What is the recommended treatment for a cough in children?

Management of Cough in Children

Honey is the recommended first-line treatment for cough in children over 1 year of age, as it offers more relief for cough symptoms than no treatment, diphenhydramine, or placebo. 1, 2

First-Line Treatment Recommendations

• Honey (10ml) should be given for children over 1 year of age with acute cough, providing superior symptomatic relief compared to no treatment or placebo 1, 3
• Honey can be administered up to three times daily, particularly before bedtime to improve sleep quality for both children and parents 4, 5
• For children under 1 year of age, honey should NOT be used due to risk of infant botulism 2
• Watchful waiting with supportive care (hydration, rest) is appropriate for most cases of acute cough, as most are self-limiting viral infections 2

Medications to AVOID

• Over-the-counter (OTC) cough and cold medicines should NOT be prescribed as they have not been shown to make cough less severe or resolve sooner in children 1
• Codeine-containing medications should be strictly avoided due to potential serious side effects including respiratory distress 1
• Antihistamines have minimal to no efficacy for cough relief in children and may cause adverse effects 1
• Dextromethorphan offers no significant benefit over honey and may cause adverse effects such as nervousness, insomnia, and hyperactivity 3, 6

Special Considerations for Chronic Cough

• For children with cough lasting more than 4 weeks (chronic cough), a systematic approach should be taken to determine the underlying cause 1
• If risk factors for asthma are present in children with non-specific chronic cough, consider a short (2-4 week) trial of beclomethasone 400 μg/day or equivalent 1, 2
• For children with chronic cough and suspected GERD with GI symptoms, treatment according to GERD-specific guidelines for 4-8 weeks may be appropriate 1
• Re-evaluate children with non-specific cough after 2-4 weeks for emergence of specific etiological pointers 1

Diagnostic Approach

• For chronic cough (>4 weeks), a chest radiograph and, when age appropriate, spirometry (pre- and post-β2 agonist) should be performed 1
• Additional tests should not be routinely performed but individualized based on clinical symptoms and signs 1
• Base management on cough characteristics and associated clinical history, looking for specific cough pointers like presence of productive/wet cough 1

Follow-Up Recommendations

• All children with persistent cough should be re-evaluated within 2-4 weeks 1, 2
• If medications are used, they should be discontinued if no effect is observed within the expected timeframe 1, 2
• Parental education about the natural course of cough and expected resolution timeframes is essential 2

Common Pitfalls to Avoid

• Using adult cough management approaches in pediatric patients 2
• Empirical treatment for conditions like asthma, GERD, or upper airway cough syndrome without supporting clinical features 1
• Prolonged use of medications without re-evaluation 2
• Using dextromethorphan in children with chronic cough that occurs with smoking, asthma, or emphysema 7
• Using honey in infants under 1 year of age due to risk of infant botulism 2