There are very good reasons why persistent cough is so common among toddlers. In fact, bronchial cough is one of the most common diagnosis codes for pediatric outpatient visits. Parents need to know that not all coughs are bad, and that there are many effective home remedies for persistent cough, some of which I describe below.
Their behavior sets toddlers up for persistent cough. Toddlers and older infants who are crawling normally cough more than youngsters of any other age. They are mobile, and as they explore, they are on the receiving end of many sneezes and coughs from other children their own size. As a child plays in a room full of other children the same size, he or she is likely to inhale a respiratory air stream that is sneezed or coughed out by other children.
Hand contact also plays a role--especially with respiratory syncytial virus. But if a toddler inhales when face to face with a sneezing child, a much larger viral innoculum lands in the upper airway and trachea. Also, the distance from the upper airway to the trachea and bronchial tree of a toddler is much less than that of an adult, so a sneeze in the face is nearly a direct hit to the bronchial air passages.
Mucus is "Good Stuff"
It is normal for children to have a mucousy cough. Nevertheless, many parents think a child who has a wet mucousy cough is sick. As long as the child is not wheezing or febrile, a wet loose cough does not indicate any problem with lung function; it is actually a natural protective response. Mucus is "good stuff." It is loaded with antibacterial and antiviral properties, including anti-adhesins that impair the ability of bacteria to adhere to the airway.
Many parents also think that cold air is "bad" and that it can make a child sick. It is true that dry/cold air can cause some reactive wheezing in some children and adults. For most children, however, being properly dressed and spending time outdoors actually cuts down on upper respiratory tract infections. In Sweden, preschool children take naps outdoors in sleeping bags. Exercising outdoors is particularly good because is causes the sinus passages to drain and helps mobilize mucus. The beneficial effects of exercising in cold weather accrue to children with cystic fibrosis. (Cold "brisk" air was also used to combat tuberculosis in the sanitariums of the Alps and the Adirondacks.)
Hypothermia is another matter. Getting "chilled" after sitting around in wet clothes or being exposed to prolonged cold while underdressed, seems to worsen pulmonary immune defenses (probably related to ciliary clearance or anti-adhesin activity.) One can become "chilled" in the warm weather as well, by (for example) getting soaked in a rain storm and then sitting in air conditioning.
Here are some home remedies I have recommended for children with persistent cough due to bronchitis:
Rose hips have been used throughout northern Europe and Siberia as cough remedies, because they are a source of vitamin C. Rose hips are high in bioflavinoids, which help "loosen mucus." Rose hips are widely available in the United States in many decaffeinated fruit-flavored teas. One of the most well known are the "Zinger" teas from Celestial Seasonings. They have very kid-friendly flavors (Wild Berry Zinger tastes like grape Koolaid, while Lemon Zinger tastes like lemonade). Unlike juice, these teas have no calories, but can be sweeted with sugar or (for older children) with honey.
Cranberry juice has been shown to help defend against viral infections by impairing the ability of viruses to adhere to the cell. This effect is in addition to its Vitamin C content, and its well known protective role against urinary tract infections (by decreasing the ability of gram negative bacteria to cling to the bladder wall). An ounce of cranberry juice can be added to rose hips tea or lemonade, or mixed with apple sauce and served with a spoon.
Concord grapes are believed to share the antiviral property of cranberries. An ounce of concord grape juice can be added to rose hip or other drink.
Elderberry syrup is widely used in Scandinavia and Israel. It probably shares the same properties as the grape and cranberry.
Green tea is packed with the bioflavinoids that improve the antibacterial/antiviral properties of the mucus layer. Many people tell me their child doesn't like tea, but will drink it if an ounce is mixed with lemonade.
Licorice tea is available in middle Eastern specialty stores. Licorice is also used in cough remedies in Israel.
Honey. The pediatric literature recently reported the results of a controlled study at a hospital in Pennsylvania that showed a teaspoon of buckwheat honey helped calm a cough.1 However, only children older than a year of age can be given honey because of the risk of botulism spores being able to germinate in the GI tracts of younger children.
There was an interesting article in The Scientist about taste receptors and metabolism.2 To the surprise of many, there are receptors in the lungs for both sweet and bitter; sweet induces bronchodilation and bitter induces bronchoconstriction.
Salt water mist. In many European countries, going to the shore was a treatment for bronchitis and asthma. Studies in Australia involving patients with cystic fibrosis showed that those with asthma who surfed had better lung function than those who did not. This led to the discovery that salt mist helped increase the efficiency of the "brushing" action of cilia. Three-percent nNormal saline inhalation treatments are being incorporated into the regimens of many children with cystic fibrosis.
No need to go to the shore: This can be another one of the home remedies.Parents who want to make their own salt mis can sprinkle a couple of tablespoons of kosher or sea salt in the bottom of the bath tub and turn on the hot water shower tap while the bathroom door is closed. As the water hits the salt, a nice mist will start to form. You can then put the stopper in and begin to fill the bath with warm water.
Chest rubs. Throughout the world, there are various forms of chest rubs that contain eucalyptus or camphor compound that give a sensation of warmth on the skin. Parents report that chest rubs seem to help with persistent cough, but evidence-based studies are sparse. The most likely mechanism of action is relaxation and bronchodilation. These compounds can be toxic if ingested, and should never be left where a child might eat or play with them. If a child is asthmatic, the smell might be asthma-inducing. For the vast majority of children, however, a small amount rubbed on the chest at bedtime would not seem to be hazardous.
The Germans make an infusion of thyme leaves. They put 1 tsp of thyme in a tea ball, and add hot water to make a tea. When sufficiently cool, they drink the tea with honey. Another one of the German cough remedies is ivy juice syrup, which is available in some health food stores.
Mustard plasters: now out of favor
Before World War II, mustard plasters were widely used in the United States. They are still available in Russian specialty stores. Mustard plaster recipes vary from family to family. One from an elderly neighbor from upstate New York is as follows:
Mix a tablespoon of dry mustard with a tablespoon of flour, add enough water to make a paste the consistency of peanut butter. Next, spread the mixture it (like peanut butter) on a 4-6 inch square of material cut from an old undershirt. Put another smaller layer of cotton cloth on top of the mustard paste and try to fold the edges so the mustard paste is sealed in. Place the cloth "sandwich" in the middle of the child's chest for only a minute or two - - until the child stays it is starting to feel warm.
An Italian woman I know in Brooklyn uses the same basic recipe, but instead of using cotton jersey, she uses newspapers to sandwich in the paste.
There are many stories of children and adults who sustained thermochemical burns with mustard plasters. Not surprisingly, this has caused mustard plasters to fall out of favor among home remedies. They have largely been replaced by the more child-friendly chest rubs, which are much easier to apply.
1.Paul IM. Therapeutic options for acute cough due to upper respiratory infections in children. Lung. 2012;190:41-44. http://www.ncbi.nlm.nih.gov/pubmed/21892785
2. Finger TE, Kinnamon SC. Matters of taste. The Scientist. December 1, 2011. http://the-scientist.com/2011/12/01/matters-of-taste/