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THE MEDICINE THAT ISN'T

“Can you please phone something for her cough, doctor? It’s keeping her and us up all night.” This is one of the most frequent request pediatricians get by phone, at office visits, or—we can now add—during telemedicine sessions.  Cough is certainly among the top five symptoms children get, and list of its etiology (causes) could, as medical instructors say, “fill a wall.”


So what about medications that control cough, and what are some good ones?  Well, to start, cough can be most effectively controlled when a specific illness or condition can be identified and treated.  Examples of this would be asthma, bacterial pneumonia, and ear and sinus infections, though even then control is not established until medication achieves enough improvement.  But the most common cause of coughs in most otherwise well (and not too-allergic) children is viral infection.  Colds, influenza, RSV, and a variety of other common conditions plague children year-round, and the coughs that accompany them can cause coughs of varying character and severity for weeks.


What, then, is available for plain symptomatic improvement?  You know, something that really knocks out that cough?  Well,there is something that we used years ago that worked pretty well, and that was codeine, formulated in various combination medications.  However, over the past 20 years, various concerns about codeine and hydrocodone gradually chipped away at its use in children, and FDA and AAP issued enough warnings about it that it just isn’t used for pediatric cough anymore. 


Then there is benzonatate, better known by one brand name, “Tessalon Perles.”  Although its label give approval for ten years and up, there have been cases of serious events of toxicity including fatalities.  These child-appealing, liquid filled round capsules are intended to swallow whole, and when they are bitten or chewed, the rapid release of the liquid content can be quite dangerous.  This agent has not found its way into safe pediatric use.


We do have dextromethorphan, the “DM” that is found in Robitussin DM and a variety of other OTC cold/cough/allergy products.  We do use it, but it is just not usually particularly effective, and there is some  element of safety and abuse concern with it.  But, it’s there and mostly non-prescription, and can be tried with appropriate medication safety precaution in ages four and up.  Then there are a few other things that can be tried.  For nearly 15 years now we have been suggesting the use of honey (some say buckwheat or dark honey is best), and this may work as well as anything else we use—with the important well-known advice not to use it under 12 months of age.  And for the last few years we have also been suggesting a trial of Vicks or other menthol rubs after one controlled  study found benefit, and it can be used from a young age.


So that’s the short answer to, “can you call out something that really works.”  Not really but try these.