Cough and Phlegm in Babies: Should You Be Alarmed?

Hearing your baby cough or seeing them struggle with phlegm can be distressing, especially if you’re a new parent. With all your precautions to keep them safe and healthy, even a little sniffle could feel like a major red flag. 

While cough with phlegm in infants are not always as alarming as some parents might think, it’s important to understand what’s normal and when to call a doctor so that you can navigate the situation with a bit more confidence.

Your Baby’s Natural Defenders

Oftentimes, a cough accompanied by phlegm (or mucus) is a sign that your baby’s body is doing what it should: defending itself. This combo serves as your baby’s natural protective reflexes.

Our airways are lined with mucus-producing tissues from the nose down to the lungs. So, when dust, germs, pollutants, and other irritants are inhaled, mucus traps them, and it’s expelled from the body through coughing.

What Causes Your Baby’s Cough?
As your baby starts to interact more with the world around them, they get exposed to viruses and irritants that may cause coughs. But that’s not always the case, as there are other possible culprits too. Here are some of the common reasons why your baby might be coughing:

• The Common Cold: Most often, a baby’s cough is caused by colds, a viral infection that causes excess mucus production, leading to a runny nose, sneezing, and coughing with phlegm.
• Infections: Other respiratory viruses like flu and croup, or bacterial infections like bronchitis, pneumonia, and pertussis (whooping cough)—may cause inflammation in the respiratory tract, triggering your baby’s cough.
•  Allergies: Your baby could be allergic to some particles in the environment, like dust, pet dander, strong perfumes, smoke (particularly from cigarettes), and other household allergens that may irritate their nose and throat, causing their cough.
• Acid Reflux: Babies commonly experience gastroesophageal reflux (GER) after feeding or when lying down. It’s when stomach acid flows back up into the esophagus, which can lead to coughing and vomiting.
• Asthma: If your baby tends to cough or wheeze while trying to sleep at night, it could be due to asthma.

How to Tell if Your Baby’s Cough Is Unlikely to Cause Harm
For a newborn with cough and phlegm, even mild symptoms should be taken seriously, as their airways are still developing. It’s best to pay close attention and continuously observe them. Most coughs caused by common colds or minor irritation go away on their own within a week or two. You don’t need to panic if:

• The cough is mild and not persistent.
• Your baby is breathing comfortably.
• Your baby is active, playful, and feeding well.
• The phlegm is clear or whitish.
• Your baby has a wet cough but no fever—or only a mild one under 38°C

When to Worry About Your Baby’s Cough

As common as infant cough and phlegm may be, it’s important to watch out for any warning signs that could indicate a more serious issue. If you see these signs in your baby, seek medical help right away:

• Troubled or labored breathing
• A persistent or worsening cough for more than 10-14 days
• A high fever of 38°C or higher, or a fever for more than 3 days.
• A cough accompanied by concerning sounds like wheezing or whooping
• Coughing or vomiting with blood
• Signs of dehydration, like dry mouth or fewer wet diapers
• A bluish tinge around the lips or fingernails
• Difficulty in swallowing or refusing to feed
• Any cough, if they’re younger than 4 months

What to Do When Baby Has Cough and Phlegm 

• Keep them hydrated: Offer your baby lots of fluids (breast milk or formula milk for babies less than 6 months old, or water for babies more than 6 months old) to help make the mucus thinner.
• Maintain humidity in the air: Dry air makes a cough worse, so it’s good to use a cool-mist humidifier in the baby's room to regulate air moisture and provide relief from cough.
• Try saline drops and suction: Saline drops or spray can help loosen the mucus in the nose. After using saline, you can also gently suction the nose with a bulb syringe to suck the mucus out.
• Avoid irritants: Babies with cough and phlegm can become more sensitive to dust, smoke, pets, or strong scents—so try to limit their exposure to these common triggers.

Baby Cough Treatment: When to Consider Mucolytics

So, you’ve tried all the home remedies, but your baby’s cough remains stubborn and persistent. This is exactly the right time to consult your pediatrician. After evaluation, your doctor may prescribe a mucolytic medication like Ambroxol HCl (Expel®) Drops.

Ambroxol HCl (Expel®) is the most prescribed branded Ambroxol.* Its active ingredient, Ambroxol, is known for effectively breaking down thick, sticky mucus in the airways, making it easier for babies to cough it out naturally.

Thoughtfully formulated with TasteRite technology, Ambroxol HCl (Expel®) Drops comes with a yummy orange flavor, designed to make it easier for babies and kids to take it when needed, without the fuss.

You can find Ambroxol HCl (Expel®) Drops online and in leading drugstores nationwide. But remember: always consult your pediatrician first before giving any medication to your child.

*Source: PMDI, IQVIA SOLUTIONS PHILIPPINES, INC., reprinted with permission. Prescription data of brands under: AMBROXOL in 0 – 19 Years in Branded and Originator among PEDIATRICIANS covering period: January 2024-December 2024

References:
7 Cough Remedies for Babies | https://www.healthline.com/health/baby/how-to-help-baby-with-cough#contact-a-doctor
8 Reasons Your Baby Might Be Coughing | https://www.parents.com/baby/health/cough/decoding-babys-cough/
Cough (0-12 Months) | https://www.seattlechildrens.org/conditions/a-z/cough-0-12-months/
Cough – Infants (0-1 year) | https://home.kinsahealth.com/guidance/cough-infants-0-1-year
7 Cough Remedies for Babies | https://www.chla.org/blog/advice-experts/decoding-your-babys-cough

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