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* A cough is the sound made when the cough reflex suddenly forces air and secretions from the lungs.

* A coughing spasm is more than 5 minutes of continuous coughing


* Most acute coughs are part of a cold, a viral infection of the large airway (viral bronchitis).

* Other Common Causes: Croup, bronchiolitis, asthma, allergic cough, whooping cough.

Sputum or Phlegm:

* Yellow or green phlegm is a normal part of the healing process of viral bronchitis.

* This means the lining of the trachea was damaged by the viral infection and is being coughed up as new mucosa replaces it.

* Bacteria do not cause bronchitis in healthy children. Antibiotics are not indicated for the yellow or green phlegm seen with colds.

* The main treatment of a productive cough is to encourage it with good fluid intake, a humidifier (if the air is dry), and warm chicken broth or apple juice for coughing spasms (if child is older than 1 year).

Return to School: Your child can return to child 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.

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 or stopped breathing

* Lips are bluish when not coughing

Call Your Doctor Now (or in Alberta, Canada call 780-408-LINK)) If:

* Your child looks or acts very sick

* Choked on a small object that could be caught in the throat

* Difficulty breathing for child younger than 1 year and not relieved by cleaning the nose

* Difficulty breathing present when not coughing

* Lips have turned bluish during coughing

* Ribs are pulling in with each breath (retractions)

* Can’t take a deep breath because of chest pain

* Severe chest pain, coughed up blood, or wheezing

* Weak immune system (eg, sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids)

* Child is younger than 12 weeks with fever above 100.4°F (38.0°C) rectally (CAUTION: Do NOT give your baby any fever medicine before being seen)

* Fever above 104°F (40°C) and not improved 2 hours after fever medicine

Call Your Doctor Within 24 Hours (Between 9:00 am and 4:00 pm) If:

* You think your child needs to be seen

* Continuous (nonstop) coughing

* Child is younger than 3 months

* Earache or sinus pain (not just congestion) is also present

* Fever present for more than 3 days

* Fever returns after gone for longer than 24 hours

* Chest pain present even when not coughing

Call Your Doctor During Weekday Office Hours If:

* You have other questions or concerns

* Coughing has kept child home from school for 3 or more days

* Symptoms of nasal allergy are also present

* Cough has been present more than 3 weeks

Parent Care at Home If: Cough with no complications and you don’t think your child needs to be seen

Home Care Advice for Cough:

1. Reassurance:

* Coughs are a normal part of a cold

* Coughing up mucus is very important for protecting the lungs from pneumonia

* We want to encourage a productive cough, not turn it off

2. Homemade Cough Medicine:

• Goal: Reduce the irritation or tickle in the throat that triggers a dry cough

* Child Aged 3 Months to 1 Year: Give warm, clear fluids (eg, warm water, apple juice) to treat the cough. Amount: 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. Avoid honey until 1 year of age.

* Child Aged 1 Year and Older: Use HONEY, ½ to 1 teaspoon (2 to 5 mL), as needed as a homemade cough medicine. It can thin the secretions and loosen the cough. (If not available, you can use corn syrup)

* Child Aged 6 Years and Older: Use COUGH DROPS to coat the irritated throat. (If not available, you can use hard candy)

3. Nonprescription Cough Medicine (Dextromethorphan):

* Nonprescription cough medicines are NOT recommended (Reason: no proven benefit for children and not approved for children younger than 4 years) (Food and Drug Administration, 2008).

* Honey has been shown to work better for coughs

* If you decide to use cough medicine from your drugstore anyway, and your child is older than 4 years, choose one with dextro-methorphan (DM). It’s present in most nonprescription cough syrups.

* Indication: Give only for severe coughs that interfere with sleep, school, or work (every 8 hours)

4. Coughing Spasms:

* Expose to warm mist (eg, foggy bathroom)

* Give warm fluids to drink (eg, warm water, apple juice) if child is older than 3 months

* Amount: If child is 3 months to 1 year of age, give warm fluids in a dosage of 1 to 3 teaspoons (5 to 15 mL) 4 times per day when coughing. If child is older than 1 year, use unlimited amounts as needed.

* Reason: relax the airway and loosen up the phlegm

5. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (eg, in infants, give 2 oz less formula) (Reason: cough-induced vomiting is more common with a full stomach).

6. Fluids: Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out nasal secretions and loosen phlegm in the airway.

7. Humidifier: If the air is dry, use a humidifier (Reason: dry air makes coughs worse)

8. Fever Medicine: For fever above 102°F (39°C), give acetaminophen (eg, Tylenol) or ibuprofen (eg, Advil)

9. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse

10. Contagiousness: Your child can return to child 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.

11. Extra Advice: Antihistamines for Allergic Cough

* Antihistamines can bring an allergic cough and nasal allergy symptoms under control within 1 hour

* Benadryl is very effective and no prescription is needed

• They need to be given every 6 to 8 hours

12. Expected Course:

* Viral bronchitis causes a cough for 2 to 3 weeks

* Sometimes your child will cough up lots of phlegm (mucus). The mucus can normally be gray, yellow, or green.

* Antibiotics are not helpful

13. Call Your Doctor If:

* Difficulty breathing occurs

* Wheezing occurs

* Cough lasts more than 3 weeks

* Your child becomes worse

Based on recommendations/advice in “My Child is Sick; Expert Advice for Managing Common Illnesses and Injuries”, 14th Edition, by Barton D. Schmitt