Parents bring their coughing children to the practice , often repeatedly , even though every visit results in the same advice : ‘ This is viral . Over-the-counter medicines may or may not manage symptoms , and there is no need for treatment with antibiotics .’

Parents ’ concerns Various studies have looked at parental beliefs on cough and other ‘ minor ’ childhood illnesses – although it could be argued that we can only call them minor in retrospect . As far back as 1993 , a study carried out interviews with 30 mothers who had taken their children to a GP due to a cough . ¹ When the recordings were reviewed , it was found that the mothers were concerned about the effects of the cough itself , not just the underlying condition . There were concerns that the child would choke on their phlegm or vomit , or might die from an asthma attack or cot death .

Particularly worrying for parents was a night-time cough , both because of disturbed sleep and the worry the child might die in the night . There was a common belief that a cough ‘ on the chest ’ was damaging and needed antibiotics to break up the phlegm – we now know this isn ’ t the case .

A more recent study in Australia carried out interviews in GP waiting rooms and elicited a variety of worries from the parents of coughing children . ² Personal or family experiences were important , with some parents citing serious illness in their other children as heightening their fears , or concerns regarding things they had read about , such as a child who had inhaled a foreign body . This probably sounds familiar to many clinicians , as our own thought process might change in the aftermath of the diagnosis , or missed diagnosis , of a rare disease , or after we have attended a study session focusing on a condition and then seem to see it every week .

Some parents were concerned about symptoms alone , such as pain in the chest associated with a cough , and others cited the internet as worsening their fears .

Reassurance from a clinician was seen as important , which we should bear in mind . Not every parent wants antibiotics for their child ’ s cough ; many simply want to be reassured they can safely manage it at home .

What ’ s the best approach ? So , what is the reality ? Do we need to suppress a cough , or should we focus solely on the underlying diagnosis ? In most cases , a cough is an appropriate response to a short-term viral illness and not in itself harmful . It is

a reflex , in response to a stimulus such as dust , pollen or infection , and can help to clear the airway . It can be useful to explain this to parents , possibly backed up by easily available video resources ³ , so they understand that in the vast majority of cases the important thing is any underlying condition , rather than the cough itself .

If that condition is a viral respiratory tract infection , then supportive care is all that is needed , with perhaps the addition of a salbutamol inhaler for the group of children who wheeze when they have a cold .

Serious causes Some coughs are inherently dangerous , the most obvious example being whooping cough ( pertussis ) in a baby . Pertussis is a highly infectious disease that causes | a prolonged cough ( it is known in some countries as the ‘ 100-day cough ’). Antibiotics within 21 days of the start may improve prognosis , but otherwise management for most cases is symptomatic . A significant exception is for children in the first six months of life who should always be admitted for monitoring , as there is a risk of apnoea and a mortality rate of 3.5 % ( compared with

0.03 % in the general population ). ⁴ A chronic cough in a child , particularly at night , may point to a new diagnosis of asthma and very rarely can be a presentation of a more serious condition such as heart failure secondary to undiagnosed congenital heart disease , cystic fibrosis or primary ciliary dyskinesia . In particular , a continuous ‘ wet ’ cough that does not settle between apparent viral infections should raise your antenna for possible serious disease .

Reassure and empower In summary , a cough is not usually in itself a serious symptom . The important thing is to know the underlying condition – usually a self-limiting viral infection . Most children ( and adults ) don ’ t need antibiotics , and OTC cough medicines aren ’ t usually useful . Viral causes including bronchiolitis are extremely common ( a third of all children will have bronchiolitis in the first year of life ⁵ ) and for the group with asthma , good management with appropriate use of an inhaler is likely to be more useful than antibiotics .

Many parents will be reassured by an assessment and explanation of why antibiotics are not needed . Your time doing this may be well spent – indeed , the psychotherapist Michael Balint suggested the concept of ‘ the doctor [ or nurse ] as the drug ’ in the 1950s . ⁶ Not only will you spare the child unnecessary antibiotics now , but you might empower the parent to manage future respiratory tract infections at home .

By Dr Toni Hazell , a GP in north London

References 1 Cornford C et al . Why do mothers consult when their children cough ? Fam Pract 1993 ; 10 ( 2 ): 193-6 2 Sharma M and Usherwood T . Up close - reasons why parents attend their general practitioner when their child is sick . Aust Fam Physician 2014 ; 43 ( 4 ): 223-6 3 CoughPro . com . Blog : Why do we cough ? 2020 . bit . ly / 3ikajRd 4 NICE CKS . Whooping cough . London : NICE , 2022 . bit . ly / 3UeduHz 5 NICE CKS . Cough – acute with chest signs in children . London : NICE , 2022 . bit . ly / 3OEzv0U 6 Kairys S . The doctor as drug , paternalism and apostolic function . New Jersey , US : Seton Hall University , 2018

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