Scott Webb (Host): All of us parents know that children cough, sometimes a lot and knowing how to help our kiddos, which over-the-counter medications are best, and when it's time to see the doctor, are just a few of the questions that my guest today, Board Certified Pediatrician, Dr. Shivani Parikshak, is going to answer. 

This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, it's so nice to have you here today. I have a couple of kids and they always had coughs and we're going to talk about that today. We're going to talk about those coughs in our kids and medications and have you answer a whole bunch of questions for us today. So let's just start there. What are the most common causes of coughs in children?

Shivani Parikshak, MD: I would say the most common infectious cause of coughs is viruses. So as I'm sure you're aware of the flu, influenza has been pretty terrible this year. So usually about this time of the year, we should be seeing less of the flu. But that's not really the case this year. And then other viruses such as RSV and COVID-19 are also very common viruses that can cause children to cough and have cold symptoms.

And, you know, there are many, many other viruses that can cause cough and cold symptoms in children. So there's rhinovirus, adenovirus, human metapneumovirus, but they're not really, I would say discussed often or well known because they're not commonly tested for in the clinic setting, urgent care or even in the emergency room.

But you know for coughs, there's many other causes. There's, you know, other illnesses such as chronic illnesses such as asthma or allergies that also contribute to children coughing.

Host: Yeah, as you say, it could be asthma, allergies, cold flu, RSV, all the, you know, the greatest hits, if you will. So when should we consider giving our children cough medications?

Shivani Parikshak, MD: So, you know, if the cough isn't bothering the child, they likely don't need any medication or anything really. Most children with a cough or cold symptoms, they can be happy and playful and sleeping well. So I only really recommend treating symptoms if your child's uncomfortable. So they're having trouble sleeping. The cough is, you know, really bothering them and keeping them awake at nighttime. Those are the times that you want to do something about that cough.

Host: Yeah. And I want to ask you about over-the-counter, OTC cough medications. I, I'm sure a lot of parents went through what I did, which is you're trying to follow the instructions and they have age restrictions for children and then what, when they cross over to being an adult. But when your child is basically the size of an adult, at a certain age you have some questions about what to do.

So what are the age restrictions and how mindful do we need to be of them?

Shivani Parikshak, MD: Over-the-counter cough and cold medicine. So OTC for over-the-counter not really recommend for babies and young children under the age of four. So over the age of six, cough medicines are more safe to use. So it's important to follow the instructions on the package, on the bottle about the right amount of medication to give.

And also make sure when you're done giving the medication, you're storing it properly so the child isn't like, oh, this tastes great. Let me have some more. Um, because that's when it kind of gets a little dangerous. And then I would say the age is like four to six. It's kind of a gray area. There's Children's Mucinex and Children's Delsym, and you know, looking at those labels.

 It says these are for ages four and up, but then if you look at Children's Delsym for nighttime, you know, that's actually for six and up just because it has some of those sedating effects in it as well. So, between the ages of four and six, I would do recommend kind of discussing with your child's pediatrician because it may do more harm than good, when giving those medications.

Host: Yeah, you mentioned harm there and that obviously we don't want to, you know, make things worse for our children, of course. What are some of the potential side effects of cough medications?

Shivani Parikshak, MD: So side effects kind of vary. So some of them are very similar to like any medication we take over-the-counter and things such as stomach discomfort, so nausea, vomiting, diarrhea, and then other things like headache, dizziness, and drowsiness. So, the side effects I really worry about are those that can happen if taking too much of a medication at once or taking it more often than advised.

So this includes things like the child's breathing may slow down, their heart may beat faster. Things like psychosis or hallucinations and seizures as well. And in severe cases such as an accidental overdose, in case where the child is taking a lot, lot more than they should be, this can even result in coma and death.

I have not seen that, but I have seen, in my residency, in my training, a child having hallucinations due to taking too much cough medication.

Host: Sure. Yeah. As you say, we need to be the ones in charge and storing those, and even though sometimes they taste good, we don't want to overdo it with our kids. And I, guess it makes me wonder, we're talking about OTCs, but are there any natural or home remedies that we can try?

