Cough

SYMPTOM DEFINITION

*A cough is the sound made when the cough reflex suddenly expels air and secretions from the lungs.

*A coughing spasm is >5minutes of continuous coughing.

SEE OTHER PROTOCOL

*ASTHMA ATTACK

*CROUP

*WHEEZING (OTHER THAN ASTHMA)

TRIAGE ASSESSMENT QUESTIONS FOR COUGH

Activate Emergency Medical Services (911)

*Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath).

*Child has passed out with coughing (R/O apnea, anaphylaxis, and cough syncope).

*Lips or face are bluish when not coughing (R/O cyanosis and need for oxygen).

See Immediately in Emergency Department or Office (ask primary care physician)

*Choked on a small object that could be caught in the throat (R/O airway foreign body (FB)).

*Child sounds very sick or weak to the triager (R/O sepsis).

See Immediately in Office

*Difficulty breathing (<1 yr old) not relieved by cleaning the nose.

*Difficulty breathing (>1 yr old) present when not coughing.

*Lips have turned bluish during coughing (R/O bronchiolitis, FB or pertussis).

*Age<12 weeks with fever>100.4 F rectally (R/O sepsis).

*Severe chest pain (R/O pneumothorax).

*Blood coughed up (R/O pneumonia, FB, tuberculosis).

See Today

*Continuous (nonstop) coughing (Reason: may need asthma medicine).

*Age<1 mo old (EXCEPTION: coughs a few times) (R/O pneumonia).

*Age 1-3 months with a cough for >3 days (R/O chlamydia,pertussis).

*Fever >105 F (R/O serious bacterial infection).

Continued…..

Cough

TRIAGE ASSESSMENT QUESTIONS CON’T

See Today or Tomorrow

*Parent wants child seen.

*Fever present>3days (R/O pneumonia).

*Chest pain that’s present when not coughing (R/O pleurisy & pneumonia).

*Coughing has kept home from school for 3 or more days.

*Earache is also present.

*Sinus pain or pressure is also present (R/O cough triggered by sinusitis).

*Symptoms of nasal allergies are also present (R/O allergic cough or asthma).

*Cough has been present>3 weeks (R/O asthma, exercise-induced bronchospasm, FB, smoking in teens).

*Frequent vomiting with cough.

Home Care

*Cough with no complications.

HOME CARE ADVICE FOR COUGH

  1. Reassure the caller: It doesn’t sound like a serious cough. Coughing up mucus is very important for protecting the lungs from pneumonia.
  2. Destromethorphan (DM) for Severe Coughs: Cough medicines are generally not useful, but for children 5 years and over with coughs that interfere with sleep, school or work may try a cough suppressant (DM), which is present in most over-the-counter cough syrups. See dosage chart at the end of protocol. Teens: 20 mg. Do not use if <5 years old.
  3. Coughing Spasms: For coughing spasms, give warm fluids (apple juice). Expose to warm mist in foggy bathroom. (Reason: Both relax the airway and loosen up the phlegm)(Avoid juice if <4 months old)). Children >4 yrs can suck on hard candy or cough drops (Reason: to coat the irritated throat). Also try not to talk or cough at these times.
  4. Vomiting: For vomiting that occurs with hard coughing, reduce the amount given per feeding (e.g. in infants, give 2 ounces less formula). (Reason: Cough –induced vomiting is more common with a full stomach).
  5. Humidifier: If the air is dry, use a humidifier, (Reason: Dry air makes cough worse).
  6. Fever Medicine: For fever give acetaminophen or ibuprofen if the child is uncomfortable.
  7. Avoid Tobacco Smoke: Active or passive smoking makes coughs much worse. Continued………

Cough

Home Care for Cough con’t

  1. Expected Course: Viral illnesses can cause a cough for 2-3 weeks. Sometimes the child coughs up lots of phlegm (mucus). The mucus can normally be gray, yellow or green. Antibiotics are not helpful in most cases.

The providers at Tonawanda/Island Pediatrics do not recommend cold and cough medicines for children less than 5 years of age. They have been proven ineffective and/or potentially dangerous. We would be glad to have you speak further with one of our doctors if you are considering using them with your child.

  1. Call back If:
  1. Signs of respiratory distress.
  2. Wheezing occurs.
  3. Cough lasts >3 weeks.
  4. Your child becomes worse.

DEXTROMETHORPHAN (DM) DOSAGE (COUGH SUPPRESSANT)

Child’s weight more than (lb) / 48 / 64 / 80 / 96 / 130 / lb
Total amount (mg) / 7.5 / 10 / 12.5 / 15 / 20 / mg
Liquid 5mg/5ml (tsp) / 1 1/2 / 2 / 2 1/2 / 3 / ---- / tsp
Liquid 7.5 mg/5ml (tsp) / 1 / 1 / 1 1/2 / 2 / 3 / tsp
Liquid 10 mg/5ml (tsp) / ---- / 1 / 1 / 1 ½ / 2 / tsp

*Dosage: 0.15 mg/lb/dose every 6-8 hours (0.3 mg/kg/dose)

*Adults: 20 mg/dose

*Don’t use <5 year of age (Reason: cough is a protective reflex, cough medicine is not helpful and has side effects in young children.)

11/16/07