It is hard to listen to your child cough. Coughing can be uncomfortable. When it is strong, it may interfere with sleep — both your child’s and yours! A very strong cough sometimes makes a young child spit up or even throw up. Even after the other symptoms of a cold — such as congestion or fever — go away, a cough may continue for several weeks. What can a parent do to relieve their child’s cough?
While parents may have the best intentions in wanting to provide that relief, it is best to NOT reach for the cough or cold syrup. Over-the-counter cold/cough medicines have more risks than benefits for children. Research generally questions if these medicines are even effective as they do not shorten the duration of a cold or cough. Worse, some children have experienced concerning side effects and even overdoses. That is why the American Academy of Pediatrics recommends children avoid OTC cold medicines.
Further, the AAP and the Food and Drug Administration (FDA) caution parents and doctors about codeine or hydrocodone medicines for children. Codeine and its derivatives have been used in cough formulations for a long time. Codeine suppresses cough, which can give temporary relief, but also presents possible dangers. One such danger is caused by the suppression itself. Cough can help remove whatever causes the cough, including mucous and infectious particles. Without the strong cough to expel them from the body, those substances may cause more serious infection, including pneumonia.
As well, some children may ingest too much of the medicine — on their own or given to them — which can cause respiratory depression or even death. In other cases, the ingredients in these medicines, along with the other medicines kids are given when sick can lead to overdoses or “medication mix,” which should not happen.
Codeine is a member of the opioid family. The opioid addiction epidemic has led to even more concerns about these medications, which may be abused, misused or lead to overdose. Indeed, any exposure to opioids can result in future addiction. Given the high prevalence of opioid addiction, and the strong research evidence that the risks of cold medicines with codeine or hydrocodone significantly outweigh the benefits, the FDA has issued new safety labeling. Manufacturers of such medications must now provide a “black box warning” on their labels, to advise users of the clear danger.
It is worth mentioning that many coughs are accompanied by congestion and runny nose. Parents should know that for these symptoms as well, it is good to “let it all out.” Encourage children to blow their nose. A suction bulb may be necessary for younger children. There is no role for antihistamines with a cough or cold. They are not effective and only add to the possibility of side effects as antihistamines are meant for allergy treatment, not a cold.
So what can you do for a bad cough? Perhaps surprisingly, natural or home remedies seem to be best. One such natural and available product has been shown not only to work, but to be more effective than OTC cold medicines — a spoonful of honey! For children who have already had their first birthday, honey can be mixed with tea, or given straight to soothe the throat and reduce cough symptoms. Corn syrup is a reasonable alternative, too.
However, the youngest of babies must avoid honey. No one under a year should ever be given honey because of the possibility of infant botulism. Infants under a year may benefit from a very small amount of warm (not hot!) liquids.
In addition to honey for cough, children may benefit from a humidifier or a warm mist from the shower to loosen congestion, especially if a coughing spasm takes place. In addition, drinking more fluids, including soup, caffeine-free teas and water can help. Not all coughs need treatment. If your child seems happy and comfortable despite the cough, sometimes watching and waiting is best. Of course, all children with a cough or cold need some extra sleep, and lots of tender loving care (TLC)!
Dr. Judy Schaechter is the chair of the department of pediatrics at the University of Miami Health System. For more information, visit UHealth.com/patients/pediatrics.