Probably the most common ailment that parents have to deal with in their children is the routine cough and cold. Cough and cold can keep both parents and children up for many nights while we wait for a child’s body to fight off a viral upper respiratory infection. It is common for parents to wonder what, if anything, they can give their children to help alleviate these symptoms, and, hopefully, get the entire family some extra rest.
In the past, it was very common to use over-the-counter or prescribed cough and cold medications for people of all ages, including young children and infants. Unfortunately, more than 7,000 children a year were being seen in emergency rooms for unintentional overdoses on these medications! The side effects of an overdose of cough and cold medication can be severe, including seizures, respiratory arrest (a person completely stops breathing), hypertension (high blood pressure), strokes, coma, and, at its worst, death. In addition, studies were finding that neither prescription nor over the counter cough medications were leading to much improvement in childrens’ symptoms. Any way you look at it, the risks that these medications carried, with the minimal benefit in symptoms seemed like a bad scenario! For these reasons, the recommendation was made to STOP giving cough and cold medication to ALL children under the age of 4, and to use caution in giving them to children between the ages of 4-6. In fact, the American Academy of Pediatrics recommends not using them in children under 6. Since these recommendations have come out, and the number of children receiving these medications has decreased, the number of emergency room visits and unintentional overdoses has dropped more than 50%!
So, what can you do?
For infants less than 1 year old with a routine upper respiratory infection (cold) the best treatment is supportive care. This means acetaminophen or ibuprofen as needed for fever, nasal suctioning with saline drops (these are over the counter drops of salt water that can help loosen up nasal mucous and make it easier to suction out), and ensuring that children remain hydrated. For children over 1 year of age, studies have shown that honey is more effective in decreasing symptoms of cough than cough and cold medications, so older children can have 1 teaspoon to 1 tablespoon of honey 2-3 times a day as a natural cough suppressant. I recommend a dose before bed, since this is often when cough is at its worst. Older children (older than 1 year) can also be given an extra pillow to sleep which elevates their head and helps mucous drain out of the nose rather than down the throat. We NEVER give honey to children less than 1 year of age because of the risk for infantile botulism, a disease caused by natural spores that can be in honey which don’t affect older children or adults but can cause temporary paralysis in children less than 1 year of age.
It’s important to understand that cough from a viral upper respiratory infection is not harmful or dangerous. It is certainly bothersome, and it is hard to watch children have these symptoms, but knowing the potential for harm from medications, a bothersome but not dangerous cough is a much better choice than a medications which can cause seizures or coma.
There are times when we need to treat a child who has a cough, but in these instances it is not the SYMPTOM of cough that we are treating, it is the underlying disease that is causing the cough. So, when do you need to see a doctor and when should a doctor be prescribing medication?
If your child has pneumonia, it is appropriate to prescribe an antibiotic to treat the pneumonia. Again, the cough may be a symptom of pneumonia, but the doctor is treating the infection, not the cough. Signs of pneumonia include fever, cough, and difficulty breathing.
If your child has asthma causing a cough, or bronchiolitis (a viral infection of the small airways in the lungs) your doctor might prescribe an inhaler, nebulizer or oral steroids. Signs of asthma and bronchiolitis are cough, wheezing and difficulty breathing. Pertussis, more commonly known as whooping cough, is one disease where the cough itself leads children to be in danger. Pertussis leads to severe coughing fits that can last for minutes without a break, during which children cannot breathe. The cough of pertussis is very different than the usual cough of a normal cold. Luckily, we have vaccinations that protect children from pertussis. All children should receive the pertussis shot at 2, 4, and 6 months of age, with a booster dose between 12-15 months and at 4 years old. The most common place for children to get whooping cough is from teenagers or older family members, so all adults should be vaccinated for pertussis, as well. If your doctor thinks your child has pertussis, there are specific antibiotics that can be given.
It is never wrong to see your doctor to evaluate your child if they have a cough and/or fever. If your doctor determines that your child’s cough is from an upper respiratory infection (cold) with no underlying pneumonia, asthma, or bronchiolitis, however, it is likely they will not prescribe any medication and in this case they are doing what is best for your child.