COUGH

Symptom Definition

  • A cough is the sound made when the cough reflex suddenly expels air and secretions from the lungs.
  • A coughing spasm is longer than 5 minutes of continuous coughing.

Causes

  • Most are part of a cold, a viral infection of the large airway (viral bronchitis).
  • Other common causes: croup, asthma, allergic cough.

See More Appropriate Topic (instead of this one) If

  • Barky cough and hoarseness, see CROUP.
  • Previous diagnosis of asthma, see ASTHMA ATTACK.
  • Wheezing but no previous diagnosis of asthma, see WHEEZING.

WHEN TO CALL YOUR DOCTOR FOR COUGH

Call 911 Now (your child may need an ambulance) If:

  • Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath).
  • Child has passed out with coughing spasms.
  • Lips are bluish when not coughing.

Call Your Doctor Now (night or day) If:

  • Your child looks or acts very sick.
  • Choked on a small object that could be caught in the throat.
  • Difficulty breathing (less than 1 year old) not relieved by cleaning the nose.
  • Difficulty breathing (older than 1 year ) present when not coughing.
  • Lips have turned bluish during coughing.
  • Birth to 12 weeks with fever above 100.4°F (38°C) rectally.
  • Fever above 104°F (40°C) at any age.
  • Severe chest pain, coughed up blood or wheezing.

Call Your Doctor Within 24 Hours (between 9am and 4pm) If:

  • You think your child needs to be seen.
  • Continuous (nonstop) coughing.
  • Age less than 1 month old with any cough.
  • Age 1 to 3 months with a cough for more than 3 days.
  • Earache or sinus pain/pressure is also present.
  • Fever present for more than 3 days.
  • Chest pain present even when not coughing.

Call Your Doctor During Weekday Office Hours If:

  • You have other questions or concerns.
  • Coughing has kept home from school for 3 or more days.
  • Symptoms of nasal allergy are also present.
  • Cough has been present for more than 3 weeks.

Parent Care at Home If:

  • Cough with no complications and you don't think your child needs to be seen.
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HOME CARE ADVICE FOR COUGH

  1. Cough Medicine for Mild Coughs:  Use corn syrup ½ to 1 teaspoon as needed as a homemade cough medicine.  It can thin the secretions and loosen the cough.  After age 4, use cough drops.
  2. Cough Suppressant for Severe Coughs:  For coughs that interfere with sleep, school or work, use dextromethorphan (DM) which is present in most cough syrups.  See dosage chart.  Do not use under 1 year old.
  3. Coughing Spasms:  For coughing spasms, give warm fluids (e.g. apple juice).  Expose to warm mist (e.g., foggy bathroom) (reason: both relax the airway and loosen up the phlegm).  (Avoid juice if less than 4 months old.)  Children older than 4 years can suck on hard candy or cough drops (reason: to coat the irritated throat).  Also, try not to talk or cough at these times.
  4. Vomiting:  For vomiting that occurs with hard coughing, reduce the amount given per feeding (e.g., in infants, give 2 oz. less formula) (reason: cough-induced vomiting is more common with a full stomach).
  5. Humidifier:  If the air is dry, use a humidifier (reason: dry air makes coughs worse).
  6. Fever Medicine:  For fever above 102°F (39°C), give acetaminophen (e.g. Tylenol) or ibuprofen.
  7. Avoid Tobacco Smoke:  Active or passive smoking makes coughs much worse.
  8. Contagiousness:  Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities.  For practical purposes, the spread of coughs and colds cannot be prevented.
  9. Expected Course:  Viral bronchitis causes a cough for 2 to 3 weeks. Sometimes the child coughs up lots of phlegm (mucus).  The mucus can normally be gray, yellow or green.  Antibiotics are not helpful.  Coughing up mucus is very important for protecting the lungs from pneumonia. We want to encourage a productive cough, not turn it off.
  10. Call Your Doctor If:
    • Difficulty breathing occurs.
    • Wheezing occurs.
    • Cough lasts for more than 3 weeks.
    • Your child becomes worse or develops any of the "Call Your Doctor" symptoms.
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Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Pediatric HouseCalls Online. Copyright © 2000-2004 Barton Schmitt, M.D. FAAP

Reviewed 8/2004

Revised 8/2002

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