From the Guidelines
For a 17-month-old with a cough, safe treatments include using a cool-mist humidifier in the child's room, offering plenty of fluids to keep them hydrated, and using saline drops with gentle suction to clear nasal passages. Elevating the head of the bed slightly can help with nighttime coughing. For specific medications, acetaminophen (Tylenol) can be given at a dose of 160mg/5mL, typically 120-160mg every 4-6 hours for fever or discomfort, as suggested by general pediatric guidelines 1. Most over-the-counter cough and cold medicines are not recommended for children under 4 years old due to potential side effects and limited effectiveness. Honey can help soothe coughs in older children but should never be given to babies under 12 months due to botulism risk; since your child is over 12 months, a small amount of honey (about 1/2 teaspoon) can be offered, as supported by a recent study 1. Some key points to consider in managing cough in children include:
- The definition of chronic cough in pediatrics, which is a daily cough lasting for more than 4 weeks 1
- The importance of evaluating the child's activity, parental expectations, and concerns in managing cough 1
- The recommendation for children with chronic wet or productive cough to receive 2 weeks of antibiotics targeted to common respiratory bacteria, as suggested by the 2017 Chest guideline 1 Contact a doctor if the cough persists beyond 7-10 days, is accompanied by high fever (over 102°F), difficulty breathing, lethargy, or if your child isn't drinking fluids. These non-medication approaches are generally preferred as first-line treatments because young children's respiratory systems are still developing, and their bodies process medications differently than adults. It is essential to follow up with a doctor to assess the effectiveness of the treatment and to rule out any underlying conditions that may be causing the cough, as emphasized in the guidelines 1.
From the FDA Drug Label
Pediatric Patients 6 to 23 Months of Age with Asthma Safety and effectiveness in pediatric patients younger than 12 months of age with asthma have not been established.
The FDA drug label does not answer the question for a 17-month-old patient, but it does mention that safety and effectiveness have not been established for pediatric patients younger than 12 months of age. For patients between 6 to 23 months, montelukast was generally well tolerated. However, since the patient is 17 months old, which falls within the 6 to 23 months age range, but the label does not provide a clear answer for the treatment of cough in this age group, no conclusion can be drawn.
From the Research
Safe Treatments for a 17-Month-Old with Cough
- The American College of Chest Physicians recommends a "wait, watch, review" approach for managing acute cough in children, as cough medications offer no symptomatic relief and can have potential side effects 2.
- The US Food and Drug Administration (FDA) does not recommend the use of cough and cold products that contain an antihistamine or decongestant in children younger than 2 years 3.
- Saline nasal irrigation is a safe and effective treatment for upper respiratory conditions, including mild to moderate allergic rhinitis and acute upper respiratory tract infections 4, 5.
- Nasal irrigation or nebulizing aerosol of isotonic or hypertonic saline can help reduce symptoms of respiratory viruses, including coronaviruses, by promoting mucociliary clearance and inhibiting viral replication 5.
Non-Pharmacologic Therapies
- Educating parents on expected illness duration and the risks of using over-the-counter medications is an important part of managing acute cough in children 2.
- Discussing safe, supportive care measures to alleviate the child's discomfort is also crucial 2.
- Non-pharmacologic therapies, such as zinc or echinacea, may be used to treat cold symptoms, but their safety and efficacy in pediatric patients are not well established 3.