Cough Care Guide

If you or your child are dealing with a cough, read on for a clinically-vetted cough care guide so you can ensure you start to feel better, faster.

It’s always important to remember that coughing is mostly to protect our airways or to clear out gunk (or both). Translation: coughing isn’t bad! If you can, fight the urge to suppress the cough with medicine.

There are a few things you can do to speed up the healing process and/or help your child find a bit of comfort while their body battles this virus.

In today’s email, we’ve got:

• Tips on decreasing mucus
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• Medication-free options
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• Medication options
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• When to call the doctor
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Getting rid of excess mucus

Oftentimes, coughing is caused by excess mucus shifting around. If you keep this in mind, the overarching theme to decrease coughing is simple: get rid of as much mucus as you can!

If you’re dealing with a runny nose:

• Decrease the amount of mucus dripping down your throat while you’re trying to sleep by clearing your nose well before bedtime. Help your child with this as well and if they haven't mastered nose-blowing yet, you can help them by suctioning their nose clear.
  
  
• Prop up the head of the bed to slow the drainage process. Use an extra pillow or elevate the head by placing a pillow underneath the mattress.
  
  
• For our babies under 1 year old, they need to remain flat on their backs for safe sleep purposes. If they're still coughing after clearing their nose, hold them upright to let them sleep for a while. Also for safety, you should stay awake while you hold them. Take turns with a partner if able and make sure you're getting plenty of rest when the baby is sleeping!
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If you’re dealing with a stuffy nose:

• For our older kids or adults, try a NeilMed Sinus Rinse or neti pot. Avoid using tap water; you can purchase sterile or distilled water, or you can boil your own! Boil water for 3-5 minutes, then let it cool before using.
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• Babies and kiddos under 6 years old will have more luck (and comfort) using saline drops or sprays to thin the mucus. Then suction with a bulb syringe or NoseFrida, or have them blow their nose well if they know how.
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• Ensure whoever is sick is increasing their fluid intake. The more fluids you drink, the thinner the mucus becomes and the easier it is to clear your nose.
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• Warm fluids loosen respiratory secretions and increase the flow of nasal mucus. Great options based on age:

         0-6 months: stick with breast milk and/or formula

         6-12 months: warm water is an extra option. If you’ve introduced juice already, warm apple juice is a great option (half juice, half water).

         12 months and beyond: warm tea or chicken soup can be added to the arsenal.
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• Try a cool-mist humidifier, which can also help loosen the mucus.
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• Sit in the bathroom while a hot shower runs or breathe in steam from a bowl of hot water. The steam may also loosen congestion (be careful to prevent burns from the hot steam).

Medication-Free Options

If you’ve got the mucus under control but you or your child is still coughing, there are a few other things you can try.

• For anyone over 1 year old, a spoonful of honey right before bedtime has been shown to be an excellent cough “medicine.” 
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• Apply a vapor rub to their chest or feet to reduce the severity of coughing. Avoid applying it directly under their nose - we don’t want them breathing it in so directly. For kids under 2 years old: must be a menthol-free vapor rub.
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• For anyone over 4 years old, a piece of hard candy has been shown to work just as well as a cough drop at reducing coughing. Either one is okay to try! Choking risk here so use your best judgement on the appropriate age.
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• For anyone over 6 years old (or whenever you think your child is capable), mix ¼ teaspoon of salt into 8 oz of warm water, gargle and spit. This may help with coughing and ease a sore throat, which is a common complaint after coughing so much.
  

Medication Options

If you've exhausted all other options and your kiddo is miserable, you may want to try some over-the-counter medicine. As with anything, if you’re unsure, discuss it with your doctor first.

• 0-3 months: Don’t give any medication until it is approved by your pediatrician.
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• 3-6 months: You may give acetaminophen (Tylenol) for discomfort or if a moderate fever develops (>100 ℉ underarm or >102 ℉ rectally).
  
  

• 6 months and older: You may give (or take) ibuprofen (Motrin) or acetaminophen (Tylenol) for discomfort or if a moderate fever develops (>100 ℉ underarm, >101 ℉ under the tongue, >102 ℉ rectally or in the ear).
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• Nasal decongestants can help both stuffy and runny noses which will in turn help with coughing, as we learned! They may be taken as pills by mouth or as a nasal spray. Some options are Pseudoephedrine (sudafed), Oxymetazoline nasal drops (afrin) or Phenylephrine nasal drops (Neo-Synephrine). These should not be given in our kiddos under 12 years old unless approved by their doctor first.
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• Cough and cold medicines, such as dextromethorphan (Robitussin DM), are technically okay to give to children over 6 years old, but they are not recommended. There are no well-controlled studies proving efficacy or safety. If you decide to give some, be sure to give an accurate dose and avoid mixing and matching a bunch of medications.
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• For adults, expectorants, such as guaifenesin (Mucinex), may help thin and loosen secretions.

When to call the doctor

• Since our 0-6 month age is more fragile than the rest, we want to have any cough investigated by the doctor. Give them a call within the next day or two to discuss.
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• Additionally with the 0-6 month group, call the doctor if your baby develops a fever (>99 ℉ underarm or >100.4 ℉ rectally)
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• 6 months and above should call the doctor if they develop a high fever (>102 ℉ underarm, >103 ℉ under the tongue, >104 ℉ rectally or in the ear)
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  For all age groups, call the doctor if you or child:
  
  
• Begin coughing up green, yellow or blood-tinged phlegm
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• Vomit with coughing more than 3 times
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• Are still coughing with no improvement after 2 weeks
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• Has asthma or another underlying lung condition

If you begin hearing a barking cough - the telltale sign of croup - this can be managed at home if your kiddo is tolerating it well (rare in adults but that applies to you as well). However, if you begin to hear tight, raspy breaths or excessive wheezing/whistling: give the doctor a call while you sit in a hot, steamy bathroom. Always skip the call and head to the ER if it feels more urgent.

I’ll list the main reasons to head to the ER below just so you’re aware. Don’t fret though! These symptoms are rare. Head to the ER if…

• You or your child is experiencing shortness of breath or difficulty breathing
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• You or your child is having difficulty swallowing
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• You or your child vomit blood
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Coughing is one of those symptoms that linger and test everyone’s sanity. Keep up with the fluids and remove mucus and you (or your kiddo!) will be feeling better in due time. Hang in there!