Congestion occurs when the lungs and lower airway passages (bronchial tubes) are inflamed and fill with mucus or phlegm. It causes a “wet” cough. Symptoms that accompany chest congestion vary by illness.
This article explains what can cause chest congestion, other symptoms that can occur with those illnesses, and how you would normally treat congestion at home. In addition, it outlines signs that a cough or congestion may be something serious and when you should see a doctor for treatment.
Common Cold
As the name states, the common cold is common. Colds are caused by respiratory viruses and are the number one reason parents call the pediatrician or take children in for a sick visit.
Healthy children experience about six colds per year, and colds are rarely serious.
Chest congestion can last up to two weeks for a cold. Other normal symptoms of colds include:
Runny nose and nasal congestion Sore throat Hoarse voice Cough Fever under 104° F
Colds can develop into more serious illnesses. Of those children that come down with a secondary health problem, 5% to 10% develop an ear or sinus infection.
If your child’s cold seems to be getting worse, you should schedule an appointment with your doctor.
Signs of a secondary infection 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’s 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
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 generally develop and go away quickly, and most cases are mild.
Croup: A seal bark sounding cough with a stridor (high-pitched whistling sound on inhalation) associated with swelling in the upper airway Wheezing: A wheezing, whistling sound when exhaling (breathing out) Wet: Produces mucus; comes from the chest; can be forceful and may trigger the gag reflex, or cause vomiting Whooping: A deep breath that makes a “whooping” sound at the end of the coughing
In children, acute bronchitis is usually caused by a viral infection. It may develop after a cold or other viral upper respiratory infection. It can also be caused by bacteria or exposure to irritants such as dust, allergens, strong fumes, or tobacco smoke.
Symptoms of acute bronchitis usually last one to two weeks. In addition to chest congestion, your child may have:
Dry or mucus-filled coughWheezingSore throatVomiting or gaggingRunny nose (often before the cough starts)Chest sorenessFatigueGeneral feelings of discomfort or unwellSlight fever (under 100. 4° F)ChillsMild muscle/back pain
Take your toddler to a doctor if bronchitis progresses and your child has these symptoms:
Fever of 100. 4° F or higherBloody mucus with the coughTrouble breathing or shortness of breathSymptoms that last more than three weeksRepeated or reoccurring incidences of bronchitis
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.
Struggling for each breath Shortness of breath Tight breathing (your child can barely speak or cry) Ribs pulling in with each breath (retractions) Noisy breathing (such as wheezing) Breathing that is much faster than usual Lips or face turning a blue color Nasal flaring
Flu symptoms are more severe than cold symptoms. They include:
Fever, usually high (can be 103 F/39. 4 C to 105 F/40. 5 C)HeadacheBody aches (may be severe)Cough (often that gets worse)Sore throatFatigue/tiredness (can be extreme and last up to four weeks)Runny or stuffy noseNausea/vomitingDiarrhea
If you suspect your child has the flu, call the pediatrician right away—some treatments such as antivirals work best or are only effective if given early.
RSV
Respiratory syncytial virus (RSV) is a leading cause of childhood respiratory infection. Nearly all children contract an RSV infection by the age of 2 years old.
If your child is also vomiting or has diarrhea, it’s likely that you’re looking at the flu and not a cold. Talk to your doctor about appropriate treatment that can help your child recover more quickly.
Most often, RSV infection is mild, but it can be serious for children who are immunocompromised and those with disorders that put them at risk for serious RSV infections.
RSV generally 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 the hospital for RSV infections each year.
Symptoms of RSV include:
Runny noseLoss of appetiteCoughingSneezingFeverWheezing
If your child is at risk for RSV infection, your pediatrician may discuss Synagis (palivizumab) with you. Palivizumab is a shot that can help protect certain infants and children 2 years old and younger who are at high risk of serious complications from RSV. It’s typically given once a month during the RSV season.
Bronchiolitis
Bronchiolitis is an infection in the upper respiratory tract which spreads down into the windpipe and lungs. It’s usually caused by RSV and results in swelling in the bronchioles (smaller airways) of the lungs, which blocks airflow in and out of the lungs.
Most often, bronchiolitis occurs in winter and early spring, and it generally affects children under two years old.
Bronchiolitis likely looks like a common cold at first, but then the cough (and often other symptoms) get worse over time. It’s important to see a doctor for a diagnosis, as the symptoms are similar to other conditions, especially in babies and young toddlers.
