Cough

Definition

• A cough is the sound made when the cough reflex suddenly forces air and secretions from the lungs
• A coughing spasm is over 5 minutes of continuous coughing

Causes

• Most are part of a cold, a viral infection of the large airway (viral bronchitis)
• Other common causes: croup, bronchiolitis, asthma, allergic cough, whooping cough

Return to School

• Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

Sputum or Phlegm

• Yellow or green phlegm is a normal part of the healing process of viral bronchitis.
• This means the lining of the trachea was damaged by the viral infection and is being coughed up as new mucosa replaces it.
• Bacteria do not cause bronchitis in healthy children. Antibiotics are not indicated for the yellow or green phlegm seen with colds.
• The main treatment of a productive cough is to facilitate it with good fluid intake, a humidifier (if the air is dry) and warm chicken broth or apple juice for coughing spasms (if over age 1).

When to Call Your Doctor for Cough

Call Your Doctor Now (night or day) If

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

Call Your Doctor During Weekday Office Hours If

Parent Care at Home If

Home Care Advice for Cough

1. Reassurance:
   • Coughs are a normal part of a cold.
   • Coughing up mucus is very important for protecting the lungs from pneumonia.
   • We want to encourage a productive cough, not turn it off.
2. Mild Coughs: For infants, use sweet warm liquids to thin secretions and loosen the cough (avoid fruit juice if < 4 months old.) Do not use honey in children under 2 years old. Some physicians may recommend the use of honey over 1 year of age; however, its use in the 1-2 year age range has not been well studied. Corn syrup is not recommended as a cough suppressant (no evidence based data or age recommendations available).
   • From 3 months to 1 year of age, only use warm clear fluids (e.g., water or apple juice) to treat the cough. Dosage: 1-3 teaspoons (5-15 ml) four times per day when coughing. Avoid honey.
   • After age 6, use COUGH DROPS to coat the irritated throat. (If not available, can use hard candy.)
3. OTC Cough Medicine (DM): 
   • OTC cough medicines are not recommended. (Reason: no proven benefit for children and not approved by FDA for children under 4 years old)
   • - Evidence-based use of honey for coughing (recommended at bedtime only in the following amounts):
     - 2-5 years: ½ teaspoon
     - 6-11 years: 1 teaspoon
     - 12-18 years: 2 teaspoons
     - Possible side effects of honey are diarrhea or sugar-induced hyperactivity, particularly if honey is given more frequently.
     - For daytime coughing, treat with warm fluids and humidity.
     - Follow up with child’s PCP if cough worsens.
   • - Dextromethorphan (DM) is a cough suppressant found in most OTC cough medicines.
     - Age < 4 years: never use (AAP recommendation). Reason: risk of side effects and cough is a protective reflex.
     - Age 4-6 years: do not recommend (AAP recommendation). Reason: lack of proven benefit. However, if caller insists, advise them to check the package or their pharmacist. (Avoid multi-ingredient products).
     - Age 6 years or more: Recommend DM for SEVERE COUGHS that interfere with sleep, school or work. Check package insert or pharmacist for dosage.
     - NO ANTIBIOTICS: Antibiotics are not helpful for coughs.
4. Coughing Spasms:  
   • For infants, use sweet warm liquids to thin secretions and loosen the cough (avoid fruit juice if < 4 months old.) Do not use honey in children under 2 years old. Some physicians may recommend the use of honey over 1 year of age; however its use in the 1-2 year age range has not been well studied. Corn syrup is not recommended as a cough suppressant (no evidence based data or age recommendations available).
5. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (e.g., in infants, give 2 oz. less formula) (Reason: Cough-induced vomiting is more common with a full stomach).
6. Humidifier: If the air is dry, use a humidifier (reason: dry air makes coughs worse).
7. Fever Medicine: For fever above 102° F (39° C), give acetaminophen (e.g., Tylenol) or ibuprofen.
8. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
9. Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.
10. Expected Course:
    • Viral bronchitis causes a cough for 2 to 3 weeks.
    • Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow or green.
    • Antibiotics are not helpful.
11. Call Your Doctor If:
    • Difficulty breathing occurs
    • Wheezing occurs
    • Cough lasts over 3 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "When to Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 7/1/2008

Copyright 1994-2009 Barton D. Schmitt, M.D.