Pulmonary Testing

Dr. Hall’s Answer:

I’m sorry to hear that your child has been ill. Certainly frequent colds are part of the package when your child starts daycare. In fact, studies estimate that a child in their first year of daycare will experience up to 10 colds! Unfortunately, if your child doesn’t attend daycare, they aren’t off the hook – he or she will likely experience that same burst of frequent illnesses when they start school.

The use of over-the-counter cough medications, such as Tussin DM, for children is strongly discouraged by the American Academy of Pediatrics (AAP). In fact, in 2007, drug companies voluntarily began withdrawing children’s preparations from the shelves due to the dangers of side effects, and in 2008, the Food and Drug Administration recommended that no cough and cold medications be used in children younger than 4 years of age due lack of evidence that they help relieve symptoms and due to the risk of side effects.

Over-the-counter adult preparations are especially dangerous because:
¹ no safe dose for children or infants is known – toxicities and dangerous side effects can occur at any dose and ² many medicines are combinations of several drugs, such as acetaminophen, diphenhydramine, pseudoephedrine, etc. – all of which have their own side effects and toxicities. Side effects specifically due to Dextromethorphan (the “DM” in Tussin DM) include dizziness, drowsiness, nausea, vomiting, decreased breathing, apnea (no breathing), rapid or irregular heart rate and death. Scary stuff!

So what can you do for your child when they are feeling miserable with a cold? For cough treatment, the AAP recommends for children older than one year of age, ½ to 1 teaspoon of honey, taken as needed. Honey helps to thin mucous and soothe cough. Recent research (1,2) showed that honey is better than drugstore cough syrups at decreasing the frequency and severity of coughing at nighttime. For congestion, saline nasal drops and suction, and a cool mist vaporizer in the bedroom at night is helpful.

Regarding your question of asthma, in young children, frequent viral infections are the most typical cause of cough, congestion and fever. Wheezing can occur as part of viral or bacterial infection, so wheezing alone cannot clinch a diagnosis of asthma. Predictors of asthma include eczema or allergies in the patient, and a strong history of asthma in the parents of the patient. Pulmonary testing is usually not practical before school age. Careful follow-up with your pediatrician and monitoring of the breathing symptoms over time is required for a diagnosis of asthma.

^{1) Paul IM, Beiler J, McMonagle A, Shaffer ML, Dada L, Berlin CM., Jr Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161:1140–6.}

^{2) Shadkam MN, Mozaffari-Khosravi H, Mozayan MR. A Comparison of the effect of honey, dextromethorphan and diphenhydramine on nightly cough and sleep quality in children and their parents. J Altern Complement Med. 2010 Jul;16(7):787-93.}