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Should Your Child See a Doctor?

Cough

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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 acute coughs 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 child 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 encourage 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 911 If…

 
  • Your child has severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)
  • Your child has passed out or stopped breathing
  • Your child's lips are bluish when not coughing
 

Call Your Doctor Now (night or day) If

 
  • Your child looks or acts very sick
  • Choked on a small object that could be caught in the throat
  • Difficulty breathing (under 1 year old) and not relieved by cleaning the nose
  • Difficulty breathing present when not coughing
  • Lips have turned bluish during coughing
  • Ribs are pulling in with each breath (retractions)
  • Can't take a deep breath because of chest pain
  • Severe chest pain, coughed up blood or wheezing
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc.)
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
 

 

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

  • You think your child needs to be seen
  • Continuous (nonstop) coughing
  • Age under 3 months old
  • Earache or sinus pain (not just congestion) is also present
  • Fever present for more than 3 days
  • Fever returns after gone for over 24 hours
  • Chest pain present even when not coughing
 

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns
  • Coughing has kept home from school for 3 or more days
  • Symptoms of nasal allergy are also present
  • Cough has been present over 3 weeks
 

Parent Care at Home If

  • Cough with no complications and you don't think your child needs to be seen
 

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. Homemade Cough Medicine:
    • Goal: reduce the irritation or tickle in the throat that triggers a dry cough.
    • Age 3 months to 1 year: Give warm clear fluids (e.g., water or apple juice) to treat the cough. Amount: 1-3 teaspoons (5-15 ml) four times per day when coughing. Avoid honey until 1 year old.
    • Age 1 year and older: Use honey 1/2 to 1 teaspoon (2-5 ml) as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, can use corn syrup.)
    • Age 6 years and older: Use COUGH DROPS to coat the irritated throat. (If not available, can use hard candy.)
     
  3. Non-Prescription Cough Medicine (DM):
    • Non-prescription cough medicines are not recommended. (Reason: no proven benefit for children and not approved for children under 4 years old) (FDA 2008)
    • Honey has been shown to work better for coughs.
    • If you decide to use a cough medicine from your drugstore and your child is over age 4 years, choose one with dextromethorphan (DM). It's present in most non-prescription cough syrups.
    • Indication: Give only for severe coughs that interfere with sleep, school or work.
    • DM Dosage: See Dosage table. Give every 6 to 8 hours for severe coughs that interfere with sleep, school or work.
     
  4. Coughing Spasms:
    • Expose to warm mist (e.g., foggy bathroom).
    • Give warm fluids to drink (e.g., warm water or apple juice) if over 3 months of age.
    • Amount: If 3 months to 1 year of age, give warm fluids in a dosage of 1-3 teaspoons (5-15 ml) four times per day when coughing. If over 1 year of age, use unlimited amounts as needed. · Reason: both relax the airway and loosen up the phlegm
     
  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. Fluid: Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen the phlegm in the airway.
  7. Humidifier: If the air is dry, use a humidifier (reason: dry air makes coughs worse).
  8. Fever Medicine: For fever above 102° F (39° C), give acetaminophen (e.g., Tylenol) or ibuprofen.
  9. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
  10. Contagiousness: Your child can return to child 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.
  11. Extra Advice — Antihistamines for Allergie Cough:
    • Antihistamines can bring an allergic cough and nasal allergy symptoms under control within 1 hour.
    • Benadryl or chlorpheniramine (CTM) products are very effective and no prescription is needed
    • They need to be given every 6 to 8 hours (See Dosage table).
     
  12. 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.
     
  13. 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.


References

  1. American Academy of Pediatrics, Committee on Drugs Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99:918-919
  2. Cromer BA, Goydos J, Hackell J, et al. Unrecognized pertussis infections in adolescents. Am J Dis Child. 1993;147:575.
  3. Guilbert TW, Taussig LM. "Doctor, he’s been coughing for a month. Is it serious?" Contemp Pediatr. 1998;15(3):155-172.
  4. Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25(4):115-123.
  5. Margolis P and Gadomski A. Does this infant have pneumonia? JAMA. 1998; 279:308-314.
  6. Olsen SJ, Swerdlow DL. Risk of infant botulism from corn syrup. Pediatr Infect Dis J. 2000;19:584.
  7. Paul IM; Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140-1144.
  8. Paul, IM, Yoder KE, Crowell KR, et al. Effect of Dextromethorphan, Diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114:e85-e90.
  9. Schaefer MK, Shehab N, Cohen AL, et al. Adverse events from cough and cold medications in children. Pediatrics. 2008;121(4):783-787.
  10. Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr. 1993;122:799-802.
  11. Woods C. Acute bacterial pneumonia in childhood in the current era. Pediatr Ann. 2008;37(10):694-702.

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: 8/1/2010

Last Revised: 9/30/2010 10:10:21 PM

Copyright 1994-2011 Barton D. Schmitt, M.D.

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