can include:

  • Coughing (constant, made worse by viral infections, happens while sleeping and/or is triggered by exercise or cold air)
  • Wheezing or whistling sound when breathing out
  • Shortness of breath or rapid breathing (may be worse when exercising)
  • Labored breathing that causes the skin around the ribs or neck to pull in tightly
  • Fatigue (slowing down, stopping playing)
  • Chest tightness (may say it hurts or feels funny)
  • Difficulties feeding/grunting while feeding (infants/young toddlers)
  • Trouble sleeping (because of coughing/difficulty breathing)
  • Avoidance of physical and/or social activities

A sudden worsening of symptoms caused by the constriction of muscles surrounding the bronchial tubes, narrowing the airway, and making breathing very difficult is called an asthma attack. Asthma attacks are serious and potentially life-threatening. If your child has asthma, discuss with their healthcare provider what to do to prevent and manage asthma attacks, and call 911 during an attack if necessary.

Pneumonia

Pneumonia is a lung infection usually caused by a virus, but is sometimes caused by bacteria. It often follows an upper respiratory infection.

Symptoms include:

  • Fever (may be accompanied by sweating, chills, flushed skin, discomfort)
  • Cough (may produce mucus)
  • Wheezing
  • Loss of appetite
  • Lack of energy
  • Pallor (looking pale), limpness, increased crying (in babies and toddlers)
  • Fast breathing
  • Difficulty breathing
  • Pulling in of the skin between and around the ribs and breastbone while breathing
  • Flared nostrils
  • Tightness/pain in the chest (especially with coughing or ​deep breathing)
  • Bluish tint to the lips, nails, or fingertips
  • Fatigue
  • Vomiting/diarrhea
  • Headache
  • Fussiness

If you suspect your child may have pneumonia, call their healthcare provider as pneumonia can become serious.

The Flu

The flu is a serious respiratory infection caused by influenza A and influenza B viruses. It is highly contagious and can be especially dangerous for young children.

Flu symptoms are more severe than cold symptoms. They include:

  • Fever, usually high (can be 103°/39.4°C) to 105°F/40.5°C)
  • Headache
  • Body aches (may be severe)
  • Cough (often that gets worse)
  • Sore throat
  • Fatigue/tiredness (can be extreme and last up to four weeks)
  • Runny or stuffy nose
  • Nausea/Vomiting
  • Diarrhea

If you suspect your child has the flu, call their healthcare provider right away as some treatments such as antivirals work best or are only effective if given early.

Cystic Fibrosis

Cystic fibrosis is a progressive, genetic disease that causes the mucus in various organs to become thick and sticky, resulting in infections, inflammation, and problems with organ function.

Cystic fibrosis is present at birth and usually diagnosed by age two.

Symptoms of cystic fibrosis include:

  • Coughing (persistent, at times with phlegm)
  • Very salty-tasting skin
  • Frequent lung infections (including pneumonia and/or bronchitis)
  • Wheezing
  • Shortness of breath
  • Frequent greasy, bulky stools/difficulty with bowel movements
  • Poor growth/weight gain (despite having a good appetite)
  • Male infertility

Babies Require Different Care

Chest congestion, cough, and fever can look different in infants than in toddlers and older children, and often require more urgent medical care, particularly for babies under six months.

If your baby is ill, make sure you follow advice and information specifically for infants, not for toddlers or older children.

When to See a Doctor

Whether a cough and/or chest congestion needs medical attention depends largely on the cause of the illness, the accompanying symptoms, the age of the child, the severity of the symptoms, and the duration of the symptoms.

Generally speaking, call your child's healthcare provider if there's:

  • Persistent, lasting cough (more than three weeks)/non-stop coughing spells
  • Trouble breathing/fast breathing.
  • High fever (especially with a cough but without a runny or stuffy nose)
  • Coughing that makes your child unable to speak normally
  • Signs of dehydration (dizziness, drowsiness, dry mouth, sunken eyes, crying with little or no tears, urinating less often, or having fewer wet diapers)
  • Ear or sinus pain
  • Ear drainage
  • Fever that lasts longer than 3 days, or returns after being gone for 24 hours or more
  • Chest pain (even when not coughing)
  • Coughing that causes vomiting more than three times
  • More than three days off school/daycare
  • A runny nose for more than two weeks
  • Allergy symptoms
  • You have any concerns you feel need medical attention

Seek medical care immediately if your child:

  • Has trouble breathing (if severe, call 911)
  • Has a bluish tint to their lips or face during coughing
  • Has stridor
  • Is breathing faster than normal
  • Is wheezing
  • Has severe chest pain/can't take a deep breath because of chest pain
  • Has coughed up blood
  • Has a weakened immune system or medical condition that makes them high risk
  • Has a temperature over 104° F (40° C)
  • Looks or acts very sick
  • Shows signs of an infection elsewhere in the body (such as red, swollen joints, bone pain, neck stiffness, vomiting, rash, or other new symptoms)
  • You think your child needs urgent medical attention

What Symptoms Indicate You Should Call 911?