Symptoms of bronchiolitis include:
Runny noseCongestionCoughVomitingFeverFast or hard breathingWheezingLoss of appetiteIrritability
Contact your pediatrician or seek emergency care if your child:
Has trouble breathingTurns blue in color (especially the lips and fingertips)Is breathing very fastIs not eating or drinkingCan’t keep fluids down
Croup
Croup is an infection in children that causes swelling in the upper part of the airway in the neck. It’s usually seen in the winter.
Croup is most often 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 coughLaryngitis (“lost voice,” hoarse voice or cry)FeverStridor (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
Allergies
Allergies are especially common in children who have a family history of allergies, but any child can develop them.
Children can have allergies to environmental triggers such as pollen, insect bites, or animals. Certain medications or foods such as peanuts or milk can also trigger allergic reactions.
A runny nose and nasal congestion from allergies can turn into chest congestion. Other symptoms of allergies in children include:
Itchy/watery eyesSkin problems (rashes, eczema, hives, etc. )Difficulty breathing/asthmaSneezingCoughingUpset stomachEar problems (itching, pain, feeling blocked)
In severe cases, allergies can cause a 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.
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. Asthma causes a build up of mucus in the lungs that results in chest congestion as well.
Children with asthma may also have a range of symptoms that include:
Wheezing or whistling sound when breathing outShortness of breath or rapid breathing (may be worse when exercising)Labored breathing that causes the skin around the ribs or neck to pull in tightlyFatigue Chest tightness Difficulty feeding, or grunting while feeding (infants/young toddlers)Trouble sleeping 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.
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. It can result in severe chest congestion.
Cystic fibrosis is present at birth. Newborns are routinely screened for the disease, and it’s most often diagnosed before age 2.
Symptoms of cystic fibrosis include:
Coughing (persistent, at times with phlegm)Very salty-tasting skinFrequent lung infections (including pneumonia and/or bronchitis)WheezingShortness of breathFrequent greasy, bulky stools/difficulty with bowel movementsPoor growth/poor weight gain (despite having a good appetite)Male infertility
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 doctor in cases where your child has:
Persistent cough for more than three weeks or non-stop coughing spells Trouble breathing/fast breathing 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 three 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
Diagnosis
To determine if a child has chest congestion and what’s causing their symptoms, your pediatrician may use a number of diagnostic tools.
Is having severe trouble breathing (struggling for each breath, can barely speak or cry)Has lost consciousness (passed out) and/or stopped breathingHas a bluish tint to their lips or face when not coughingYou think your child has a serious or life-threatening emergency
Physical Exam
During an office or hospital visit, a healthcare provider is likely to do a physical examination. This might include:
Asking about symptomsAsking about health historyAsking about family historyListening to the child’s chest/breathingChecking 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 order 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 RSVSputum (mucus coughed up from the lungs) culture
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 dietsKeeping a diaryOther 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.
Treatment
Treatment depends on the symptoms and what is causing them. Your doctor 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.
At-Home Treatment
For mild illnesses, you can manage symptoms at home and work on keeping your child comfortable while they get better.
Encourage your child to drink lots of fluids. Ensure your child gets lots of rest. Use a cool-mist humidifier. Use a nasal aspirator and saline (saltwater) spray or nose drops for a stuffy nose. Sit with your child in a steamy bathroom for about 20 minutes at a time. Prepare an asthma action plan to manage 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 secondhand smoke. Administer 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. )
Medical Treatment
If your child isn’t improving with at-home treatments, your doctor may prescribe some of the following.
Children over age 6 can take cough and cold medicine according to the dosage guidelines, but it still isn’t recommended since the medicines aren’t very effective and may cause side effects.
Antibiotics (if the infection is bacterial)Antivirals (for some viral infections such as the flu)IV (intravenous) fluids to prevent dehydration if your child is having trouble taking in or keeping down fluidsBreathing treatments, extra oxygen, or in extreme cases a breathing machineSteroid treatments (sometimes given for croup)Other medications such as allergy or asthma medications as neededTreatment for cystic fibrosisProphylaxis with palivizumab for premature babies and children at high risk of RSV
Summary
Chest congestion accompanied by a cough is related to a number of conditions. A cold, the most common cause of congestion, normally goes away within two weeks, but watch for signs that it’s turned into something more serious, and be alert to symptoms that show you’re dealing with something besides a cold. These may include:
Vomiting and diarrheaHigh feverDifficulty breathingSymptoms triggered by seasonal or environmental factorsSymptoms triggered by weather or exercise
See a doctor for these and other serious symptoms or if home treatments such as OTC pain relievers, rest, and fluids are not helping your child get better. If your child is younger than 2 years of age, talk with your pediatrician about RSV prevention with palivizumab.
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’re 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. Fortunately, most of the time the congestion clears up with the help of medical treatment or on its own with home treatments and lots of TLC.
