COUGH:
(VIRAL BRONCHITIS)
DEFINITION:
The cough reflex expels air from the lungs with a sudden explosive noise. 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. Many parents worry that their child needs antibiotics because the parent has been to
their doctor and received them for “bronchitis”. The family is usually sharing a viral cough, and
it usually does not require antibiotics for children.
EXPECTED COURSE:
Usually a viral cough is a dry, tickly cough that lasts for 2 to 3 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.
HOME TREATMENT
Medicines to Loosen the Cough and Thin the Secretions:
• Nasal Saline: Many coughs are caused or worsened by post-nasal drip. Using a nasal
saline spray or saline rinses, especially before bedtime, may help coughing.
• Cough drops: Most coughs in children over 4 years of age can be controlled by sucking
on cough drops or hard candy. Any brand will do.
• Homemade cough syrup: For children under age 4 years, use ½ to 1 teaspoon of corn
syrup instead of cough drops. Corn syrup can thin the secretions and loosen the cough.
• Warm liquids for coughing spasms: Warm liquids usually relax the airway and loosen
the mucus. Start with warm lemonade, warm apple juice, or warm herbal tea if your child
is over 6 months old. Do not add any alcohol because inhaling the alcohol fumes
stimulates additional coughing and also because there is a risk of intoxication from
unintentional overdose.
Cough Suppressants:
1 of 2
Recent studies suggest that cough suppressants do little to help coughs, but they are usually
safe to try in children over the age of 6 years. The cough reflex does protect the lungs, so
suppressants are only indicated for dry coughs that interfere with sleep, school attendance, or
work. They also help children who have chest pain from coughing spasms. They should not be
given to children under 6 years of age or for wet coughs. A nonprescription cough suppressant
is dextromethorphan (DM). Ask your pharmacist for help in choosing a brand that contains DM
without any other active ingredients. Often 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 for
easy carrying and as a long-acting (12-hour) liquid.
Expectorants:
Expectorants have unproven use but may help to thin bronchial secretions and help with mucous
clearance. A nonprescription expectorant is guaifenisin (eg Mucinex).
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.
Don't add medication or methol to the water in the humidifier because it irritates the cough in some
children.
Active and Passive Smoking:
Don't let anyone smoke around your coughing child. Tobacco smoke is extremely irritating to the
lungs and will make coughs worse and last longer. 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 fever reducers are found in many cough syrups. These
ingredients are of unproven value, and the antihistamines carry the risk of sedation. Stay with the
simple remedies mentioned above or use dextromethorphan. 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:
•Your child starts acting very sick.
•Breathing becomes more labored and difficult and is not better after you clear the nose.
Take the shirt off to observe breathing while the child is at rest. Call if you observe the
following:
o Retractions (caving in above the collarbone, between the ribs or below the
ribcage).
o Grunting or flaring (widening) of the nostrils with each breath.
o Rapid breathing at rest: Count breaths taken in 60 seconds.
Call if your child’s breathing is:
Greater than 60 if <6 months
Greater than 50 if 6-12 months
Greater than 40 if 1-3 years
Greater than 30 if 3-5 years
Greater than 20 if >5 years
Call during regular hours if:
•A fever lasts more than 3 days.
•The cough lasts more than 3 weeks.
•You have other concerns or questions.
•The cough occurs in spasms followed by vomiting, fainting, or a sensation of “loss of breath.”
(Revised 1/09)
2 of 2