Coughing is a common symptom and can be caused by various factors such as allergies, colds, flu, irritants in the air, asthma, acid reflux, and more. Coughing is often the body's natural reflex to clear the airways of irritants and secretions.
Use these links to jump to the section you want to read:
- Home Care Tips
- Over the counter cough medicines
- Signs of Trouble Breathing
- What's normal for mucus and phlegm
- Causes of Cough
- Related Conditions
- Prevention
- Prescription Medications
- Upper respiratory tract infection tips (separate page)
- Asthma tips (separate page)
- Influenza and flu like illness (separate page)
Home Care Tips:
- Encourage Hydration: Plenty of fluids like water, herbal teas, or clear broths to help thin mucus and soothe the throat. (Infants under 6 months should drink their typical breastmilk or formula primarily and never offer water or other drinks under 4 months of age.)
- Use Humidifiers: Running a cool mist humidifier during cold/dry months can help keep the air moist, which may ease coughing. Once the air is warm enough to run the air conditioner, do not use a humidifier. Warm air holds more water and can lead to mold growth if the humidity gets too high.
- Elevate the Head: Extra pillows while sleeping can be used for those old enough to stay propped up. Infants should only sleep on a flat surface.
- Honey: For children older than one year, honey can be a natural cough suppressant. It can be given on a spoon, on toast, or mixed with warm water or herbal tea.
- Warm Baths: A warm bath before bedtime can help relax muscles and soothe the cough.
- Avoid Irritants: Avoid smoke, vapors, strong odors, and other environmental irritants that can worsen cough.
- Rest: Ensure plenty of rest to help the body recover from illness and reduce coughing episodes.
- Cough Drops: The menthol in cough drops may help calm the trigger in the throat that causes cough. These should only be used in those mature enough to not choke on them.
- Saline: Saline sprays and rinses can help thin and remove mucus from the nose so it doesn't drip into the throat and trigger a cough. Learn how to use nasal rinses in Nasopure's Library. This and other brands are available over the counter.
Over the counter cough medicines
Despite their popularity, a growing body of evidence suggests that cough suppressants aren't particularly effective, especially in children's medications.
Dextromethorphan
Dextromethorphan is the suppressant used in OTC remedies that acts on the brain to suppress the cough reflex. Unfortunately, newer evidence does not support its use - it is not very effective. It is sold in many over the counter brands for people over 6 years of age, but we do not recommend use.
Dextromethorphan can cause significant and sometimes intolerable side effects, including:
- Drowsiness or dizziness
- Blurred vision
- Shakiness
- Restlessness and irritability
- Nausea and vomiting
- Confusion
- Slowed breathing
- Difficulty urinating
Expectorants
An expectorant is a type of drug that may break up and thin respiratory mucus so that it is easier to cough up. Guaifenesin is the only expectorant approved for use in the United States. It can be used in addition to adding humidity to the air to thin mucus.
Side effects are relatively mild and may include:
- Dizziness
- Headache
- Nausea
- Vomiting
- Rash
Multi-symptom medications
Many cough and cold medications include multiple ingredients. We recommend single-ingredient formulations if you use these at all. Find the ingredient that treats the symptoms - and the only ingredient we recommend is guaifenesin to thin mucus.
Taking unnecessary drugs in medications with multiple ingredients increases the risk of side effects.
For more on cough medicines
Related conditions:
CAUSES OF COUGH
- Common Cold. Most coughs are part of a cold that includes the lower airway. The medical name is viral bronchitis. The bronchi are the lower part of the airway that go to the lungs. Bronchitis in children is always caused by a virus. This includes cold viruses, influenza and croup. Bacteria do not cause bronchitis in healthy children.
- Sinus Infection. The exact mechanism of the cough is unknown. It may be that post-nasal drip irritates the lower throat. Or pressure within the sinus may trigger the cough reflex.
- Allergic Cough. Some children get a cough from breathing in an allergic substance. Examples are pollens or cats. Allergic coughs can be controlled with allergy medicines, such as Benadryl.
- Asthma. Asthma with wheezing is the most common cause of chronic coughs in children. In adults, it's smoking.
- Cough Variant Asthma. 25% of children with asthma only cough and never wheeze. The coughing spells have the same triggers as asthma attacks.
- Air Pollution Cough. Fumes of any kind can irritate the airway and cause a cough. Tobacco smoke is the most common example. Others are auto exhaust, smog and paint fumes.
- Exercise Induced Cough. Running will make most coughs worse. If the air is cold or polluted, coughing is even more likely.
- Serious Causes. Pneumonia, bronchiolitis, whooping cough and airway foreign object
Signs of trouble breathing
Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:
- Struggling for each breath or shortness of breath
- Tight breathing so that your child can barely speak or cry
- Ribs are pulling in with each breath (called retractions)
- Breathing has become noisy (such as wheezes)
- Breathing is much faster than normal
- Lips or face turn a blue color
What is normal for mucus?
- 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.
When to Seek Medical Attention:
- Any difficulty breathing, wheezing, or signs of dehydration - please seek medical attention.
Prevention:
- Teach your child proper hand hygiene to prevent the spread of infections.
- Stay up to date with vaccines against preventable illnesses like COVID, flu and pertussis (whooping cough).
- Mask when others around you are sick.
- Stay home when you're sick or wear a mask around others.
Prescription Cough Medications
We get requests for prescription cough medications frequently, but evidence shows honey to be superior, so that is our usual recommendation. If you have cough medications in the home, keep them stored where children do not have access to them.
Tessalon Perles
- Benzonatate (tessalon perles) may be attractive to children because of the drug's appearance (it is a round-shaped liquid-filled gelatin capsule).
- Overdose with benzonatate in children less than 2 years of age has been reported following accidental ingestion of as few as 1 or 2 capsules. Overdose of benzonatate has been reported in adults and adolescents.
- Individuals who experience overdose of benzonatate may exhibit restlessness, tremors, convulsions, coma, and cardiac arrest.
- Signs and symptoms of overdose can occur rapidly after ingestion (within 15-20 minutes). Deaths in children have been reported within hours of the accidental ingestion.
- Benzonatate capsules are to be swallowed whole and are not to be broken, chewed, dissolved, or crushed. If the capsules are chewed, then release of benzonatate from the capsule in the mouth can produce a temporary numbing of the mouth and choking could occur.
- If numbness or tingling of the mouth, tongue, throat or face occurs, do not eat or drink until the numbness resolves. If the symptoms worsen or persist, seek medical attention.
- If you miss a dose of benzonatate, skip that dose and take the next dose at the next scheduled time.
- Do not take more than 200 mg of benzonatate at one time.
Hydrocodone
- Hydrocodone is a semi-synthetic opioid, which acts as an analgesic (pain reliever) and as an antitussive (cough suppressant).
- ​Hydrocodone can also produce feelings of euphoria, and is an extremely popular drug of abuse.
- Hydrocodone is an addictive drug that can lead to serious illness, injury, or death if not used properly. Overdose can result in respiratory depression and cardiac arrest. Normal use may impair motor skills or judgment, making it unsafe to operate machinery, drive, or engage in other potentially hazardous activities while taking the drug.
- If you have any opioid in your home for pain or cough, it needs to be locked away from children and teens. Keep Narcan in the home in case of overdose and learn how to use it.
