COUGH

Symptom Definition

A cough is the sound made when the cough reflex suddenly expels air and secretions from the lungs.
A coughing spasm is longer than 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.

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 FOR COUGH

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 (less than 1 year old) not relieved by cleaning the nose.
Difficulty breathing (older than 1 year ) present when not coughing.
Lips have turned bluish during coughing.
Age under 12 weeks with fever above 100.4° F (38° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
Birth to 12 weeks with fever above 100.4°F (38°C) rectally.
Fever above 105°F (40.6°C) at any age.
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 less than 1 month old with any cough.
Age 1 to 3 months with a cough for more than 3 days.
Earache or sinus pain/pressure 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 for more than 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

Cough Medicine for Mild Coughs:After age 1 year, use corn syrup � to 1 teaspoon as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. After age 6, use cough drops.
Cough Suppressant for Severe Coughs: For coughs that interfere with sleep, school or work, use dextromethorphan (DM) which is present in most cough syrups. See dosage chart. Do not use under 1 year old.
Coughing Spasms:
For coughing spasms, give warm fluids (e.g., apple juice). Expose to warm mist (e.g., foggy bathroom) (Reason: both relax the airway and loosen up the phlegm). Avoid juice if less than 4 months old.
Children older than 6 years can suck on hard candy or cough drops (Reason: to coat the irritated throat).
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).
Humidifier: If the air is dry, use a humidifier (reason: dry air makes coughs worse).
Fever Medicine: For fever above 102 F (39 C), give acetaminophen (e.g., Tylenol) or ibuprofen.
Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse.
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.
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. Coughing up mucus is very important for protecting the lungs from pneumonia.
We want to encourage a productive cough, not turn it off.
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.

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REFERENCES

American Academy of Pediatrics, Committee on Drugs Use of codeine- and dextromethorphan-containing cough remedies in children. Pediatrics. 1997;99:918-919.
Cromer BA, Goydos J, Hackell J, et al. Unrecognized pertussis infections in adolescents. Am J Dis Child. 1993;147:575.
Guilbert TW, Taussig LM. "Doctor, he�s been coughing for a month. Is it serious?" Contemp Pediatr. 1998;15(3):155-172.
Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25(4):115-123.
Margolis P and Gadomski A. Does this infant have pneumonia? JAMA. 1998; 279:308-314.
Paul, IM, Yoder KE, Crowell KR, et al. Effect of Dextromethorphan, Diphenhydramine, and placebo on nocturnal cough and sleep quality for coughing children and their parents. Pediatrics. 2004;114:e85-e90.
Taylor JA, Novack AH, Almquist JR, Rogers JE. Efficacy of cough suppressants in children. J Pediatr. 1993;122:799-802.

Disclaimer: This information is not intended 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.

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