Shivani Parikshak, MD: Yeah, of course. So that's usually what I suggest first line for any like cough and cold symptom. So, you know, if your child has like a stuffy or like even a runny nose, that mucus that's running down the throat, that's probably what's causing some of the coughing. So, I always recommend using like a saline nasal spray.

If the child is able to blow their nose, that can also help. I usually send my patients home with nasal saline. We have some in the office to provide, if they're presenting with cough and cold symptoms and if available at home, like a cold mist vaporizer can also help with kind of making that mucus keep moving and getting rid of that.

Other good things that I recommend for the kids over the age of one is honey. So you know, a teaspoon or two of honey can kind of help coat the throat and soothe it a little bit. But just a reminder, it's only for ages one and up because it can cause infant botulism in children under the age of one.

 And then for some older kiddos, you can use things like the Vicks Vapor Rub. So that can be applied on top of the chest or kind of in that throat area to kind of help reduce the cough so the kid can sleep better at nighttime and like all illnesses I do advise plenty of rest, fluids. If your child is coughing, their throat is likely irritated, so I really recommend pushing fluids instead of trying to get them to eat something.

I always like to tell parents like, you know, they'll eat when they're ready, but I want to have them drinking, you know, water, Gatorade, whatever's going to keep them hydrated.

Host: Yeah. Gatorade or Powerade was our go-to. Uh, it seemed to go down a little easier than water, you know, with kids.

Shivani Parikshak, MD: Yeah.

Host: You know. Yeah. And it has, it has some sugar in it and it tastes good, but it has a lot of good, quote unquote medicinal properties as well.

Shivani Parikshak, MD: Yeah. Of Course.

Host: So, just wondering, you know, when we're trying to figure out, like you said, you know, the threshold for you is sort of like, is the kid uncomfortable? Are they able to do things? Are they able to sleep? That kind of thing. But how do we know, or tell the difference between a harmless cough and one that, you know, requires medical attention?

Shivani Parikshak, MD: Sure. So you know, if your child is having difficulty breathing or swallowing or the cough's so severe where you know they're vomiting because of it, I would definitely let your pediatrician know. I'd also recommend, you know, calling the pediatrician if your child's symptoms last a long time. So, you know, that's lasting a couple weeks at this point, and it's just kind of there and it's not getting much better or they're getting better and now they're starting to get worse all of a sudden. That could be a sign that there's a secondary infection on top of whatever virus they already have. I do like to let my families know that coughs can linger for two to four weeks after an illness.

I expect it to get, you know, better with every day, but it can last several weeks and it can be quite bothersome. So that's important to keep in mind. And then if the kid has a fever, so a fever for a child 101 or higher could mean that there's more serious infection. And then of course for our younger infants under the age of, you know, a few months old, a fever with a cough and cold symptoms, they should be seen by their pediatrician as well.

And I know we discussed asthma a little bit earlier, kind of as one of the major causes of coughing in children. So you know, if your child has asthma, now they're coughing more. They're coughing more at nighttime especially, it could mean that the asthma is actually getting worse and it's not necessarily due to an illness.

So at that point, definitely reach out to your pediatrician because we might need to change up their asthma medication as well.

Host: For sure. Yeah. We talked earlier about the importance of reading labels and following the labels and all of that. What about if we only have adult cough medications at home, but we're dealing with children? Is there ever a circumstance where we could give them just, you know, a little bit of the adult medications? Or should, we really just avoid that?

Shivani Parikshak, MD: The difference kind of is between adult cough medicines and children cough medicines, the dosing's different. So the dosing for adult cough medicines isn't going to be the same as this dosing for children. So what I worry about is the child getting more medication than they need, and then having those side effects that we talked about earlier. That could be, you know, dangerous sometimes. And it's also to keep in mind like reading the labels. Because like things like NyQuil and things like that, there's lots of other medications mixed together. So this may include Tylenol, acetaminophen mixed in with the cough medicine. So making sure that we're reading labels, because if a child has a fever and we're giving them Tylenol and then adult cough medicine, they might be getting two doses of, you know, Tylenol in. And that's not appropriate either.

