What is the symptomatic management of cough in Pediatrics (Peds)?

From the Guidelines

Symptomatic management of cough in pediatric patients should prioritize addressing the underlying cause while providing comfort, with a focus on using pediatric-specific cough management protocols or algorithms 1.

Key Considerations

• For children with chronic cough, a systematic approach should be taken to determine the cause of the cough, using a validated guideline and considering cough characteristics and clinical history 1.
• The management of chronic cough should be based on the etiology of the cough, and an empirical approach should not be used unless other features consistent with the suspected condition are present 1.
• For children with chronic cough, a chest radiograph and spirometry (pre- and post-β2 agonist) should be undertaken, and tests evaluating recent Bordetella pertussis infection should be considered when pertussis is clinically suspected 1.

Treatment Options

• For children with acute cough due to upper respiratory infections, supportive care is the mainstay of treatment, and honey may be effective for children over 1 year of age 1.
• For children with allergic cough, antihistamines like cetirizine may help, and humidified air and adequate hydration can soothe irritated airways 1.
• For children with somatic cough disorder, non-pharmacological trials of hypnosis or suggestion therapy or combinations of reassurance, counselling, or referral to a psychologist and/or psychiatrist may be suggested 1.

Important Safety Considerations

• Avoid codeine and other narcotic antitussives in children due to safety concerns, and over-the-counter combination cold medicines are not recommended for children under 6 years 1.
• Never give honey to infants under 12 months due to botulism risk, and use of cough algorithms or pathways can potentially lead to earlier diagnosis and reduce morbidity, unnecessary costs, and medication use associated with chronic cough 1.

From the FDA Drug Label

Helps loosen phlegm (mucus) and thin bronchial secretions to make coughs more productive. Purpose Cough suppressant For symptomatic management of cough in pediatrics, two options are available:

• Guaifenesin 2 can be used to make coughs more productive by loosening phlegm and thinning bronchial secretions.
• Dextromethorphan 3 can be used as a cough suppressant.

From the Research

Symptomatic Management of Cough in Pediatrics

• The management of cough in pediatric patients is a complex issue, with various studies highlighting the lack of clear guidelines and effective treatments 4, 5, 6, 7, 8.
• According to a study published in 2020, many remedies for cough are self-prescribed, reflecting strong demand, but significant evidence of their efficacy and safety is missing in pediatric populations 4.
• A review article published in 2011 presents a framework for approaching pediatric patients with chronic cough, highlighting the importance of a multidisciplinary team consisting of pulmonologists, gastroenterologists, allergists, immunologists, and otolaryngologists 5.
• Evidence-based guidelines for the diagnosis and treatment of acute cough in children recommend a "wait, watch, review" approach, with clinicians educating parents on expected illness duration and the risks of using over-the-counter medications 6.
• A systematic review and practical algorithm published in 2021 by the Italian Society of Pediatric Allergy and Immunology provides guidance on the management of acute cough in pediatric patients, including the use of non-sedative agents and natural compounds such as honey and glycerol 7.
• A study published in 2023 highlights the evidence gaps in the management of pediatric cough, particularly for acute pediatric cough, and notes the need for harmonization of pediatric cough management and the development of standard guidelines suitable for all regions and patient circumstances 8.

Treatment Options

• Various treatment options are available for pediatric cough, including:
  • H1 receptor antagonists
  • Mucolytics and expectorants
  • Drugs acting peripherally on the cough reflex
  • Drugs acting centrally on the cough reflex
  • Drugs acting both peripherally and centrally on the cough reflex
  • Other compounds, including menthol, glycerol, honey, and medical devices composed of complex natural substances 4.
• Non-sedative agents such as levodropropizine and natural compounds including honey, glycerol, and herb-derived components may be safely used to manage acute cough in pediatric patients 7.

Challenges and Unmet Needs

• There are significant challenges and unmet needs in the management of pediatric cough, including:
  • Lack of clear guidelines and effective treatments for acute pediatric cough
  • Limited evidence-based guidance for the management of acute cough
  • Need for harmonization of pediatric cough management and development of standard guidelines
  • Need for better understanding of the causes, phenotypes, and prevalence of pediatric cough
  • Concerns regarding safety and potential side effects of cough medications in pediatric patients 4, 5, 6, 7, 8.