Cough and Colds

What is coughing?  Coughing is a reflex mechanism in which the body self-protects its airway by

1. Clearing the airway from debris, so that air can travel to the lungs.  Without coughing to clear the airway, airflow to the lungs may be impeded.
2. Forcing expiration in the presence of airway obstruction.  For example, during an asthma exacerbation, coughing forces air through a narrowed airway, thereby helping with ventilation.

Remember, coughing is a protective mechanism.

What is a cold?  Colds are upper respiratory infections (URI’s).  They involve infections in the nasal passage, throat, sinuses, and sometimes the eyes.  They usually present with running nose and coughing.  Coughing from colds is mainly due to mucous dripping down from the nose, through the throat (“postnasal drip”), and down to the windpipe (trachea).  Because the mucous can cause debris buildup in the airway when it reaches the trachea, coughing occurs to clear the debris.  This “dripping” of mucous down from the nose to the trachea increases with gravity, and thus coughing to clear the airway worsens or is more frequent when lying down (e.g., lying down to sleep at night).

Colds (URI’s) do not involve the neck or lungs.  Lower respiratory infections (LRI’s) involve the airways of the neck and chest (e.g.,croup and bronchiolitis), as well as the lungs (e.g., pneumonia).

What causes a cold?  In most cases, colds are caused by viruses.  Therefore antibioitics are not usually needed.  Antibiotics are for the treatment of bacterial infections, not for viral infections.

May I use cold medications for my child?  Cough and cold formulas generally are not needed because colds are self-limiting.  Cough and cold formulas only treat symptoms and are for comfort use.  They do not combat against the viral infection or increase the resolution of the viral infection.  Again, antibiotics are not indicated because they are used to fight bacteria, not viruses.  Here are some common ingredients in cough and cold formulas, as well as their side effects (always look at the active ingredients in cough and cold formulas):

1. Antitussives (cough suppressants).  Antitussives are weak opioid derivatives which cause slight depression in breathing/respiratory drive in the brainstem, thus blunting the cough reflex.  Because of this blunting of the protective cough reflex, airflow to the lungs may sometimes be impeded, resulting in difficulty breathing.  Also, since antitussives are respiratory/breathing depressants, their very nature may cause slowing of breathing. The most commonly used over-the-counter cough suppressant is dextromethorphan.  Antitussives are not indicated for patients with the following:

1. Patients with lower respiratory infections (LRI’s)
2. Patients in respiratory/breathing distress (e.g., shortness of breath)
3. Asthmatics
4. Patients with neurological damage with an already decreased cough reflex
5. Patients with sleep apnea
6. Not highly recommended in children less than 4 years of age.  Cough suppressants may cause difficulty in breathing.  Also most children less than 2 years old may not be able to communicate that they can’t breathe well.

2. Decongestants.  This class of medication decreases nasal congestion, which helps relieve post-nasal dripping, and thus relieve post-nasal drip cough.  Oral pseudoephedrine and phenylephrine and nasal oxymetazoline are the more commonly used decongestants.  Decongestants are stimulants.  Decongestants may produce a rebound increase in nasal congestion when the effect wears off.  This is called rhinitis medica mentosa.  This increase in nasal congestion can lead to a vicious cycle of decongestant use, rebound increase in nasal congestion, more use of decongestants, more nasal congestion, etc.  The way to stop rhinitis medica mentosa is to stop the use of the decongestant, otherwise the patient will be at risk for developing a middle ear or sinus infection.  Sometimes, only a 3-day use of nasal spray decongestants or a 7-day use of oral decongestants may produce rhinitis medica mentosa.

3. Expectorants.  These are medications that help thin out mucous secretions to make it easier to cough up the mucous from the lower airways.  The most commonly used is called guaifenesin.  Because expectorants make mucous thinner, this may make postnasal drainage to drip more easily, thus making coughing more likely to occur for URI’s.  Therefore expectorants are not very good for URI’s.  However, it is good for LRI’s, because it makes coughing up, of thinner mucous from the lower airway, easier.

4. Antihistamines.  Antihistamines are commonly used in cold formulas.  Antihistamines are medications mainly used to treat allergies (e.g., hay fever), and therefore are controversial for the treatment of cold symptoms due to a viral infection.  First generation antihistamines have a drying effect (anticholinergic effect) which helps decrease mucous production.  Some studies show that using first generation antihistamines may also thicken middle ear fluid, thus increasing the risk of middle ear infections while having a cold.

Other side effects:  In general cough suppressants and antihistamines make people drowsy—decongestants make people more alert.

Be careful about advertisement for cough and cold formulas.  Remember, these advertisements are trying to convince you to buy their products and are not necessarily for the best interest of your child.  For example, does it make sense to have an expectorant and cough suppressant in the same formula?  The purpose of the expectorant is to make it easier to cough up phlegm, but then the cough suppressant blunts the coughing reflex.  So why suppress the cough when you want to make it easier to cough up the phlegm!?  Also, always read the label for the active ingredients.  You want to make sure you’re not giving the same medications in different formulas simultaneously, thus overdosing on some medications.

What can I do to help comfort my child?  Colds are self-limiting, meaning they resolve on their own within 7 to 10 days.  Here are some tips to comfort your child during the meantime:

• Using a cool mist humidifier/vaporizer may help relieve sore throat and nasal congestion.
• For infants, use some normal saline drops in the nostrils (1-2 drops per nostril) and then bulb suction to remove the mucous, if your child is uncomfortable from the nasal congestion.
• Elevating the head while lying down will help relieve gagging/choking on post-nasal drainage.
• Honey can be given to children over 15 months old (not under 15 months because of botulism risk) to help with coughing and sore throat.  Multiple studies have shown that honey can provide relief from coughing and sore throat.  Sometimes dissolving honey in cool water to make “honey juice” can facilitate intake by your child.
• Remember coughing is a protective mechanism.  On occasion, coughing can “overprotect” causing discomfort, vomiting, and difficulty sleeping.  If the above advice does not comfort your child, then try an over-the-counter cough and cold formula.  Remember, if you suspect a “chest cold” or chest wheezing or shortness of breath, do not use a formula with a cough suppressant in it, for this may cause your child to have/or worsen difficulty in breathing.

When should I bring my child to see the healthcare professional for a cough/cold:

1. If the cough or cold lasts more than 2 weeks.
2. If your child is less than 3 months old, even without fever.
3. If your child is between 3 months and 6 months old and has a fever greater than 102 F.
4. If your child is greater than 6 months old with a fever greater than 104 F.
5. If your child has a fever greater than 3 days.
6. If your child is sickly appearing (increasing lethargy, unable to drink fluids, increasing fussiness, etc.).
7. If there are any other symptoms, besides nasal congestion and coughing, which concern you (e.g. ear pain or ear tugging).
8. If you suspect your child has a “chest cold,” barky cough, chest wheezing, or shortness of breath, then have him/her examined by a healthcare professional.  If you notice that your child is struggling hard to breathe or is turning blue, then call 911. 

For children less then three months, be especially careful, because infants less than three months do not fully learn to breathe through their mouths.  If a young infant’s nose is clogged with mucous and is not suctioned, the baby can suffocate because he/she hasn’t learned to breathe through the mouth yet.

At any point, if your child cough or cold concerns you, then please have him/her examined by a healthcare professional.

1-2-3 Pediatrics
3925 75th Street, Suite 105; Aurora, IL 60504
(630) 978-7337