Cough in the Pediatric Population

Abstract

Cough is the most common presenting symptom for medical office visits in the United States. Cough in children is usually related to viral respiratory tract infection and typically resolves spontaneously. Between 35% and 40% of school-age children still cough 10 days after the onset of a common cold, and 10% of preschool children have cough 25 days after respiratory tract infection. 1 Hay A.D. Wilson A. Fahey T. Peters T.J. The duration of acute cough in preschool children presenting to primary care: a prospective cohort study. Fam Pract. 2003; 20: 696-705 Crossref PubMed Scopus (121) Google Scholar In children, cough has been associated with environmental factors, such as outdoor and indoor air pollution, including particulate matter, irritant gases, environmental tobacco smoke exposure, and dampness in the home. 2 Fuentes-Leonarte V. Tenias J.M. Ballester F. Levels of pollutants in indoor air and respiratory health in preschool children: a systematic review. Pediatr Pulmonol. 2009; 44: 231-233 Crossref PubMed Scopus (44) Google Scholar The frequent presentation of cough in children is further complicated by studies documenting that parental reporting of cough in children correlates poorly with objective measurement of frequency, duration, or intensity of cough. 3 Archer L.N.J. Simpson H. Night cough counts and diary cough scores in asthma. Arch Dis Child. 1985; 60: 473-474 Crossref PubMed Scopus (92) Google Scholar Cough in children disrupts both the parent's and the child's daily activities and can be associated with impaired quality of life in the child and significant stress in parents that improves with cough resolution. 4 Marchant J.M. Newcombe P.A. Juniper E.F. Sheffield J.K. Stathis S.L. Chang A.B. What is the burden of chronic cough for families?. Chest. 2008; 134: 303-309 Crossref PubMed Scopus (150) Google Scholar It is extremely common for parents to treat children with over-the-counter (OTC) cough and cold medications (CCMs) before seeing a health care provider. In a recent survey, approximately 10% of US children were found to be receiving an OTC CCM in any given week. Although OTC CCMs receive Food and Drug Administration (FDA) approval for adults, testing for efficacy and safety in young children has not been adequate, 5 Lokker N. Sanders L. Perrin E.M. Kumar D. Finkle J. Franco V. et al. Parental misinterpretations of over-the-counter pediatric cough and cold medication labels. Pediatrics. 2009; 123: 1464-1471 Crossref PubMed Scopus (106) Google Scholar and inappropriate use of CCMs in children has been documented. 6 Schaefer M.K. Shehab N. Cohen A.L. Budnitz D.S. Adverse events from cough and cold medications in children. Pediatrics. 2008; 121: 783-787 Crossref PubMed Scopus (86) Google Scholar Adverse events associated with use of OTC CCMs do occur and rare infant deaths have been reported. In January 2008, the FDA issued a public health advisory regarding OTC CCM use in children questioning safety and efficacy and whether the clinical benefits justify potential risks; 7 US Food and Drug Administration Nonprescription Drug Advisory Committee. Cold, cough, allergy, bronchodilator, antiasthmatic drug products for over-the-counter human use, October 18 and 19, 2007. Available from: www.fda.gov/ohrms/dockets/ac/07/briefing/2007-4323b1-02-FDA.pdf. Accessed September 21, 2008. Google Scholar it now recommends avoiding these medications in children under age 2 years. The FDA also has supported the recent recommendation by the Consumer Health Product Association to avoid OTC CCM use in children under age 4 years. An American Academy of Pediatrics (AAP) position statement questions the efficacy and safety of these medications in children under age 6 years.