Symptom Definition

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

8. 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.

9. Call back If: a. Signs of respiratory distress. b. Wheezing occurs. c. Cough lasts >3 weeks. d. Your child becomes worse.

DEXTROMETHORPHAN (DM) DOSAGE (COUGH SUPPRESSANT) Child’s weight more than 48 64 80 96 13 lb (lb) 0 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 2 tsp ½

*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