What to try for a cough

When you try to google cough remedies, chances are you’ll be inundated by all sorts of options. But how many of these are data-based? And safe? Here’s some info.

Make sure you check out my prior post, which goes through some of the common causes of cough in kids and red flags for when to call your pediatrician.

Setting expectations

As a parent, I totally understand how frustrating coughs are. They interfere with sleep (for both the kids and us) and they can cause a whole lot of discomfort. And I also fully appreciate your desire as a parent to help your child feel better as quickly as possible.

This is why I believe one of the most important things we can do as pediatricians is to make sure parents have the right expectations. Especially after a viral infection, sometimes a cough may linger for up to 10-14 days. Knowing what to expect can help you avoid the spiral/google search, and potentially avoid attempting non-evidence based or less safe home remedies.

But here are some evidence-based remedies

Honey

The Pediatrician Mom Tip: This tip is only for children over 12 months old

Believe it or not, we actually have good data to support the use of honey for cough. The studies aren’t huge or robust, but they have been replicated and consistently find that honey reduces cough frequency compared to either no treatment, a placebo, or other medications such as Benadryl (which we do not recommend; PMID: 25201759)

Worth noting, honey specifically reduces night-time cough and improves sleep (PMID: 18056559, 20618098, 22869830).

And when compared to cough suppressants like Dextromethorphan (PMID: 29633783), honey was found to be as effective, but without the side effects known to occur with those meds.

Why would it work?

Honey has known antibacterial, antiviral and anti-inflammatory properties, and the consistency may also be helpful to clear mucus. In general, if you’re doing this for longer than 3-5 days without any improvement, it may be worth checking in with your pediatrician.

How do you do it?

For kids under 1y: NO honey

For kids 1-2y: Use 0.5-1 teaspoon as needed. It can be given directly or thinned out with water. Can be done a few times per day.

For kids over 2y: 1-2 teaspoons as needed.

Other ways to use honey include:

• As part of a herbal tea (if you do this, make sure it is lukewarm and without caffeine)

• Mixed with turmeric: this is an old Ayurvedic remedy (I grew up getting a spoonful of honey mixed with half a teaspoon of powdered turmeric before bed when I was sick… and I still do it. It definitely helps. Some people also mix it with milk and make something called Haldi Doodth

• Mixed with pedialyte, lukewarm water, or lukewarm juice

The Pediatrician Mom Tip: If you’re doing it before bed, make sure you brush your child’s teeth.

Humidified air

In general, there is mixed data on whether humidified air is helpful, but this is a hard thing to study in a systematic way. Anecdotally, I think many find it soothing and so I’m personally a huge fan, especially as - if done properly - it can be a low-risk intervention. However….

• Steam inhalation over a bowl of steaming water

  • This is something I would avoid

  • We have research showing an increased risk of burns in the pediatric population using this method (PMID: 32943275).

• Steamy shower

  • Simply run a shower until bathroom mirrors are foggy then sit in bathroom for 10-15mins. If it helps, you can do this several times per day.

• Humidifer

  • I’m personally less of a fan of this method because I find humidifiers to be high maintenance - and if they are improperly maintained, they can cause more harm than good. Make sure you follow the instructions on your device.

  • Both cool & warm mist humidifiers are effective (by the time vapor reaches lower respiratory tract, temp is the same).

  • However, cool mist humidifers are safer to have around.

Saline

Saline has been shown to improve cough associated with allergic rhinitis, acute respiratory infections, and more. It can break up mucus and help flush out the nose, so it is particularly helpful for cough associated with postnasal drip. (PMID: 28452705)

• Saline drops or spray

  • These are both effective, although I found drops easier to administer when my kids were younger.

  • Focus on doing this before times when the cough is interfering. most - such as before feeds or sleep.

  • Follow up saline with a nasal suction device, such as a bulb suction, or the manual or electric Nose Frida.

  • I usually do this after a steamy shower for my kids for a layered effect!

• Boogiewipes micromist inhaler

  • This was a recent discovery (and is not a sponsored recommendation). I liked it!

• Nasal irrigation

  • This is typically most helpful for chronic conditions rather than acute infections. However, some kids find it helpful. I review how to do it, along with the evidence, on instagram.

Warm liquids

We actually have some research that shows that warm liquids are effective for thinning out mucus, and in particular that chicken noodle soup does this more effectively than other warm liquids (PMID: 32387517)

But trying sips of warm juice, pedialyte, honey water or low sodium broth should be helpful. Culturally, there’s also an association between warm liquids and TLC, so even the placebo effect may help!

Don’t forget anti-inflammatories

Medications like Ibuprofen and Acetaminophen can also be immensely helpful for the sore throat/inflammation that often accompanies a cough. Again, always remember you are focusing on comfort rather than trying to make the cough “go away”.

What about OTC meds?

I’m sorry to disappoint you. The vast majority of data (including a comprehensive Cochrane review), has found no proof that cough suppressants, decongestants, or antihistamines perform any better than placebo when it comes to helping with cough.

These medications can also cause side effects that cloud the clinical picture (is your child sleepy because of the Benadryl or because they are getting worse?)

The American Academy of Pediatrics specifically does not recommend the use of these medications in young children under 4y.

What about homeopathy?

Same thing here. The data doesn’t support that any homeopathic remedies, essential oils, or other similar products have any significant effect on coughing in children. Additionally, these products aren’t regulated or safety tested, we don’t know what doses would even be safe in children.

Side effects also exist from some of these products. For example, Eucalyptus can cause bronchospasm and worsen wheezing, and Menthol (such as Vicks vaporub) can actually increase mucus production, so both have the potential to worsen symptoms.

What about putting onions or potatoes in my kids socks?

There is also no data behind putting potatoes or onions in socks. Not harmful, though. The main side effects here will be stinkiness and dirty socks.

Prescription medications

Depending on the cause of the cough, sometimes a clinician will prescribe medications to help. These can include inhalers (for asthma), antibiotics (for bacterial infections), antihistamines (for allergies) or proton pump inhibitors (for reflux). Your child may also need imaging, such as a chest X-ray.

The Pediatrician Mom Tip: Medications containing codeine are no longer recommended for pediatric patients. And some medications that are used in adults (such as Tessalon Perles) can be very dangerous if any overdose occurs, so these are rarely prescribed for children. If you have any in the house, make sure they are locked out of reach.

I know coughs can be frustrating. But I promise you, your pediatrician isn’t holding out on you with some magical home remedy that they want to keep to themselves.

Hopefully these remedies help, but otherwise the best thing for most coughs is tincture of time.

And in the meantime, keep washing those hands so you don’t catch it!