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Cough - Allied Physicians Group - Pediatric Medicine
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    • A cough is the sound made when the cough reflex clears the lungs
    • A coughing fit or spell is over 5 minutes of nonstop coughing
    • Coughs can be dry (no mucus) or wet (with white, yellow or green mucus)


    • Most coughs are part of a cold. These symptoms are caused by a virus (called viral bronchitis).
    • Other common causes: croup, bronchiolitis, asthma, allergic cough, whooping cough.
    • Allergic cough. Some children get a cough from an inhaled substance they are allergic to. Examples are pollens or cats.

    Phlegm or Sputum

    • Yellow or green phlegm is a normal part of the healing of viral bronchitis.
    • This means the lining of the trachea (windpipe) was damaged by the virus. It’s part of the phlegm your child coughs up.
    • Bacteria do not cause bronchitis in healthy children. Antibiotics are not helpful for the yellow or green phlegm seen with colds.
    • The main treatment of a cough with phlegm is to drink lots of fluids. Also, if the air is dry, using a humidifier will help. Sipping warm clear fluids will also help coughing fits.

    Return to School

    • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities. For practical purposes, the spread of coughs and colds cannot be prevented.

    When to Call Us for Cough

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

    • Severe trouble breathing (struggling for each breath, can barely speak or cry)
    • Passed out or stopped breathing
    • Lips or face are bluish when not coughing
    • You think your child has a life-threatening emergency

    Call Us Now (night or day) If:

    • Your child looks or acts very sick
    • Choked on a small object that could be caught in the throat
    • Trouble breathing (Exception: present only when coughing)
    • Lips or face have turned bluish during coughing
    • Ribs are pulling in with each breath (called retractions)
    • Can’t take a deep breath because of chest pain
    • Harsh sound with breathing in (called stridor)
    • Wheezing (purring or whistling sound during breathing out)
    • Severe chest pain OR coughed up blood
    • Weak immune system. (Such as sickle cell disease, HIV, cancer, organ transplant, taking oral steroids)
    • Age under 12 weeks old with fever. (Caution: Do NOT give your baby any fever medicine before being seen.)
    • Fever over 104° F (40° C)
    • You think your child needs to be seen urgently
    • You think your child needs to be seen urgently

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

    • You think your child needs to be seen, but not urgently
    • Nonstop coughing spells
    • Age under 3 months old
    • Earache or sinus pain (not just congestion)
    • Fever lasts more than 3 days
    • Fever returns after gone for more than 24 hours
    • Chest pain even when not coughing

    Call Us During Weekday Office Hours If:

    • You have other questions or concerns
    • Coughing causes vomiting 3 or more times
    • Coughing has kept home from school for 3 or more days
    • Allergy symptoms (such as runny nose and itchy eyes) also present
    • Runny nose lasts more than 14 days
    • Cough lasts more than 3 weeks

    Parent Care at Home If:

    • Cough with no complications

    Care Advice for Cough

    What You Should Know:

    • Coughs are a normal part of a cold.
    • Coughing up mucus is very important. It helps protect the lungs from pneumonia.
    • A cough can be a good thing. We don’t want to fully turn off your child’s ability to cough.
    • Here is some care advice that should help.

    Homemade Cough Medicine:

    • Goal: Decrease the irritation or tickle in the throat that causes a dry cough.
    • AGE 3 months to 1 year: Give warm clear fluids to treat the cough. Examples are apple juice and lemonade. Amount: Use a dose of 1-3 teaspoons (5-15 ml). Give 4 times per day when coughing. Caution: Do not use honey until 1 year old.
    • AGE 1 year and older: Use HONEY ½ to 1 teaspoon (2-5 ml) as needed. It works as a homemade cough medicine. It can thin the secretions and loosen the cough. If you don’t have any honey, you can use corn syrup.
    • AGE 6 years and older: Use COUGH DROPS to coat the sore throat. If you don’t have any, you can use hard candy.

    Non-Prescription Cough Medicine:

    • Non-prescription cough medicines are not advised. Reason: No proven benefit for children and not approved under 4 years old. (FDA 2008.)
    • Honey has been shown to work better for coughs. (Caution: Do not use honey until 1 year old).
    • If age over 4 years old, you might decide to use a cough medicine. Choose one with dextromethorphan (DM). It’s present in most non-prescription cough syrups.
    • When to Use: Give only for severe coughs that interfere with sleep or school.
    • DM Dose: See Dose Table. Give every 6 to 8 hours as needed.

    Coughing Fits or Spells:

    • Breathe warm mist (such as with shower running in a closed bathroom).
    • Give warm clear fluids to drink. Examples are apple juice and lemonade. Don’t use before 3 months of age.
    • Amount. If 3 – 12 months of age, give 1 ounce (30 ml) each time. Limit to 4 times per day. If over 1 year of age, give as much as needed.
    • Reason: Both relax the airway and loosen up any phlegm.


    • For vomiting that occurs with hard coughing, give smaller amounts per feeding.
    • In infants, give 2 ounces (60 ml) less formula.
    • Reason: Vomiting from coughing is more common with a full stomach.


    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also will thin out the mucus discharge from the nose.
    • It also loosens up any phlegm in the lungs. Then it’s easier to cough up.


    • If the air in your home is dry, use a humidifier. Reason: Dry air makes coughs worse.


    • For fevers above 102° F (39° C), give acetaminophen (such as Tylenol) or ibuprofen. See Dose Table. Note: Lower fevers are important for fighting infections.
    • For ALL fevers: Keep your child well hydrated. Give lots of cold fluids.
    • For babies, dress lightly. Don’t wrap in too many blankets. Reason: Can make the fever higher.

    Avoid Tobacco Smoke:

    • Tobacco smoke makes coughs much worse.

    Return to School:

    • Your child can go back to school after the fever is gone.
    • Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of coughs and colds cannot be prevented.

    Extra Advice- Allergy Medicine for Allergic Cough:

    • Allergy medicine can bring an allergic cough under control within 1 hour. The same is true for nasal allergy symptoms.
    • Benadryl or Chlorpheniramine (CTM) products are very helpful. No prescription is needed.
    • Give every 6 to 8 hours until the cough is gone. See Dose Table.

    What to Expect:

    • 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.

    Call Your Doctor If:

    • Trouble breathing occurs
    • Wheezing occurs
    • Cough lasts more than 3 weeks
    • Your child becomes worse

    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.

    Author and Senior Reviewer: Barton D. Schmitt, M.D.
    Copyright 1994-2013 Barton D. Schmitt, M.D.

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