What are the effective treatments for cough in a 1-year-old?

Treatment of Cough in 1-Year-Olds

For a 1-year-old with acute cough, honey is the only evidence-based treatment that should be used, while over-the-counter cough and cold medications should be avoided entirely due to lack of efficacy and potential harm. 1, 2

Acute Cough Management

First-Line Treatment

• Honey (for children ≥1 year old) is the only recommended treatment for acute cough, as it provides more symptom relief than no treatment, diphenhydramine, or placebo 1, 2
• Supportive care with antipyretics (avoiding aspirin) and adequate fluids should be provided 3

What NOT to Use

• Over-the-counter cough and cold medicines should never be prescribed for children with acute cough, as they have not been shown to reduce cough severity or duration and carry potential for harm 1, 4, 2
• Codeine-containing medications must be avoided due to risk of serious side effects including respiratory distress 1, 4
• Antihistamines, decongestants, and expectorants are ineffective and potentially harmful in this age group 4, 2

Chronic Cough (>4 Weeks Duration)

Wet/Productive Cough

• If cough persists beyond 4 weeks and is wet/productive without specific concerning features, consider protracted bacterial bronchitis (PBB) and treat with a 2-week course of antibiotics targeting common respiratory bacteria (amoxicillin is first-line) 1, 3
• If cough persists after 2 weeks of appropriate antibiotics, provide an additional 2-week course 1
• When chronic wet cough resolves with antibiotics, PBB is confirmed 1

Dry/Non-Productive Cough

• For children with dry cough and asthma risk factors (family history, atopy, nocturnal symptoms), consider a short 2-4 week trial of inhaled corticosteroids (400 mcg/day beclomethasone equivalent) 3, 1
• Re-evaluate in 2-4 weeks - if no response, stop the medication as the child likely does not have asthma 3
• Do not increase ICS doses if cough is unresponsive 3

Red Flags Requiring Further Evaluation

When to Investigate Further

• Cough persisting beyond 2-4 weeks without resolution should prompt re-evaluation for emergence of specific etiological pointers 3, 1
• Concerning features include: hemoptysis, weight loss, persistent focal findings, recurrent episodes despite treatment, or failure to respond to appropriate initial management 1
• Chest radiograph and spirometry (when age-appropriate) are first-line investigations when structural abnormalities are suspected 1

Important Caveats

Common Pitfalls to Avoid

• Never use empirical treatment approaches that are not based on specific clinical findings 3, 1
• Do not routinely perform additional tests (skin prick testing, bronchoscopy, CT) unless specifically indicated by clinical findings 1
• Avoid treating GERD empirically without clear gastrointestinal symptoms (recurrent regurgitation, dystonic neck posturing) 3
• Chest physiotherapy is not beneficial and should not be performed 3

Environmental Factors

• Identify and counsel on environmental tobacco smoke exposure and other pollutants 1
• Address parents' expectations and concerns directly 1

Treatment Duration

• Any trial of therapy must be time-limited with defined endpoints to confirm or refute the diagnosis 3, 1
• Medications should be ceased if there is no effect within the expected timeframe 3