Cough (Children)

Is coughing bad for my child?

Most of the time it's good for her. When your child has a cold, coughing clears infected mucus from her lungs and keeps nasal mucus from dripping down into them. If she didn't cough, a little sniffle could turn into pneumonia.

Coughing is also valuable because it signals irritation in the airways. Pollen, dust, or tobacco smoke can make the muscles in the lungs' small breathing tubes constrict. This may lead to a dry, hacking cough or a wet, wheezing cough -- either of which may be a warning sign of asthma or of a condition known as reactive airways disease.

Of course, it's easier to sing the praises of coughing, when your sick child hasn't kept you up for a few nights. A child who's ailing needs to get as much rest as possible so her body can heal, and weary parents need relief as well.

When should I call the pediatrician?

If your child is having difficulty breathing -- if she's breathing rapidly, flaring her nostrils, or sucking in her chest with every breath, or if you see her turning blue in the lips -- call 911 or go to an emergency facility immediately.

You should also get immediate medical help if your child has any of these symptoms:

  • Severe chest pain or shortness of breath, which could be signs of pneumonia, asthma, or collapsed lung
  • Persistent coughing after an episode in which she temporarily choked on a piece of food -- a possible indication that something has lodged in the airway
  • Severe coughing fits, possibly followed by a whooping sound, which could signal pertussis, or whooping cough. If your child turns blue or stops breathing after a coughing spasm, call 911 and give her CPR (cardiopulmonary resuscitation) immediately

You should also call your pediatrician for an appointment if your child has any of the following symptoms:

  • The seal-like, barking cough characteristic of croup
  • A cough that lingers for more than three weeks after an illness
  • Asthma accompanied by coughing episodes that don't get milder

What causes coughing?

Upper- and lower-respiratory-tract infections are the most common cause. The average child gets six viral respiratory infections (including colds and flus) per year, a majority of them during the winter months. Among the foremost culprits is respiratory syncytial virus (RSV), which causes bronchiolitis. RSV circulates during the winter; almost all children catch it before they turn 2. RSV bronchiolitis inflames the linings of the lung, leading a child to cough and wheeze. As a result, a child who was born prematurely or who has underlying lung disease can develop respiratory problems marked by fast breathing, dehydration, and inadequate oxygen levels.

Persistent coughing may also be caused by any of the following:

  • Microbes. Certain bacteria trigger pneumonia, which often results in bad coughs and high fevers. Other microbes, such as the microorganisms that cause whooping cough and tuberculosis, can also give rise to severe coughing.
  • Asthma. Children with this condition cough more often, and their coughs last longer. They tend to get hay fever and eczema (red, itchy patches of skin) and frequently have strong family histories of allergy and asthma.
  • Irritants such as tobacco smoke, dust, wood smoke, and chemical fumes. Some children who have acid indigestion (heartburn), which irritates the throat, cough as well.
  • Certain genetic diseases. Some of these illnesses may cause coughing by distorting the breathing passages; the thick mucous that accompanies cystic fibrosis also causes persistent coughing.
  • Foreign matter in the lungs. Kids can choke on small toys or bits of food that go down the wrong passage and land in the lungs. To prevent that, make sure you child is seated and supervised when she eats. Any toy that's small enough to swallow or that includes loose pieces should be thrown away, and round or cylindrical foods like grapes and hot dogs should be cut into smaller pieces. Children under two shouldn't eat raw carrots, popcorn, or pieces of nut.

What kinds of home remedies are available?

Try running a cool-mist vaporizer or humidifier, and encourage your child to drink fluids, especially water. Both methods help keep the mucus in the nose and chest looser and make it easier for her to move mucus up and out of the lungs. Hard candy or lozenges are good for coughs in children older than 4 (younger children may choke on them). You can also try warm liquids or tea with honey and lemon to a child above age of 1. There's no evidence to support the belief that milk products increase mucus production, so if your sick child wants a glass of milk, you needn't say no.

Should I use a cough medicine?

Using medicine to suppress a cough can be dangerous if your child has asthma or whooping cough or is less than 1-year-old. A wet, productive cough that brings up mucus should never be suppressed. Prescription cough medicines often include codeine and hydrocodone -- powerful opiate drugs that need to be used with caution and only under your pediatrician's direction. Both drugs can make it more difficult for very young children to breathe.

Currently, there are differing opinions on the safety and effectiveness of over-the-counter cold and cough remedies. Despite the widespread use of cough medications for children, researchers haven't studied their usefulness or the dosages at which they should be administered. No good study has ever shown that cough medicines are effective for kids under 12. Because of the lack of evidence and rare cases of overdose from these medications, the American Academy of Pediatrics (AAP) recommended in 2007 against the use of over-the-counter cold or cough medicines in children under 6, In line with the AAP, a pediatric advisory committee to the U.S. Food and Drug Administration advised the agency not to recommend the use of these medicines in children under 6.

The FDA, however, acted against its own committee recommendations, and issued a public health advisory in January 2008 that over-the-counter cold remedies not be used in children younger than 2. The agency said it was investigating the effects of these medications on children between the ages of 2 and 11. At an FDA public hearing in October 2008, the Health Research Group of the consumer watchdog organization Public Citizen submitted testimony requesting that the FDA advise the public that over-the-counter cough medicine not be given to children under 12, because of the lack of science to support its effectiveness, and reports of side effects. In the same month, cold remedy manufacturers announced they would voluntarily change children's cough medicine labels to say that cough medicine is not recommended for children under the age of 4.

In most cases, your child will do just as well with the help of home remedies. If a dry cough is keeping your child from getting enough sleep, though, you may want to consider using a cough medicine as a last resort. Choose the one that contains the fewest active ingredients; for a child under 6, it's best to avoid products that contain decongestants and antihistamines. Dextromethorphan -- the active ingredient in most over-the-counter cough medicines -- will suppress an irritating cough. Even if it's a temptation, avoid giving cough medicine to children with asthma; use their asthma medicine instead.

Further Resources

Robert H. Pantell M.D., James F. Fries M.D., Donald M. Vickery M.D., Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care. Da Capo Lifelong Books. 2009.

References

American Academy of Pediatrics, Use of Codeine and Dextromethorpan-Containing Cough Remedies in Children (RE9722), Pediatrics Jun 1997;99(6)

"Vandana Y, Bhide, M.D."Parents and the OTC Cold Medicine Recall of 2008," American Academy of Pediatrics, www.aap.org/sections/media/workinaction.cfm

"Children's OTC Cough and Cold Medicines: Overview, Consumer Healthcare Products Association. 2008.

Public Health Advisory, Non-Prescription Cough and Cold Medicine Use in Children, U.S. Food and Drug Administration, updated October 10, 2008

"FDA Releases Recommendations Regarding Cough Medicines and Cold Products," January 17,2008, FDA press release. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2008/ucm116839.htm

FDA Statement Following CHPA's Announcement on Nonprescription Over-the-Counter Cough and Cold Medicines in Children, October 8, 2008

"Joint Meeting of the Nonprescription Drugs Advisory Committee and the Pediatric Advisory Committee," October 18-19, 2007

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