What is a good cough medicine for children?

Honey is the Best Cough Medicine for Children

For children with cough, honey is recommended as the safest and most effective over-the-counter remedy, while OTC cough and cold medications should be avoided due to lack of efficacy and potential serious side effects. 1

Evidence-Based Recommendations for Cough in Children

First-Line Treatment

• Honey:
  • Offers more relief for cough symptoms than no treatment, diphenhydramine, or placebo 1
  • Safe for children over 1 year of age
  • Dosing: 2.5-10 mL (½-2 teaspoons) based on age, given as needed
  • CAUTION: Never give honey to infants under 12 months due to risk of botulism

What to Avoid

• OTC cough and cold medicines:

  • Should not be used in children, especially those under 6 years 1
  • Lack proven efficacy for symptom control 1
  • Associated with significant adverse events including death from toxicity in young children 1
  • In 2018, FDA restricted prescription opioid cough medications to adults ≥18 years only 1

• Codeine-containing medications:

  • Must be avoided due to potential for serious side effects including respiratory distress 1

• Antihistamines:

  • Minimal to no efficacy for cough relief in children 1
  • Diphenhydramine shows no benefit over placebo 1

Special Considerations

For Persistent Cough (>2-4 weeks)

If cough persists beyond 2-4 weeks:

1. Re-evaluate for specific etiological causes 1
2. For children with asthma risk factors, consider a short (2-4 weeks) trial of inhaled corticosteroids (400 μg/day of beclomethasone equivalent) 1
3. Always re-evaluate after 2-4 weeks of any treatment 1

Common Pitfalls to Avoid

1. Misuse of OTC medications: Despite marketing claims, these products have little to no benefit and carry significant risks 1

2. Accidental overdose: Children have experienced serious adverse events including death from toxicity with OTC cough medications 1, 2

3. Prolonged use without re-evaluation: If cough doesn't resolve within 2-4 weeks, the child should be re-evaluated for emergence of specific causes 1

4. Assuming all coughs need medication: Most childhood coughs are self-limiting and resolve without pharmacological intervention 1, 3

5. Using adult cough treatments in children: Children should be managed according to pediatric-specific guidelines as treatments differ from adults 1

Environmental Interventions

• Ensure adequate hydration
• Use humidifiers in dry environments
• Eliminate tobacco smoke exposure
• Address any environmental irritants or allergens

Remember that cough is often a protective mechanism. While symptomatic relief is important for quality of life, the primary focus should be identifying and addressing any underlying cause rather than simply suppressing the cough.