Cough

COUGH

Diagnostic Findings

•	The cough reflex expels air from the lungs with sudden explosive noise.
•	A cough can be dry and hacking or wet and productive.
•	A coughing spasm is more than 5 minutes of continuous coughing.

Cause

Most coughs are due to a viral infection of the trachea (windpipe) and bronchi (larger air passages). These infections are called tracheitis and bronchitis, respectively. Most children get this infection a couple of times every year as part of a cold. Keep in mind that coughing clears the lungs and protects them from pneumonia. Bronchitis isn't serious. The role of milk in thickening secretions is doubtful, therefore you don't routinely have to take your child off milk products.

Expected Course

Usually bronchitis gives a dry tickly cough that lasts for two to three weeks. Sometimes it becomes loose (wet) for a few days and your child coughs up a lot of phlegm (mucus). This is usually a sign that the end of the illness is near. Your child may occasionally vomit after a coughing spasm and that is all right if he is improved afterward.

HOME CARE

Medicines to Loosen the Cough and Thin the Secretions
•	Cough drops: Most coughs in children over 4 years of age can be controlled by sucking
	on cough drops.. Any brand will do.
•	Homemade cough syrup: For children under age 4 years, use 1 teaspoon of honey or corn
	syrup instead. (Don't use honey for babies under 1 year of age.)
•	Warm liquids for coughing spasms: Warm liquids usually relax the airway and loosen the
	mucus. Start with warm lemonade, warm apple juice, or warm tea. Add some honey
	(corn syrup for babies under 1 year of age). Avoid adding any alcohol because inhaling the
	alcohol fumes stimulates additional coughing and also because there is a risk of intoxication from unintentional overdose.

Humidifiers in the Treatment of Cough.

Dry air tends to make coughs worse. Dry coughs can be loosened by encouraging a good fluid intake and using a humidifier in your child's bedroom. The new ultrasonic humidifiers are very quiet and they kill molds and most bacteria found in the water. If possible use distilled water instead of tap water in the humidifier. The Environmental Protection Agency reported in 1988 that tap water may contain harmful minerals (such as lead and asbestos). These minerals are present in the mist produced by ultrasonic humidifiers. Frequent inhaling of these particles may cause chronic lung problems. Don't add medication to the water in the humidifier because it irritates the cough in some children.

Cough Suppressants.

Cough suppressants reduce the cough reflex which protects the lungs. They are only indicated for dry coughs that interfere with sleep or work. It is best to let the child cough during the daytime if it is a wet cough. They also help children who have chest pain during coughing spasms. They should not be given to infants under 12 months of age or for wet coughs. A non prescription cough suppressant is dextromethorpham (DM). Ask your pharmacist for help in choosing a brand that contains DM without any other active ingredients. Dosage is 0.2 mg/lb every 4 to 6 hours as needed. It usually comes as a liquid in the strength of 15 mg/teaspoon. The following table shows the dosages that you can give a child according to weight or age.

Cough (continued)


WEIGHT OF CHILD	DOSAGE OF DM (MG)
20 lb 30 lb 4-6 yr 7-12 yr Adults	4 mg 6 mg 7.5 mg 15 mg 30 mg	Often any corn syrup or cough drops can be given during the day and DM given at bedtime and during the night. DM is also available as a cough lozenge and as a long acting (12 hour) liquid.

Exercise, Active and Passive Smoking.

Teenagers will find that physical education classes and exercise trigger coughing spasms when they have bronchitis. If so, physical activity should be avoided temporarily. Don't let anyone smoke around your coughing child. Remind the teenager who smokes that his cough may last weeks longer than it normally would without smoking.

Common Mistakes in Treating Cough.

Antihistamines, decongestants and antipyretics are found in many cough syrups. These ingredients are of unproved value, and the antihistamines carry the risk of sedation. Expectorants are of unproved value but harmless. Stay with the simple remedies mentioned above or use dextromethorphan(DM). Milk does not need to be eliminated from the diet since restricting it only improves the cough if your child is allergic to milk. Also, never stop breast feeding because of a cough.

CALL OUR OFFICE

Immediately if:

•	Breathing becomes difficult and is not better after you clear the nose.
•	Breathing becomes fast or labored (when your child is not coughing).
•	Your child passes out with coughing spasms.
•	The lips turn bluish with cough spasms.
•	Any blood tinged sputum is coughed up.
•	Your child starts acting very sick.

During Regular Hours if:

•	A fever (over 100°) F [37.8 °C) lasts more that 72 hours.
•	The cough lasts more than three weeks.
•	Coughing spasms cause exhaustion and lost sleep.
•	The coughing causes vomiting three or more times.
•	The coughing causes bad chest pains.
•	The cough causes your child to miss 3 or more days of school.
•	Your child develops sinus congestion or pain.
•	Your have other concerns or questions.