Call 911 if your child:

  • Is having severe trouble breathing (struggling for each breath, can barely speak or cry)
  • Has lost consciousness (passed out) and/or stopped breathing
  • Has a bluish tint to their lips or face when not coughing
  • You think your child has a serious or life-threatening emergency

Diagnosis

To determine if a child has chest congestion, and what is causing their symptoms, a medical health provider may use a number of diagnostic tools.

Physical Exam

During an office or hospital visit, a healthcare provider is likely to do a physical examination. This might include:

  • Asking about symptoms
  • Asking about health history
  • Asking about family history
  • Listening to the child's chest/breathing
  • Checking other areas such as looking in ears and down the throat, feeling the abdomen, etc.

Imaging

Imaging tests such as a chest x-ray or CT scan may be ordered to look at the lungs and check for congestion, foreign objects, or other areas of concern.

Lab Work

A healthcare provider may requisition various lab work including:

  • Blood tests to check for viruses, bacteria, blood cell counts, etc.
  • Nasopharyngeal swab (a swab of the nose and throat) to check for viruses such as RSV.
  • Sputum (mucus coughed up from the lungs) culture may also be taken.

A bronchoscopy is a rarely used procedure used to look inside the airways of the lungs.

Other Tests and Procedures

A pulse oximeter (a small, painless sensor on the finger or toe) may be used to check blood oxygen levels.

Allergy tests may be run to determine if symptoms are caused by an allergy. These sometimes involve:

  • Medical tests (such as skin and blood tests)
  • Elimination diets
  • Keeping a diary
  • Other measures to determine if there is an allergy and to what allergen

Tests to measure lung capacity and airflow may be ordered, particularly if asthma is suspected.

Diagnosing Cystic Fibrosis

This diagnosis requires more than a physical exam or blood test. It is a multi-step process that should include:

  • A newborn screening
  • A sweat test
  • A genetic or carrier test
  • A clinical evaluation at a Cystic Fibrosis Foundation-accredited care center

Treatment

Treatment depends on the symptoms and what is causing them. For more specific treatment plans for each condition, consult a healthcare provider who can tailor treatment to your child's needs.

In general, treatment for chest congestion and some of the conditions that cause it falls into two categories: Medical treatment and treatment that can be given to your child on your own at home.

Medical Treatment

Medical treatments include:

  • Antibiotics (if bacterial)
  • Antivirals (if viral and necessary, as in some cases of the flu)
  • Over-the-counter (OTC) medications for fever or pain such as acetaminophen or ibuprofen (check with your child's healthcare provider or pharmacist before giving medication. Never give Aspirin to children.)
  • IV (intravenous) fluids to prevent dehydration if your child is having trouble taking in or keeping down fluids
  • If necessary, breathing treatments, extra oxygen, or in extreme cases a breathing machine
  • Steroid treatments are sometimes given for croup
  • Other medications such as allergy or asthma medications may be prescribed or recommended by a healthcare provider as needed
  • Treatment for cystic fibrosis should be determined by a healthcare provider

At-Home Treatment

If the illness and symptoms are mild, or it is advised by a healthcare provider, at-home measures can help your child feel more comfortable while they get better.

Some home treatments to try include:

  • Encourage drinking lots of fluids (small amounts often), especially warm (not hot) drinks such as apple juice to ease coughing
  • Lots of rest
  • Put a cool-mist humidifier in your child's room (make sure it is properly cleaned and never use a hot water or steam humidifier)
  • A nasal aspirator and saline (saltwater) spray or nose drops can be helpful for a stuffy nose
  • Running a hot shower with the door closed to steam up the bathroom, then sitting in the room (not the shower) with your child for about 20 minutes can help with a "barky" cough and croup
  • Cool air (such as bundling your child for the weather and sitting outside in the cool air for 10 to 15 minutes, or standing in front of an open fridge if the air outside is not cool) can help relieve a coughing fit or stridor, particularly if the child has croup
  • An asthma action plan is a helpful tool for managing your child's asthma
  • Elevate your child's head while sleeping and resting (make sure to follow safe sleep guidelines for babies and toddlers)
  • For toddlers over a year old, offer half a teaspoon of honey as needed
  • Sleep close to your child (in the same room) to listen for stridor
  • Keep your child away from smoke

Can Children Take Cough Medicine?

Children under the age of 4 years should not be given cough or cold medicine, and children aged 4 to 6 years should only do so if advised by a healthcare provider.

Children over age 6 years can take cough and cold medicine according to the dosage guidelines, but it still isn't recommended because they aren't very effective and they may cause side effects.

A Word From Verywell

It's never easy when little ones don't feel well. Coughs and colds are a common part of the childhood experience, but they are no fun for kids or parents, especially when they come with chest congestion.

Chest congestion in toddlers can be caused by a lot of different illnesses, some minor and some serious-but fortunately, most of the time it clears up with the help of medical treatment, or on its own with some home treatments and lots of TLC.

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Article Sources
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