Cough medicine that really works

We all know how it goes. School starts or the first cold day hits or any number of “milestone” events occur and BOOM: your kid is coughing. Sometimes it’s with a runny nose, sometimes not. So should you reach for an over the counter cough syrup? It may surprise you to know that many doctors would say NO.

Studies on over the counter (OTC) cough medicines have not shown them to be effective (1,2,3). If you experience cough relief (and no concerning side effects) with an over the counter product — GREAT! Keep using it! If not, though, this article is for you.

So, what can we use, aside from OTC remedies and potentially dangerous pharmaceuticals like codeine and even morphine(!)?

-Honey: Honey has shown to be surprisingly good at improving cough (1,2). One trial reviewed in the Cochrane study (a meta-analysis, which means it looks at LOTS of studies at once) indicated that three types of honey were more effective than placebo over a three‐day period (1,4). The three types used in the study were eucalyptus honey, citrus honey, and labiatae (now known as lamiacae, which are plants in the mint and sage family) honey, all given in a single dose of 10 grams (about 1 and 1/2 teaspoons) 30 minutes before bedtime. (4) Honey should only be used in children over the age of 1 year. You can use it straight from the spoon or add it to hot herbal tea with lemon for a soothing elixir.

-TEA: Ginger, peppermint:, chamomile Ginger and peppermint used alone or combined in a tea can help relieve that throat “tickle” that can lead to coughing fits. Adding chamomile can give an extra anti-inflammatory, antimicrobial, and relaxing effect (5). Warm liquid brings heat to the throat, which increases blood flow and the delivery of immune system cells that circulate in the blood.

-WARM saltwater gargle: there’s a reason why our grandmothers always recommend this! It not only provides warmth (see above for why that’s important) but the salt also has an antibacterial effect. Warm liquids like chicken soup also provide healing warmth and nourishment, to boot!

-Steam: kids need close adult supervision for this! But inhaling warm steam (ensure it is not too hot! Steam can burn!) made of either plain water or even chamomile tea can bring warm, moist air deeper into not just the throat but also the airway. Chamomile adds an extra bonus, as it has anti-inflammatory, antimicrobial, AND anti-oxidant effects! (5) For babies and younger children who cannot safely steam over a bowl of hot water, for example, running the shower on hot and steaming up the shower stall or bathroom can be a wonderful way to introduce warm, moist air into their airways. For croup, however, cool moist air may be even more helpful, which, anecdotally is likely why many families report that their child’s croupy cough improved when they, in desperation to soothe their little ones, took them on a drive with the windows open —in the very early morning when the air was still cool and misty.

-Nasal saline: How many times have you taken your kid to the doctor with a cough and told that their lungs are clear? This is the very common but often very disruptive post-nasal drip cough, often due to an upper respiratory infection, but also to things like environmental allergies. If this is the case for your little one, using nasal saline multiple times a day can help thin mucous and clear out the post-nasal drip that is making their cough worse. A surprising number of children can even use a neti pot or squeeze bottle (one that is specifically made for this purpose) successfully — even enthusiastically! Doing it themselves can even feel fun (squirting water up your nose is so silly!) and empowering, as it is something they are administering to their body to feel better. Cleanliness is paramount here, so make sure to clean neti pots and squeeze bottles with soap and hot water and dry thoroughly after every use. Use bottled water or boiled and cooled tap water to make the saline — or purchase pre-made sterile saline.

-Eucalyptus: Adding eucalyptus oil to a vaporizer or to a steam (for older kids and adults — be careful because it can cause a burning sensation in your eyes!) may help ease cough associated with upper respiratory tract infections and bronchitis (6). But use CAUTION: Eucalyptus essential oil is very concentrated and is toxic when ingested, especially in children. Always dilute essential oils in a carrier oil if using them topically and keep essential oils out of the reach of children. It is important to note that eucalyptus oil may cause SEIZURES in some people, including in children (7). Nature creates powerful compounds, so we must respect and use them wisely!

-Herbal cough syrups: Although conventional OTC cough syrups have not been shown to be effective, herbal therapies (sometimes known as “phytotherapy”) HAVE shown efficacy. Look for products that contain Ivy leaf (Hedera helix) (8, 9) or Pelargonium (aka Umcka), a South African relative of the geranium plant (10). Some cough syrups contain honey, so, in addition to looking for preparations made specially for kids, also make sure to read labels and avoid honey in children under 1 year of age.

And finally: SLEEP AND GOOD NUTRITION cannot be overemphasized.

