What is the recommended treatment for an 11-month-old with a cough?

Management of Cough in an 11-Month-Old

For an 11-month-old with acute cough, provide supportive care only—do not use over-the-counter cough and cold medications, as they are ineffective and potentially dangerous in children under 2 years of age. 1

What NOT to Do

• Avoid all over-the-counter cough and cold medications in this age group, as they lack proven efficacy and carry serious safety risks including potential fatalities from decongestants and antihistamines 1
• Between 1969-2006, there were 43 deaths from decongestants in infants under 1 year, and 41 deaths from antihistamines in children under 2 years 1
• Do not use topical nasal decongestants in children under 1 year due to narrow therapeutic margins and risk of cardiovascular and CNS toxicity 1
• Do not use codeine-containing medications due to risk of respiratory distress 2
• Do not prescribe antibiotics unless bacterial infection is specifically suspected based on clinical features 1

Recommended Supportive Care

• Ensure adequate hydration to help thin secretions 1, 2
• Use antipyretics and analgesics (acetaminophen or ibuprofen if >6 months) to keep the child comfortable and help with fever-related discomfort 1
• Gentle nasal suctioning may help improve breathing if nasal congestion is present 1, 2
• Position the infant in a supported sitting position to help expand lungs and improve respiratory symptoms 1
• Address environmental tobacco smoke exposure if present 1, 2

When to Seek Immediate Medical Attention

Parents should bring the infant to medical care immediately if any of these warning signs develop:

• Respiratory rate >70 breaths/minute 1
• Difficulty breathing, grunting, or cyanosis 1
• Oxygen saturation <92% if measured 1
• Not feeding well or signs of dehydration 1
• Persistent high fever or worsening symptoms 1

Follow-Up Timing

• Review the infant within 48 hours if symptoms are deteriorating or not improving 1
• Most acute viral coughs resolve within 1-3 weeks, though 10% may persist beyond 20-25 days 1
• If cough persists beyond 3-4 weeks, this transitions to "prolonged acute cough" and warrants further evaluation 1
• At 4 weeks duration, the cough becomes "chronic" and requires systematic evaluation including chest radiograph and assessment for specific underlying causes using pediatric-specific algorithms 3, 1

Special Considerations for Persistent Cough

If the cough extends beyond 4 weeks, evaluate for:

• Specific cough pointers including coughing with feeding, digital clubbing, failure to thrive, or hemoptysis 1
• Consider pertussis testing if clinically suspected based on characteristic paroxysmal cough pattern 3
• Obtain chest radiograph as first-line investigation 3, 1
• For wet/productive cough persisting >4 weeks, consider a 2-week trial of antibiotics targeting common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) 1

Important Caveats

• Do not perform chest physiotherapy, as it is not beneficial in children with respiratory infections 1
• Avoid empirical treatment for asthma or other conditions unless specific clinical features support that diagnosis 3, 1
• The "wait, watch, review" approach is the cornerstone of managing acute cough in this age group 4