(Originally posted on Jan 31, 2021)
The short version of symptom management of 'irritant' coughs based on the recommendations by the Food and Drug Administration (FDA) expert panel meeting in 2017 (i) include:
1. Normal Saline
2. Increased humidification
3. Honey
Treatment of post-nasal drip (e.g. anti-histamines, physical manoeuvres)Vapour RubNasal suctioning and clearing.Now to put this into a real-life perspective. Last night my three-year-old, who was down with the influenza virus, started coughing at 1.00 am. It was one of those coughs that were wet, continuous, and I felt as though he would vomit due to the excess coughing. Struggling to wake myself up, the thought of vomit gave me the adrenaline that I needed to get this settled.
Fact is, the Food and Drug Administration FDA as well as the American Academy of Paediatrics, do not recommend the use of cough syrups in children under four years of age (ii). Young children do not respond well to over-the-counter (OTC) cough syrups with the risk of side effects being more significant than the benefits. Most doctors would typically prescribe an anti-histamine to help decrease the mucus production in young children.
When I started practising medicine more than ten years ago, the recommendation was, no cough syrups under the age of 6 years. Evidence-based research found no benefit under the age of 5 years (iii, iv). As a doctor, in practice, I still use the age of six-years as the cut off as well as my impression of the clinical situation to decide when to start OTC cough medication. Cough being a natural reflex occurs to help clear the airway to encourage regular breathing.
During the night when lying asleep, excess mucus secretions begin to block the airways and can cause an 'uncontrollable' cough. This is what happened to my son last night. So in practice, this is what I did, and thankfully it worked. One hour of my sleep was lost, but that also included time to fall back asleep. From a mom's perspective, I'd call it a good night with a sick child!
The short version of symptom management of 'irritant' coughs based on the recommendations by the Food and Drug Administration (FDA) expert panel meeting in 2017 (i) include:
Normal Saline
Increased humidification
Honey
Treatment of post-nasal drip (eg anti-histamines, physical manoeuvres)
Vapour Rub
Nasal suctioning and clearing.
Now to put this into a real life perspective. Last night my 3 year old who was down with the influenza virus started coughing at 1.00am. It was one of those coughs that were wet, continuous and I felt as though he would vomit due to the excess coughing. Struggling to wake myself up, the thought of vomit gave me the adrenaline that I needed to get this settled.
Fact is, the Food and Drug Administration FDA as well as the American Academy of Paediatrics, do not recommend the use of cough syrups in children under 4 years of age.(ii) Young children do not respond well to over-the-counter (OTC) cough syrups with the risk of side effects being greater than the benefits. Most doctors would normally prescribe an anti-histamine to help decrease the mucus production in young children. When I started practicing medicine more than 10 years ago, the recommendation was, no cough syrups under the age of 6 years. Evidence based research actually found no benefit under the age of 5 years.(iii, iv) As a doctor, in practice I still use the age of 6 as the cut off as well as my impression of the clinical situation to decide when to start OTC cough medication.
Cough being a natural reflex, occurs to help clear the airway to encourage regular breathing. During the night when lying asleep, excess mucus secretions begin to block the airways and can cause an 'uncontrollable' cough. This is what happened to my son last night. So in practice this is what I did and thankfully it worked. One hour of my sleep was lost but that also included time to fall back asleep. From a mom's perspective I'd call it a good night with a sick child!
Even though the cough still occurred, taking the below steps before bedtime is still highly recommended:
Encouraging lots of fluids during the day - this helps the situation on the whole.
Giving a drowsy anti-histamine before bedtime (as prescribed by a doctor). A humidifier would be my normal routine with my viral fighting child, but my humidifier was broken and my son refused the vapour rub so, it was off to bed. After 1 am, as the cough started and seemed to have the potential to disturb the rest of our night, I decided to make my own humidifier.
Humidification was created in the bathroom: I set the shower on hot water and let it flow freely. I picked up my son and held him on my chest and shoulder to sleep while I stood outside the shower with the bathroom door closed. As the mirror started to fog, the warm humidified air was being inhaled. After about 7 mins I started to hear his nose become runny again and breathing somewhat clearer. I then switched the shower off but stayed with him in the bathroom for a further 2-3 mins.
We went back to bed. I explained to him I was going to help his cough settle. I asked him to blow his nose. I then applied vapour rub on his neck, chest, back and on the soles of his feet and put socks on for him.
To help with the drainage of mucus from the back of his throat, I held him in what I call an upward cradle position, with his head against my chest and my arms supporting his back while I sat on his bed holding him. Usually I hold my kids in this position for around 20 mins until their airway has cleared and they have fallen into a deep sleep. Last night however, my son wanted to go back on his pillow sooner.
Which lead me to my last step: I placed a cushion under his regular pillow to create a safe 45 degree angle for him to sleep. This means he was propped and supported to encourage the drainage in the back of throat so it wouldn't pool to cause coughing. With thanks to God, it all worked and both him and I had a restful night sleep for the remainder of the night.
A teaspoon of honey would have been my next step if the above failed. Had I predicted a cough that night, I would have given him some honey prior to bedtime. (Note honey is not recommended for kids under 1 year old.)
For kids under 2 years of age, using normal saline and use of a suction can help clear their nostrils, which subsequently may alleviate a cough.
All mom's know about the struggles of being up with our sick kids and the need to function normally the next day. We need to support each other and I hope this article helps you through your next rough night. If you have anything to add please share!
Please note for some of these tips, discretion is needed for kids less than 2 years of age. Feel free to message if you have any concerns.
You have my support. Keep pressing on.
References:
(iv) Bronstein AC, Spyker DA, Cantilena LR Jr, Green JL, Rumack BH, Giffin SL. 2009 annual report of the American Association of Poison Control Centers' National Poison Data System (NPDS): 27th annual report. Clin Toxicol (Phila). 2010;48(10):979–1178
Editing Credit: Saira Bedar
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