Cough and cough syrups

My child has cough for last 7 days. I have finished the whole bottle of cough medicines but he is still coughing.

This is a common complained by parents.

Before I explain why cough medicine does not work, I think some knowledge about cough is essential.

Cough is our friend. It is due to a reflex action by which mucous from throat and chest is cleared away from wind pipe. The mucous is then directed towards the food pipe from where it goes to the stomach and then goes out via stool. If this reflex was not present then the mucous will go down to the wind pipe and cause chocking and pneumonia. So when a child is coughing we have to find out why the child is coughing and treat the underlying disease and not the cough.

1. The commonest cause of cough is common cold. The child will have mild fever, running nose, sneezing and coughing. Common cold is caused by rhinoviruses. There are many types of these viruses and therefore one keeps on getting colds and cough repeatedly. Common cold is not caused by cold drinks or by going out in cold weather. (Going out in cold weather may cause sneezing which will last for a very short time. This is due to cold wind damaging the nasal blood vessels, and is called vasomotor rhinitis). Common cold lasts for 10 days and therefore the child will keep on coughing and have running nose for almost 10 days. Children who are less than 5 years of age get about 7 to 8 such attacks in 1 year. So as soon as they recover from one attack they get another attack so it seems that they are coughing all the time. During these mild virus attacks they are well, playing normally, and has normal appetite. For common colds only symptomatic treatment is needed. Give your child plenty of fluids and use saline nasal drops to clear the nose. Antibiotic does not help in such cases.

2. Cough is also a symptom of influenza. The symptoms of influenza are same as common cold but child is more ill. May have high fever, severe body pain, headache, throat pain, loss of appetite .These are due to influenza viruses. In this case child should be seen by a doctor who may prescribe antiviral like tamiflu in severe cases and or antibiotic also because secondary bacterial infection is common in these cases. Influenza usually occurs in winter season. Flu vaccines are available. It should be given just before winter season.

3. Cough can also be due to allergy rhinitis which may be seasonal or throughout the year depending on what the child is allergy to.

4. If a child has dry hacking cough and this is accompanied by fever, chest pain and difficulty in breathing, the child may be suffering from pneumonia. In such a case she should be seen by a doctor as soon as possible. Older child can be treated with oral antibiotics but younger child may need hospital admission and intramuscular or intravenous antibiotics

5. Cough can be due to asthma which is very common nowadays. This is accompanied by wheezing but at times wheezing may not be obvious. This cough will only get better with asthma treatment.

6. If child has barking cough and also difficulty in breathing (stridor), it is due to swelling of voice box (larynx) and wind pipe (trachea). This occurs because of viral infection, but can also be due to allergy. In such cases you have to take the child to emergency room of a hospital where the doctor may give your child nebulizer and an injection of steroid or a course of oral steroids.

7. Sinusitis can also cause persistent cough. In this typically, child with common cold who should have got better, does not recover. Mucous in the nose gets more sticky, may have bad smell and greenish in color. He will get headaches and fever also. This is usually due to secondarily bacterial infection and your child will probably need a course of antibiotic.

8. Throat infections especially strep throat do not cause cough especially in initial stage. This usually occurs in children between 5 to 12 years of age. In these cases, typically child will have high fever, quite often with shivering. There will be severe throat pain. He will be unable to swallow anything. The glands at the angle of jaw will be enlarged and tender. When you ask your child to open the mouth, you will see the tonsils red and angry looking. There may be red spots at the roof of mouth also. These children need to be seen by a doctor who will prescribe antibiotic for 5 to 10 days depending on which antibiotic is prescribed.

9. There are other uncommon reasons for cough like whooping cough, foreign body in lung passages, tuberculosis, bronchiectasis, Cystic fibrosis etc.

So what is the role of cough medicines in cases of cough? Probably none. It should not be given to children less than 2 years of age, as it can cause irritability, drowsiness, and sometimes rapid heartbeat. A mild anti allergy medicine to make the child comfortable can be given if the cough is due to common cold or allergy rhinitis. If your child is a known case of asthma, then reliever medicine should be given as instructed by your doctor. In other cases, one should always consult a doctor before giving any medicine.

Home remedies like giving honey or soups for cough are as good or perhaps better than cough syrups.
Dr Raj Rani Mitra


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