Coping with Winter Coughs

   It’s that time of year again. In the middle of the night, your child can’t stop coughing. Is it just a cold or something worse? And considering the warnings from the American Academy of Pediatrics (AAP) and the Food and Drug Administration (FDA) about the overdosing and ineffectiveness of over-the-counter cough and cold medications for young children and babies, what’s a weary parent to do?

First, remember that, according to Dr. Daniel Rauch, MD, FAAP, director of the pediatric hospitalist program at New York University School of Medicine, “You want them to cough. You want them to clear out the mucus. You don’t want to suppress it at all.”

Then, you should try to determine what type of cough your child has. “If it’s a bad cold, they have to get through it,” says Dr. Rauch.

Parents should be concerned if the cough lasts longer than a week, disrupts the child’s sleep, and leads to vomiting up phlegm. While a dry, hacking cough can signal an upper respiratory infection like the cold or flu, it can also be bronchiolitis, an infection that causes inflammation of the smallest airways in the lungs and makes breathing difficult. If the child is asthmatic, frequent coughing ­— whether it’s dry or wet — can be a reaction to an asthma trigger such as cigarette smoke, dust mites or other irritants. “If the cough is lingering, the asthma problem is not being treated,” says Dr. Rauch. “What you want to do is treat their asthma by discussing the best options with your pediatrician.”

It’s also possible that the illness is viral. “There are certain viral illnesses that damage the lungs, and it takes a long time to get over them,” he explains. One of these is the under-diagnosed pertussis, also known as whooping cough. Rapid coughing fits followed by a “whooping” sound upon the next breath can indicate whooping cough, especially if the symptoms are similar to a cold but worse, particularly at night. Dr. Rauch recommends that kids get vaccinated (part of the routine schedule of vaccinations).

An infection of the upper airway can also be croup, which leads to a swelling beneath the vocal chords, causing a “barking” cough or a high pitched sound when inhaling. Croup is treatable with antibiotics.

Medications

What can you do to make your child feel better in the interim? Of the AAP and FDA findings, Dr. Rauch explains that it’s not the pseudoephedrine itself, found in many over-the-counter cold medicines, that is harmful. It’s the fact that it’s easy to overdose on the substance and others if medicines are combined (for example, taking one medication for fever, and another that contains the same ingredient for cough/stuffy nose). Besides, over-the-counter cough and cold medicine is not approved for children under age 2 and was found to be ineffective in children under 6.

As an alternative, Dr. Rauch suggests that decongestants like Benadryl, under the guidance of your doctor, can help. “When you decongest, you get rid of the nasal drip, which is the cause of the cough,” he explains.