What is the appropriate cough treatment for a healthy 10‑year‑old child with a simple cough?

Good Cough Medication for a 10-Year-Old

For a healthy 10-year-old with a simple cough, honey is the only recommended treatment with proven efficacy, while over-the-counter cough and cold medicines should be avoided as they provide no benefit and carry unnecessary risks. 1

First-Line Treatment

• Honey (for children over 1 year) is the single evidence-based treatment that provides superior cough relief compared to diphenhydramine, placebo, or no treatment. 1, 2
• Administer honey as needed for symptomatic relief; it has been shown to reduce nocturnal cough and improve sleep quality. 1
• Most acute coughs in children are self-limiting viral infections that resolve within 1-3 weeks with supportive care alone. 1, 3

Medications to Absolutely AVOID

• Over-the-counter cough and cold medicines should NOT be used—systematic reviews demonstrate they have little to no benefit in reducing cough severity or duration in children. 4, 1
• Dextromethorphan is no more effective than placebo for reducing nocturnal cough or sleep disturbance and should not be used. 1
• Antihistamines have minimal to no efficacy for cough relief and are associated with adverse events, including 69 reported fatalities in children under 6 years. 1, 2
• Codeine-containing medications are absolutely contraindicated due to risk of serious respiratory depression and death; the FDA has restricted prescription opioid cough medicines to adults ≥18 years only. 1, 2
• Decongestants caused 54 fatalities in children under 6 years and can cause tachyarrhythmias, insomnia, and hyperactivity, especially when combined with stimulant medications. 1

When to Re-Evaluate

• If the cough persists beyond 2-4 weeks, re-evaluate the child for emergence of specific etiological pointers such as wheezing, productive cough, or systemic symptoms. 4, 1
• For chronic cough (>4 weeks), obtain a chest radiograph and spirometry (age-appropriate for a 10-year-old) to look for specific cough pointers. 1, 3

Consider Asthma Only If Specific Features Present

• If risk factors for asthma are present (personal atopy, family history, nocturnal or exercise-induced cough, wheezing), consider a 2-4 week trial of low-dose inhaled corticosteroids (400 μg/day beclomethasone or budesonide equivalent). 4, 1
• Always re-evaluate after 2-4 weeks—if cough persists, stop the medication and do not increase the dose, as persistence indicates the cough should not be labeled as asthma. 4, 1
• Do NOT use empirical asthma treatment without clinical features consistent with asthma (recurrent wheeze, dyspnea, or documented airflow obstruction). 1, 3

Environmental Modifications

• Evaluate and eliminate tobacco smoke exposure and other environmental pollutants in all children with cough. 1, 2
• Address parental expectations through education about the natural course of viral illness and expected resolution timeframes. 1, 2

Common Pitfalls to Avoid

• Prescribing OTC medications due to parental pressure despite lack of efficacy—parents who receive education about the natural course of illness report similar satisfaction regardless of whether medication was prescribed. 1
• Using adult cough management approaches in pediatric patients—etiologic factors and therapeutic responses differ significantly between children and adults. 1, 3
• Empirical treatment for GERD without gastrointestinal symptoms (recurrent regurgitation, heartburn, epigastric pain)—acid suppressive therapy is not effective for isolated chronic cough. 4, 1
• Failure to re-evaluate children whose cough persists beyond expected timeframes or who fail to respond to treatment. 1, 3