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Cough is one of the most frustrating symptoms to deal with as a parent, and equally frustrating for the physician. MOST of the time there is very little that can be done about a cough.
Most of you reading this will not be dealing with a child with the above level of distress and you are accessing our web site to learn if there is some way to get through the night. First, a bit about why we cough:
As it is with most “symptoms”, our bodies produce the cough as a means of protection. Coughing increases mucous clearance and speeds up the tiny hair cells in our airways that help protect our lower recpiratory tract from infection. So, think of a Cough as a good thing. This is why we don’t necessarily recommend suppressing it. A good example of how helpful our cough is comes from the experience in caring for children with cystic fibrosis. These children have much thicker mucous and have damage to their Cilia (the tiny Hair cells mentioned above) consequently, their cough is less effective. They suffer from recurrent bouts of pneumonia and need external assistance to bring up mucous. So, hopefully after reading this as you hear your child cough you may have less anxiety about it and actually welcome a bit of coughing.
Most coughs then, are a product of an upper respiratory infection (a cold or flu) that causes increased secretions. Mucous that an adult or older child would spit out or blow into a tissue is swallowed by the young ones. This post nasal drip is what accounts for the more severe sounding cough in our children. Cough without the post nasal drip can also be caused by irritation or mild inflammation to the upper respiratory tract, such as croup. Croup causes a dry dog or seal like barking cough that is worse at night. Most of these viral coughs last about 2 weeks, but some cause a prolonged (>3 week) cough. If your childs cough has lasted more than 2 weeks and is not improving or worsening we should see them in the office the next day. Prolonged cough without the above emergency symptoms does not need emergency care.
If you think you are dealing with one of the viral coughs this is where the frustration comes in. First, calm yourself by re-reading how protective coughs are, then get a humidifier or vaporizer going in your childs room (unless they have a known allergy to dust mites or molds). This adds moisture to the air and may make the cough less disruptive to sleep–it DOES NOT stop the cough. Some menthol and camphor based products, like Vicks can either be put in the humidifier or rubbed on the chest if they are old enough not to touch it and might put it in their eyes.
There are now menthol products that can be plugged indo an outlet, but I am unsure of their safety with small children at this time. The menthol conctricts the blood vessels in the nasal passage and may indirectly reduce cough by reducing the amount of congestion.
Cough syrups are rarely helpful. Dextrometorphan is the DM added to the end of the brand name and it is foul tasting and not very effective. It is hard to justify the fight it takes to get this medication into your child when it may reduce the frequency of cough by 5 – 0%. Expectorants don’t help as children don’t expectorate, so skip this one in total. If sleep is disturbed (the childs, not just yours) a single dose of diphenhydramine, (Benadryl) may help your child cross over from drowsy to actually asleep .
Of course, one should not forget the tried and true concentration on pushing fluids during a cold, it helps clear the secretions, and provides some calories for the little ones who reduce their solid food intake during the illness.
If your child has a hictory of wheezing or asthma and has a significant cough it is never wrong to try the Albeterol or Xopenex and monitor for decreased cough as a result. Remember that for a few minutes after the treatment the Cough may worsen as the treatment opens up previously closed airways and secretions are mobilized.