Cough is the most frequently presenting symptom in primary care settings. It can negatively affect activity level of children and their potential to sleep, play or attend school. Besides, it is often a source of parental anxiety. The presentation, etiology and management of cough vary in children in comparison to adults. Therefore, cough treatment approaches should include characterizing the cough by means of clinical assessment to recognize and address its underlying etiology appropraitely. Clinical algorithms made based on acute/chronic presentation and specific/non-specific causes of cough can provide guidance for clinical practice and improve quality of affected child. The present review presents the clinical statement of the Saudi Pediatric Pulmonology Association (SPPA) in relation to the management of cough in children.

General concepts for management

• The goal of the management should focus on identifying the underlying cause of cough in children.
• It has been observed that etiology in majority of children presenting with cough, is significantly associated to upper respiratory tract infection (URTI) and warrants only supportive measures such as antipyretics, good hydration, and saline washes.
• Evidences does not strong efficacy data regarding over-the-counter therapies such as antitussives, antihistamines and decongestants as they have proven to have comparable efficacy as placebo for acute cough and can cause adverse effects. Hence, they are not indicated in children less than 2 years of age. Intranasal steroids can be beneficial in children with allergic rhinitis presenting with cough during pollen season.
• Bronchodilators are not efficacious and should be administered in non-asthmatic children presenting with acute cough.
• Antibiotics are usually non-advantageous and should be avoided in children with acute cough caused by viral URTI. However, in case of pertussis infection, macrolide antibiotics should be prescribed early (1–2 weeks of illness).
• Specific causes of acute cough including asthma, bronchiolitis, croup, and community-acquired pneumonia should be treated according to evidence-based guidelines specific for such entities.
• Honey products can be safely and effectively used in acute cough following URTI in children greater than 2 years of age
• Education of parents and community is essential to increase the awareness of the natural course and supportive measures for acute cough caused by URTI in young children.

Source: Alsubaie H, Al-Shamrani A, Alharbi AS, Alhaider S. Clinical practice guidelines: Approach to cough in children: The official statement endorsed by the Saudi Pediatric Pulmonology Association (SPPA). Int J Pediatr Adolesc Med. 2015 Mar;2(1):38-43.