Cough Treatment for an 11-Month-Old
Over-the-counter cough medicines should NOT be used in an 11-month-old child, and honey cannot be given until after 12 months of age due to botulism risk. 1
What NOT to Use
- Over-the-counter cough and cold medicines are contraindicated in children under 2 years and have not been shown to make cough less severe or resolve sooner 1
- Dextromethorphan should not be used in pediatric patients as it is no different than placebo in reducing nocturnal cough or sleep disturbance 1
- Codeine-containing medications must be avoided due to potential serious side effects including respiratory distress 1
- Antihistamines have minimal to no efficacy for cough relief and are associated with adverse events 1
- These medications have been associated with significant morbidity and even mortality in young children 1
Recommended Approach
For Acute Cough (< 4 weeks duration):
Supportive care is the mainstay of treatment since most acute coughs are self-limiting viral infections 1
- Symptomatic relief with acetaminophen or ibuprofen for fever and discomfort 2
- Address environmental tobacco smoke exposure and other pollutants 1
- Ensure adequate hydration 2
When to Consider Further Evaluation:
- High fever ≥38.5°C persisting for more than 3 days warrants consideration of beta-lactam antibiotics 1
- Review the child if deteriorating or not improving after 48 hours 1
- Re-evaluate if cough persists beyond 2-4 weeks for emergence of specific etiological pointers 1
For Chronic Cough (> 4 weeks duration):
A systematic diagnostic approach is required rather than empirical treatment 3
- Obtain chest radiograph as part of the initial workup 3, 1
- Look for specific cough pointers such as coughing with feeding, digital clubbing, or wet/productive cough 1
- For chronic wet or productive cough without underlying disease, consider 2 weeks of antibiotics targeted to common respiratory bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis) 3
Critical Safety Points
- Never give honey to infants under 12 months due to infant botulism risk 1
- Do not use empirical treatment for asthma, GERD, or upper airway cough syndrome without clinical features consistent with these conditions 1
- Parental expectations should be addressed, as parents who desire medications report more improvement regardless of whether the child received medication, placebo, or no treatment 1