Although studies on supplementation have shown mixed results when it comes to susceptibility and recovery from colds and cough, eating a balanced and nutritious diet with foods that contain vitamins and minerals like Vitamin C, Vitamin D, iron and zinc can only support our health further. Sunshine provides Vitamin D, too, so, if your little one is well enough, getting outside into the sunshine can also give a wonderful boost.

And, as we know, REST and SLEEP are profound healers.

And let us not forget the deep power of a parent’s touch. Our bodies have the potential not just to help our little ones regulate their temperature, but skin to skin has shown to boost immunity in our little ones, too!

A note on severe or lingering coughs: If your child is ever short of breath, working hard to breathe or looks lethargic, please seek immediate medical attention. Additionally, if your or your child’s cough lasts longer than 2-4 weeks without a clear or known reason, make sure to seek out a healthcare professional to dig more deeply. There are many reasons for a lingering or even chronic cough, and it is in your little one’s best interest to figure out what’s going on, so their health can be properly supported.

Be well, my friends!

Photo credit: Gustavo Fring

REFERENCES

1. Smith SM, Schroeder K, Fahey T. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev. 2014 Nov 24;2014(11):CD001831. doi: 10.1002/14651858.CD001831.pub5. PMID: 25420096; PMCID: PMC7061814.

2. Vogelberg C, Cuevas Schacht F, Watling CP, Upstone L, Seifert G. Therapeutic principles and unmet needs in the treatment of cough in pediatric patients: review and expert survey. BMC Pediatr. 2023 Jan 21;23(1):34. doi: 10.1186/s12887-022-03814-0. PMID: 36670372; PMCID: PMC9860236.

3. Schroeder K, Fahey T. Systematic review of randomised controlled trials of over the counter cough medicines for acute cough in adults. BMJ. 2002 Feb 9;324(7333):329-31. doi: 10.1136/bmj.324.7333.329. PMID: 11834560; PMCID: PMC65295.

4. Cohen HA, Rozen J, Kristal H, Laks Y, Berkovitch M, Uziel Y, Kozer E, Pomeranz A, Efrat H. Effect of honey on nocturnal cough and sleep quality: a double-blind, randomized, placebo-controlled study. Pediatrics. 2012 Sep;130(3):465-71. doi: 10.1542/peds.2011-3075. Epub 2012 Aug 6. PMID: 22869830.

5. McKay DL, Blumberg JB. A review of the bioactivity and potential health benefits of chamomile tea (Matricaria recutita L.). Phytother Res. 2006 Jul;20(7):519-30. doi: 10.1002/ptr.1900. PMID: 16628544.

6. Ladda H, Kanjanasilp J, Chaiyakunapruk N, Sawangjit R. Efficacy and Safety of Eucalyptus for Relieving Cough: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Integr Complement Med. 2022 Mar; 28(3):218-226. doi: 10.1089/jicm.2021.0226. Epub 2022 Jan 17.

7. Dudipala SC, Mandapuram P, Ch LK. Eucalyptus Oil-Induced Seizures in Children: Case Reports and Review of the Literature. J Neurosci Rural Pract. 2021 Jan;12(1):112-115. doi: 10.1055/s-0040-1721199. Epub 2021 Jan 29. PMID: 33531768; PMCID: PMC7846315.

8. Sierocinski E, Holzinger F, Chenot JF. Ivy leaf (Hedera helix) for acute upper respiratory tract infections: an updated systematic review. Eur J Clin Pharmacol. 2021 Aug;77(8):1113-1122. doi: 10.1007/s00228-021-03090-4. Epub 2021 Feb 1. PMID: 33523253; PMCID: PMC8275562.

9. Völp A, Schmitz J, Bulitta M, Raskopf E, Acikel C, Mösges R. Ivy leaves extract EA 575 in the treatment of cough during acute respiratory tract infections: meta-analysis of double-blind, randomized, placebo-controlled trials. Sci Rep. 2022 Nov 21;12(1):20041. doi: 10.1038/s41598-022-24393-1. PMID: 36414647; PMCID: PMC9681772.

10. Gökçe Ş, Dörtkardeşler BE, Yurtseven A, Kurugöl Z. Effectiveness of Pelargonium sidoides in pediatric patients diagnosed with uncomplicated upper respiratory tract infection: a single-blind, randomized, placebo-controlled study. Eur J Pediatr. 2021 Sep;180(9):3019-3028. doi: 10.1007/s00431-021-04211-y. Epub 2021 Jul 24. PMID: 34304301.