Recommended Antitussive Therapies for Pediatric Patients
Over-the-counter (OTC) cough medications should not be prescribed for children as they have little to no benefit in symptom control and carry significant risk of adverse events, including potential mortality. 1
First-Line Recommendations
- Honey is recommended as first-line therapy for children over 1 year of age with acute cough, showing better efficacy than no treatment, diphenhydramine, or placebo 2
- Never give honey to infants under 12 months due to risk of infant botulism 2
- Watchful waiting with supportive care is appropriate for most cases of acute cough, as most are self-limiting viral infections 3
Medications to Avoid
- OTC cough and cold medicines have little to no benefit in the symptomatic control of acute cough in children and are associated with adverse events, including reported deaths from toxicity 1
- FDA has altered labeling for prescription opioid cough medicines to limit their use to adults ≥18 years 1
- Codeine-containing medications should be avoided due to potential serious side effects including respiratory distress 1, 4
- Antihistamines have minimal to no efficacy for cough relief in children 1
- Dextromethorphan shows limited efficacy for symptomatic relief of cough due to upper respiratory infections 1, 5
For Chronic Cough Management
- For children with suspected asthma-related cough, a short trial (2-4 weeks) of beclomethasone 400 μg/day or equivalent budesonide dose may be warranted 1
- If cough does not resolve during the medication trial within the expected response time, the medication should be withdrawn and other diagnoses considered 1
- All children with chronic cough should be re-evaluated within 2-4 weeks 1, 3
Environmental Considerations
- Identify and address exacerbating factors such as exposure to tobacco smoke 1
- Environmental modifications may help reduce cough triggers 3
Special Considerations
- Children should be managed according to pediatric-specific guidelines, as etiologic factors and treatments in children differ from those in adults 1
- When pediatric-specific cough recommendations are unavailable, adult recommendations should be used with caution in children ≤14 years 1
- Parental education about the natural course of cough and expected resolution timeframes is essential 3
Common Pitfalls
- Overuse of medications without evidence of efficacy 6, 7
- Failure to re-evaluate children whose cough persists despite treatment 3
- Using adult cough management approaches in pediatric patients 1
- Prolonged use of asthma medications without clear evidence of asthma 3
The evidence strongly suggests that most OTC cough medications lack efficacy in children while carrying significant risks. Honey (for children >1 year) and supportive care remain the safest and most effective approaches for managing pediatric cough.