Best Cough Medications for a 14-Month-Old
Do not use over-the-counter cough and cold medications in your 14-month-old child—instead, use honey as the only recommended treatment for cough relief. 1
Recommended Treatment
Honey is the first-line and only recommended medication for cough in children over 1 year of age, as it provides more relief for cough symptoms than no treatment, diphenhydramine, or placebo. 1 Your 14-month-old is old enough to safely receive honey (never give to infants under 12 months due to botulism risk). 1
Medications That Must Be AVOIDED
Over-the-Counter Cough and Cold Medicines
- The American Academy of Pediatrics and FDA explicitly recommend that children under 4 years of age should not use OTC cold medications due to potential toxicity and lack of proven efficacy. 2
- Between 1969 and 2006, there were 54 deaths associated with decongestants and 69 deaths associated with antihistamines in children under 6 years, with 43 decongestant deaths occurring in infants under 1 year. 2
- Systematic reviews conclude that OTC cough medications have little, if any, benefit in the symptomatic control of acute cough in children but are importantly associated with adverse events including reported deaths from toxicity. 3
Specific Medications to Never Use
- Dextromethorphan: The American Academy of Pediatrics specifically advises against its use for any type of cough in children, as it is no different than placebo in reducing nocturnal cough or sleep disturbance. 1
- Antihistamines: Have minimal to no efficacy for cough relief in children and are associated with adverse events when combined with other OTC ingredients. 1
- Codeine and opioid-containing medications: Must be avoided due to potential serious side effects including respiratory distress. 1 In 2018, the FDA altered labeling for prescription opioid cough medicines to limit their use to adults ≥18 years. 2
- Salbutamol (β2-agonists): There is no evidence to support using β2-agonists in children with acute cough and no evidence of airflow obstruction. 2
When to Seek Further Evaluation
- Re-evaluate if cough persists beyond 2-4 weeks for emergence of specific etiological pointers such as coughing with feeding, digital clubbing, or persistent wet/productive cough. 1
- Most acute coughs are self-limiting viral infections requiring only supportive care. 1
Environmental Modifications
- Evaluate and address tobacco smoke exposure and other environmental pollutants in all children with cough. 1
- Assess parental expectations and concerns as part of the clinical consultation. 1
Common Pitfalls to Avoid
- Do not prescribe OTC medications due to parental pressure despite lack of efficacy—parents who desire medications report more improvement at follow-up regardless of whether the child received medication, placebo, or no treatment. 1
- Avoid using adult cough management approaches in pediatric patients. 1
- Do not empirically treat for asthma, GERD, or upper airway cough syndrome without clinical features consistent with these conditions. 1