Treatment of Cough and Colds in Babies
For babies over 1 year old with acute cough, give honey; for babies under 1 year, provide only supportive care with fluids and antipyretics—do not use any over-the-counter cough or cold medications in children under 4 years of age. 1, 2
What TO Give
For Babies Over 1 Year Old
- Honey is the first-line treatment for acute cough, providing more relief than no treatment, diphenhydramine, or placebo 3, 1, 4
- Honey is superior to dextromethorphan for cough relief 3
- Typical dosing: small amounts as needed for cough symptoms 1
For All Babies (Any Age)
- Antipyretics (acetaminophen or ibuprofen) for fever control 3
- Adequate fluids to maintain hydration 3
- Nasal saline irrigation and suctioning for nasal congestion 5
- Humidification of air 5
What NOT to Give
Critical Safety Warning: Over-the-Counter Medications
- Never use OTC cough and cold medicines in children under 4 years due to potential for significant morbidity and mortality 3, 1, 2
- Between 1969-2006, there were 54 deaths from decongestants and 69 deaths from antihistamines in children under 6 years, with 43 decongestant deaths occurring in infants under 1 year 2
- These medications have not been shown to make cough less severe or resolve sooner 3, 1
Specific Medications to Avoid
- Codeine-containing medications: Risk of serious side effects including respiratory distress 3, 1
- Antihistamines: Minimal to no efficacy for cough relief in children and associated with adverse events 1, 2
- Dextromethorphan: No different than placebo in reducing cough or sleep disturbance 1
- Decongestants: Particularly dangerous in infants under 1 year due to narrow therapeutic window and cardiovascular/CNS side effects 2
When to Seek Medical Evaluation
High-Risk Features Requiring Assessment
- High fever (>38.5°C) with cough or influenza-like symptoms in babies under 1 year should be seen by a GP 3
- Breathing difficulties 3
- Severe earache 3
- Vomiting >24 hours 3
- Drowsiness 3
Re-evaluation Timeframe
- If cough does not resolve within 2-4 weeks, re-evaluate for emergence of specific causes 3, 1
- Most acute coughs are self-limiting viral infections requiring only supportive care 4
Special Considerations
Never Give Honey to Infants Under 12 Months
Environmental Modifications
- Eliminate tobacco smoke exposure and other environmental pollutants 3, 4
- This is critical for all children with cough 1
Parental Expectations
- Address parental concerns and explain that most acute coughs are self-limited 3, 4
- Educate that symptomatic cough suppression is rarely appropriate 4
Common Pitfalls to Avoid
- Giving in to parental pressure for OTC medications despite lack of efficacy and potential harm 1, 4
- Using multiple products simultaneously leading to unintentional overdose 2
- Assuming all coughs represent asthma and treating with bronchodilators without evidence of airflow obstruction 1
- Applying adult treatment approaches to pediatric patients 3