What is the recommended treatment for a dry cough in children over one year of age?

Dry Cough Treatment in Children Over One Year

For children over 1 year of age with acute dry cough, honey is the recommended first-line treatment, while over-the-counter cough and cold medications should be avoided due to lack of efficacy and potential for serious harm. 1

Primary Treatment Recommendation

• Honey should be offered as the first-line treatment for acute dry cough in children over 1 year of age, as it provides more relief than no treatment, diphenhydramine, or placebo 1, 2
• Honey cannot be used in children under 1 year due to botulism risk 2

What NOT to Use

• Over-the-counter cough suppressants and cold medicines should NOT be used in children with cough, as patients, especially young children, may experience significant morbidity and mortality 3
• Children under 4 years should not receive OTC cold medications due to potential toxicity and lack of proven efficacy 2
• Between 1969-2006, there were 54 deaths associated with decongestants and 69 deaths associated with antihistamines in children under 6 years 4, 2
• Codeine-containing medications should be avoided in children due to potential serious side effects, including respiratory distress 1
• Antihistamines have been shown to be no more effective than placebo in relieving cough symptoms 3

When to Consider Alternative Diagnoses

• If dry cough persists beyond 3-4 weeks, transition to evaluation for chronic cough using pediatric-specific algorithms 4
• At 4 weeks duration, systematic evaluation is required including assessment for asthma, upper airway cough syndrome, or post-infectious cough 1

Asthma Consideration for Chronic Dry Cough

• For children with chronic dry cough (>4 weeks) and asthma risk factors (wheeze, exercise intolerance, nocturnal symptoms), consider a short 2-4 week trial of inhaled corticosteroids such as beclomethasone 400 μg/day or equivalent budesonide 3, 1
• However, most children with nonspecific dry cough do not have asthma 3
• Children should always be reevaluated in 2-4 weeks, and if cough does not resolve during medication trial, the medication should be withdrawn and other diagnoses considered 3

Supportive Care Measures

• Address environmental factors, particularly exposure to tobacco smoke, which should be identified and cessation advised 3, 1
• Ensure adequate hydration to help thin secretions 4
• Use antipyretics and analgesics to keep the child comfortable 4
• Determine and address parental expectations and specific concerns 3, 1

Critical Pitfalls to Avoid

• Do not use empirical treatment approaches that are not based on specific findings or suspected diagnoses 1
• Avoid assuming all cough represents asthma and treating with bronchodilators without evidence of airflow obstruction 2
• Do not routinely perform additional tests (skin prick test, bronchoscopy, chest CT) unless specifically indicated by clinical findings 1
• If empirical trial is used, it must be of defined limited duration (2-4 weeks) to confirm or refute the hypothesized diagnosis 1

When to Escalate Care

• Seek medical evaluation if cough persists beyond 4 weeks, as this requires systematic evaluation with chest radiograph and spirometry as first-line investigations 1, 4
• Consider referral for children who fail to respond to appropriate initial management or present with concerning symptoms such as hemoptysis, weight loss, or persistent focal findings 1