Best Cough Medicine for a One-Year-Old
Honey is the only recommended treatment for cough in a one-year-old child, given at a dose that provides symptomatic relief (typically 2.5-5 mL as needed). 1, 2
What TO Use
- Honey is the first-line and only recommended treatment for cough in children over 1 year of age, as it provides more relief than no treatment, diphenhydramine, or placebo. 3, 1, 2
- Honey can be given as needed for symptom relief, though specific dosing studies in children suggest 2.5-5 mL doses. 2
- This recommendation comes from the American College of Chest Physicians and American Academy of Pediatrics guidelines. 1, 2
What NOT to Use
All over-the-counter cough and cold medicines are contraindicated in children under 4 years of age due to lack of efficacy and potential for serious harm, including death. 1, 4
Specifically avoid:
- Over-the-counter cough medicines - These have not been shown to make cough less severe or resolve sooner, and young children may experience significant morbidity and mortality. 3
- Codeine-containing medications - Must be avoided due to potential for serious side effects including respiratory distress. 3, 1
- Dextromethorphan - Despite being available OTC, it should not be used in children as systematic reviews show little to no benefit and it is associated with adverse events. 3, 1
- Antihistamines (like diphenhydramine) - Have minimal to no efficacy for cough relief and are associated with adverse events. 3, 1
- Decongestants - Between 1969-2006, there were 54 deaths associated with decongestants in children under 6 years, with 43 occurring in infants under 1 year. 4
Critical Safety Warning
Never give honey to infants under 12 months of age due to risk of infant botulism. 1, 2 Since your child is exactly one year old, honey is now safe to use.
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, failure to thrive, or wet/productive cough. 3, 1
- Seek immediate evaluation if the child has difficulty breathing, persistent high fever (≥38.5°C for >3 days), changes in mental status, or refusal to eat/drink. 2
Environmental Modifications
- Evaluate and eliminate tobacco smoke exposure and other environmental irritants, as this is an important exacerbating factor for any cough in children. 3, 1
Common Pitfalls to Avoid
- Do not prescribe OTC medications due to parental pressure - Between 1969-2006, there were 123 deaths (54 from decongestants, 69 from antihistamines) in children under 6 years from these medications. 4
- Do not use adult cough management approaches in pediatric patients, as etiologies and treatments differ significantly. 3, 1
- Do not empirically treat for asthma, GERD, or upper airway cough syndrome without specific clinical features supporting these diagnoses. 1
- Most acute coughs in children are self-limiting viral infections requiring only supportive care (honey) and watchful waiting. 1