Host: Right. Yeah, many is the time, we have a 24-hour pharmacy that's fairly close to our house, and there were a few times where, you know, I had a sick kid and all we had was adult medication, so dad had to drive

to the 24-hour pharmacy. It happens, of course. Yeah, wondering if you could explain the difference between antitussives and expectorants.

You know, my head starts spinning when I go to the pharmacy and I just stand there in the aisle with all the cold and flu and all of that can. Maybe from an expert, can you explain the difference and when we should use one or the other?

Shivani Parikshak, MD: Yeah, of course. So an antitussive is a cough suppressant, so this means that it works on the central nervous system or you know, the brain, to basically help suppress the cough and it works on the part of the brain to kind of reduce coughing. And then on the other hand, the expectorant, works on the respiratory tract, so that helps to thin and kind of loosen up that mucus that's in the respiratory tract.

 And so that phlegm can be removed from the body a little bit easier. So it's kind of funny one's reducing the cough, one's kind of loosening the and thinning out that mucus so we can cough it up. So, in fact, most cough medicines, believe it or not, actually have both in them. So we want to get rid of that irritating cough or like that tendency to cough.

But we also want to make sure that we're able to get rid of the mucus that's causing us to keep being sick for several days. So they kind of work together hand in hand to reduce our coughing a little bit to where it's not like bothering us so much at home or school. But enough where we're able to kind of cough up that mucus because that's going to help us get better at the end of the day.

Host: Yeah, it does seem like they usually have both of those things, but, uh, good, good to have an expert kind of explain the differences. And, uh, let's just say, Doctor, go with medication and our child's cough persists. Is that when we know, okay, this isn't working. We've tried everything else, home remedies and otherwise, is that when it's time to see a provider?

Shivani Parikshak, MD: And like we talked about earlier, if it's lasting a long time, then yes, I would say call your pediatrician. But I also think, you know, when your kid is sick and they have a cough and cold, it's important to also be patient. So the first few days I like to tell parents are usually the worst. But then the cough and cold symptoms in children tend to get a a little bit better each day.

And you know, they can last for a couple weeks and sometimes up to four weeks in terms of that lingering cough. And I think it's also important to remind parents that, you know, children get sick and they can get as many as like six illnesses in a year, and for kids who attend daycare or go to school, that number might be even higher.

So lots of coughing, sneezing, blowing our nose. Lots of boogers and snot. And also keeping in mind that since coughs and colds are caused by viruses, prescription antibiotics usually do not help. I know I see a lot of parents coming in because they're like, okay, it's been going on for this long, what can I give them?

And I'm like, you're doing everything right. Like you're, you're giving them the over-the-counter cough medicine if it's appropriate. You're doing the nasal saline, you're doing the vaporizer. It's going to get better. You just kind of have to unfortunately hang in there a little bit. I know you're trying to do everything to make your child feel better, but I think it's always best for remind families not to treat your child's cough and cold symptoms with too much medication.

Host: Right. Yeah. I remember the days doctor when I would take my kids to the pediatrician when we were pretty sure they had strep throat, and you'd be sort of on the inside, you know, rooting for it because you knew you could get medication that could help them, because if it wasn't strep then, you know, you were left with just the OTC type stuff and trying to relieve some of their symptoms and make them more comfortable.

 So good stuff today. Great to speak with. You just want to finish up and find out, you know, are there any new developments or research in pediatric cough treatments that maybe are on the horizon and we should be aware of?

Shivani Parikshak, MD: There's always ongoing research for new asthma and allergy treatments and you know, those are things that we can kind of keep under control, so, definitely if your child's coughing a lot due to those symptoms and viruses can make asthma worse, viruses can make allergies worse.

 Making sure that we're managing their chronic illnesses like asthma and allergies, that's going to be our best bet in kind of keeping those viruses at bay and keeping those symptoms not as severe as they can be.

Host: Yeah, and we could probably do an entirely separate podcast on asthma and allergies. And maybe,

Shivani Parikshak, MD: That is

Host: Yeah, maybe we'll do that. But for today, thank you so much.

Shivani Parikshak, MD: Of course. Thank you.

Host: And learn more about caring for children at franciscanhealth.org. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.