It dawned on me this flu season that it was time I wrote a post on the commonest medication we all purchase over the pharmacist’s counter – cough syrups. I know most parents don’t take a child to see the paediatrician for a simple cold and they give the “usual” medications themselves. There are however a majority of people who go around saying that these medicines don’t work and worse that they “hold the cough”,’ “aggravate the cough” and do more harm than good.

I want to emphasise that cough syrups need not be taken every time and they need to be chosen carefully each time.

Coughing protects the air passages by clearing them of irritants and excessive or murky secretions produced within them. Many of us cough once or thrice a day to clear airways of irritants around us. In the presence of excessive irritation (as in an allergy or inflammation like asthma) or in the event of an infection, the cough starts to bother us. It will start to interfere with exercise or sleep, and cause distress, especially if accompanied by dizziness, breathlessness or chest pain.

Coughs are generally described as either dry or productive. Dry cough signifies irritation. If cough brings up a mixture of mucus, irritants, and other substances from the lungs (sputum or phlegm), it is called a productive cough.  In the case of an infection, the sputum brought up may be greenish, gray, or brown. In the case of an allergy or viral infection it may be clear or white. In the most serious conditions, the sputum may contain blood.

In the US the FDA has a ruling that these products are not be given to children under age four. This was done after extensive research established that fever medications by themselves reduce aches and pains and a cool mist vaporizer can help loosen congestion in simple colds. These drugs, if overdosed, are life threatening and can also be addictive in the hands of caregivers and adolescents. It is easy to accidentally give a child a dose that is too high; parents might use two different brands of medicine at the same time, not realizing they contain the same ingredients, or may incorrectly measure a dose if they get up in the middle of the night to soothe a child.

In India we are a little more lenient and many of us paediatricians prescribe cough syrup after age one. Personally I have given my daughter a cough syrup only once and not for more than two days in her two years. So what are the alternatives?

• Offer fluids: Water, juice and soup can help loosen congestion and if warm, have a soothing effect.
• Moisten nasal passages:I am generous with the use of my nebuliser. Run a cool-mist humidifier in your child’s room. Remember to change the water daily and follow the manufacturer’s cleaning instructions. Steam from a hot shower is also helpful. So please don’t restrict bathing when the child has a cold.
• Use a nasal suction bulb for a baby or young child to draw mucus out of the nose.
• Use saline nasal drops.Over-the-counter saline nasal drops — or saline spray, for an older child — can loosen thick nasal mucus and make it easier for your child to breathe. For babies or young children it may be required to follow up with a suction bulb.
• Soothe a sore throat:Gargling salt water or sucking on a piece of hard candy or a throat lozenge helps older kids. They are choking hazards, so keep them away from younger children.
• Encourage rest.Consider keeping your child home from child care, school and other activities. It is really important and often overlooked.

If compelled to use them (in older kids and  physician recommended conditions), it’s good to know about the different types of cough medication.

• Demulcents are cough syrups (or cough linctuses) that may suppress coughing by forming a protective layer over the throat (pharynx). These are useful in dry irritating cough. These are given to children. Honey, a popular home remedy is a demulcent.
• Cough suppressants suppress the body’s urge to cough. These are not suitable for children. These drugs make children drowsy and they might choke on the mucus and suffocate. This is because their reflexes and attention centres are still maturing. These drugs are given only to adults with chronic inflammatory (non infectious) conditions. So please do not be tempted to give a child some of the syrup that eases chronic cough for an older person.
• Mucolytics are cough medicines that reduce the tenaciousness of the phlegm (and ease congestion.
• Expectorants loosen mucus and enhance its clearing from respiratory tract (and actually help you cough it out)

Mucolytics and expectorants are the choice in moist cough. If you give only a demulcent then the child feels uncomfortable because the phlegm gets thicker. Also these medications may cause the child to vomit out sputum which actually helps him and should not be looked at as a problem.

Antihistamines are a part of many cold medications to reduce the nasal discharge. They have an added benefit in suppressing irritant cough. They may cause constipation as a side effect.  Make sure you plan the child’s diet accordingly. If there is an infection, the cough will not subside till the antibiotic starts to work and it will continue for a few days even after fever subsides.

Finally, I’d like to say that cough prescriptions should not exceed a dosage period of more than two weeks. If a cough does not subside by then we should look for chronic conditions in and outside the lungs.

Re-published with permission from the blog of ParentEdge, a bi-monthly parenting magazine that aims to expose parents to global trends in learning and partner with them in the intellectual enrichment of their children. This blog was written by Dr. Krishna Mahathi holds diplomas in Pediatrics and in the management of allergies and asthma.

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