Cough Management in Children Under 2 Years Old

Contraindicated Medications

The American Academy of Pediatrics advises against the use of all OTC cough and cold medicines in children under 2 years due to lack of efficacy and risk of significant morbidity and mortality 1, 2
Codeine-containing medications should be avoided in children under 2 years due to potential respiratory distress and serious adverse effects 2
Antihistamines have minimal to no efficacy for cough relief and are associated with adverse events, including 69 reported fatalities in children under 6 years between 1969-2006 4, 2
Dextromethorphan is no more effective than placebo and has been specifically advised against by the American Academy of Pediatrics 2
Decongestants caused 54 fatalities in children under 6 years, demonstrating their narrow therapeutic window and cardiovascular/CNS toxicity risk 4, 3

The American Academy of Pediatrics recommends honey as the only treatment for acute cough in children over 1 year of age, providing more relief than diphenhydramine, placebo, or no treatment 2, 5
Supportive care and watchful waiting are appropriate for most cases of acute cough in children under 2 years, as acute coughs are typically self-limiting viral infections 2, 5

The American Academy of Pediatrics recommends eliminating tobacco smoke exposure and other environmental pollutants, which should be assessed in all children with cough 1, 2, 5
Addressing parental expectations and specific concerns through education about the natural course of viral illness is crucial 1, 2

If asthma is suspected, consider a 2-4 week trial of low-dose inhaled corticosteroids, but always re-evaluate after the trial period 1, 2, 5
Beta-agonists like salbutamol should not be used in children with acute cough and no evidence of airflow obstruction 2
GERD treatment should only be considered if gastrointestinal symptoms are present, not for cough alone 2, 5