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Posted by Dr. Monica Wonnacott | January 23, 2016

What To Do About That Cough

As a pediatrician, I get exposed to every possible bug. My first year in practice I got sick constantly, but since then, I never seem to get sick — until this season.

I managed to dodge the dreaded Swine flu (kids coughed in my face daily for a month before I got the vaccination), but some sneaky virus got me. Needless to say, it seemed appropriate to discuss cough (since I can’t quite seem to kick mine).

There are lots of causes of cough. Asthma, reflux, aspiration, some heart conditions, post nasal drip/allergies, anatomical problems, and some medications all cause cough. Now I’m talking about cough caused by viruses, a good ole’ fashioned sickness.

What to expect?

As mentioned in the virus article, the average virus lasts 7-10 days. Often times, the cough seems to linger a bit longer than that though. Cough is often worse at night and first thing in the morning. With the average viral cough, there is usually an associated runny nose. Typically, when a person lays down, the snot drains on the back of the throat and makes the cough worse.

Should I see a doctor?

If the cough is unusual in any way, i.e., barky or seal-like, associated with blue spells, apnea (stopping breathing), or difficultly breathing, etc, it is worth having your doctor take a look and listen. As for the “lingering cough,” as long as the cough is steadily improving and there aren’t new associated symptoms (like shortness of breath or fever), it is reasonable to wait and watch for resolution of the cough. If a cough persists for a long time (weeks), it’s also worth evaluation. As always, the great exception to the rule is the very young infant. If your child is very young, it is always a good idea to have your pediatrician evaluate.

What medications can I treat it with?

This is the million dollar question. Many parents are aware of the fact that in January of 2008, the FDA put an advisory out against using combination cough and cold remedies in children 4 and younger. This is because there were some associated deaths in young children given these drugs and there is no identified safe dosing. So in the young child range, there is very little to do. It ends up being all symptomatic treatment (elevate the head of the bed, use a humidifier, etc.). In older children, you can try over the counter cough remedies, but the reality is that they don’t work very well. The drug that works best to make a person stop coughing is codeine. It is a narcotic, adult drug. It is not routinely given in children (only in controlled settings like the hospital) because in addition to making your child stop coughing, it can make your child stop breathing. It simply isn’t safe, so pediatricians don’t prescribe it. I empathize with parents who have a sick child that is up all night coughing; I’ve been there. Last night, I was the patient up all night coughing (wishing I had some codeine). Unfortunately, it is largely a wait it out game.

What about honey?

A few newer studies have looked at honey as an alternative to cough syrup with promising results. In the studies, the dose used is 2 mL for 2-5 year olds, 5 mL for 6-11 year olds, and 10 mL for 12-18 year olds. As always, do not use honey in children less than 1 year of age (risk of botulism).

Will an antibiotic help?

After another rough night of coughing, a family member of mine said, “can’t you take an antibiotic already?” I smiled as I realized that they believed what many others believe. If after a few days, it doesn’t get better, take an antibiotic and it will get better. The truth is that an antibiotic never did and never will treat a virus. An antibiotic is only indicated if there is bacterial cause (like a complication of pneumonia or sinusitis). Yellow or green sputum (the nasty gunk you cough up) is part of the normal healing process and does not mean you need antibiotics.