Cough

Pediatric HouseCalls Online

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.

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).

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.

See More Appropriate Topic (instead of this one) If

• Barky cough and hoarseness, see CROUP.
• Previous diagnosis of asthma, see ASTHMA ATTACK.
• Wheezing but no previous diagnosis of asthma, see WHEEZING.

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WHEN TO CALL YOUR DOCTOR

Call 911 Now (your child may need an ambulance) If:

• Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath).
• Child has passed out with coughing spasms.
• 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) not relieved by cleaning the nose.
• Difficulty breathing (over 1 year old ) present when not coughing.
• Lips have turned bluish during coughing.
• 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 
• Severe chest pain, coughed up blood or wheezing.

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

• You think your child needs to be seen.
• Continuous (nonstop) coughing.
• Age under 1 month old with any cough.
• Age 1 to 3 months with a cough for more than 3 days.
• Earache or sinus pain (not just congestion) is also present.
• Fever present for more than 3 days.
• 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.

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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:

   • 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 1 year, use HONEY, ½ to 1 teaspoon as needed as a homemade cough medicine.  It can thin the secretions and loosen the cough. (If not available, can use corn syrup.)

   • 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). Never use them under 4 years of age. (Reason: risk of serious side effects and not approved by FDA)

   • 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 OTC 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 under 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. 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 "Call Your Doctor" symptoms.

Disclaimer: This information is not intended to 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: 11/4/2008

Content Set: Pediatric HouseCalls Online

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