Clinical Reference Systems: Pediatric Advisor 10.0
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Cough

DESCRIPTION

The cough reflex expels air and secretions from the lungs with a sudden explosive noise.
The cough can be dry and hacking or wet and productive.
A coughing spasm is more than 5 minutes of continuous coughing.

SIMILAR CONDITIONS

Croup

CAUSE

Most coughs are caused by a viral infection of the trachea (windpipe) or bronchi (larger air passages in the lungs). These infections are called tracheitis and bronchitis, respectively. Most children get such a viral infection a couple of times a year as part of a cold. Keep in mind that coughing clears the lungs and protects them from pneumonia. Bronchitis isn't serious.

The role of milk in thickening the secretions is doubtful.

EXPECTED COURSE

Usually bronchitis causes a dry tickly cough that lasts 2 to 3 weeks. Sometimes the cough becomes loose (wet) for a few days, and your child coughs up a lot of phlegm (mucus). This is usually a sign that the end of the illness is near.

HOME CARE

  1. Medicines to loosen the cough and thin the secretions
    Cough drops: Most coughs in children over age 4 years can be controlled by sucking on cough drops or hard candy freely. (The cough drops or candy coat the irritated throat.)
    Homemade cough syrup: For children under age 4 years, use 1/2 to 1 teaspoon of corn syrup instead of cough drops. (The corn syrup thins the secretions and loosens the cough.)
    Warm liquids for coughing spasms: Warm liquids usually relax the airway and loosen up the mucus. Start with warm lemonade, warm apple juice, or warm herbal tea. (Avoid this if your child is less than 4 months old.) Do not add liquor because it may aggravate the cough if your child inhales the fumes of alcohol into his lungs. Also, your child could become intoxicated from an unintentional overdose.

  2. Cough-suppressant medicines

    Cough-suppressant drugs reduce the cough reflex. However, the cough reflex helps protect the lungs. Use cough-suppressant drugs only for dry coughs that interfere with sleep, school attendance, or work. They also help children who have chest pain from coughing spasms. Do not give them to infants less than 1 year old or for wet coughs.

    Most nonprescription cough suppressants contain dextromethorphan (DM). Your child needs the medicine recommended by your physician.

    You may want to give your child corn syrup during the day and DM at bedtime and during the night. DM is also available as a cough lozenge and as a long-acting liquid (effective for 12 hours).

  3. Humidifiers in the treatment of cough

    Dry air tends to make coughs worse. Dry coughs can be loosened up by encouraging your child to drink a lot and by using a humidifier in your child's bedroom.

    The new ultrasonic humidifiers are very quiet and they kill molds and most bacteria that might be in the water. If possible, use distilled water instead of tap water in the humidifier. The Environmental Protection Agency reported in 1988 that tap water may contain harmful minerals (such as lead and asbestos). If these minerals are in your tap water, they will also be in the mist produced by the humidifier. Frequent inhaling of these particles may cause chronic lung problems. Don't add medication to the water in the humidifier because it irritates the cough in some children.

  4. Exercise

    Teenagers and other schoolchildren will find that gym and exercise trigger coughing spasms when they have bronchitis. If so, they should avoid such physical activity temporarily.

  5. Active and passive smoking

    Don't let anyone smoke around your coughing child. Remind the teenager who smokes that his cough may last weeks longer than it would without smoking.

  6. Common mistakes in treating cough

    Antihistamines, decongestants, and antipyretics are found in many cough syrups. There is no proof that these ingredients will help your child's cough, and the antihistamines may make your child sleepy. Expectorants are of unproven value but harmless. Stay with the simple remedies mentioned above or use dextromethorphan (DM).

    Milk does not need to be eliminated from the diet. Restricting it improves the cough only if your child is allergic to milk.

    Never stop breast-feeding because of a cough.

CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:

Breathing becomes difficult AND is not better after you clear the nose.
Breathing becomes fast or labored (when your child is not coughing).
Your child starts acting very sick.

CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:

A fever (over 100°F, or 37.8°C) lasts more than 3 days.
The cough lasts more than 3 weeks.
You have other concerns or questions.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems