When a child has a high fever and cough, parents and other caregivers are often understandably alarmed. A number of conditions can cause these symptoms, such as the flu, sinusitis, pneumonia and other airway infections. While symptoms of these conditions often overlap, differentiation between them is based on the child's recent medical history, the nature of the cough, a physical examination and other symptoms that may be present. Additional testing, such as blood tests or x-rays, may be needed in some cases.
Croup is a viral infection of the upper airway near the voice box. It most commonly affects young children 3 months to 3 years of age and is usually seen during the winter months. The illness often begins with a runny nose and low-grade fever that may rise up to 103 F over a day or two as the child develops a cough. Croup is characterized by a barking cough, hoarseness and noisy breathing when the child inhales. Symptoms are often worse at night. In most cases, croup goes away without treatment in 3 to 7 days.
Children of any age can develop acute sinusitis, which is a bacterial infection of the air-filled spaces in the facial bones around the nose. In most cases, the infection develops as a complication of a simple head cold. A persistent cough and runny nose along with a fever -- which may be 102 F or higher -- are typical symptoms. The child's cough is characteristically worse at night or when the child is lying down. Antibiotics are recommended for treating acute bacterial sinusitis.
Pneumonia represents an infection that occurs deep in the lungs, which can be caused by viruses, bacteria or both, in some cases. Preschool age children more commonly develop viral pneumonia while older children are more prone to bacterial or mixed viral and bacterial pneumonia. A wet cough and fever -- which is usually higher with bacterial pneumonia -- are classic symptoms. Other symptoms may include shortness of breath, loss of appetite or poor feeding, lack of energy and chest pain. Pneumonia varies in severity, depending on the cause, the child's age and other illnesses that may be present. Severe pneumonia can be life-threatening.
Influenza, or the flu, represents another common cause of high fever and cough in children. The illness typically begins with a sudden high fever accompanied by chills, achiness and lack of energy. Other symptoms typically follow, such as a cough, sore throat, stuffy nose and possibly irritated eyes. Babies and young children are particularly vulnerable to the flu and can get very sick quickly.
Other Airway Infections
Less common but serious infections affecting the upper airway can also present with a high fever and cough. Bacterial tracheitis is an infection of the windpipe, or trachea. Children with this infection typically start out with cold-like symptoms but grow increasingly sicker with a high fever, cough and high-pitched noisy breathing. A retropharyngeal abscess is another rare but dangerous infection in which a pus pocket forms behind the main airway in the neck. Often the child starts out with a sore throat but then develops a high fever and, frequently, a cough. Both of these infections are medical emergencies.
Warnings and Precautions
Respiratory infections in children can progress quickly, especially in babies and toddlers. If you have any concerns about a child with a fever and cough, call your doctor right away. Seek emergency medical care if your child has any difficulty breathing, cannot swallow or is unable to eat and drink.
- Pediatrics: Clinical Characteristics of Children With Complicated Pneumonia Caused by Streptococcus pneumoniae
- American Family Physician: Croup: An Overview
- Journal of Allergy and Clinical Immunology: The Diagnosis and Managment of Sinusitis: A Practice Parameter Update
- Family Practice Notebook: Pediatric Acute Cough
- Textbook of Pediatric Emergency Medicine, Sixth Edition; Gary R. Fleisher, et al.
- Pediatrics: Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years
- Primary Care Pediatrics; Carol Green-Hernandez et al.