Cough-Your Child’s Friend or Foe? (Pedcast)


I don’t know about you, but in Charlotte, the kiddies have been doing a lot of coughing this winter. Even though it has been unseasonably warm, those viruses have managed to get into the noses and lungs of babies with amazing ease, generating a lot of coughing and sleepless nights. I talk to parents every day in my office, who seem to be frantic to stop their children’s cough. Since when did cough become enemy number one for children? Yes, it’s true, a cough makes your kids uncomfortable and means that they are sick, but, in reality, his or her cough is weapon number one preventing them from contracting pneumonia.  So in today’s pedcast, I want to change your thinking about cough and have you think of this symptom as a vital protective reflex rather than a nuisance symptom keeping your child awake at night and making them miserable.

Oh, I’m sorry, I forgot to introduce myself. How rude of me. I am Dr. Paul Smolen, a board certified pediatrician with 35 years of practice and a whole lot to say. Welcome to another edition of Portable Practical Pediatrics.

Music Intro:

Science Drive:

Long time listeners of Portable Practical Pediatrics know that I like to take my listeners to a fictional place I call Science Dr., a place where we talk basic concepts in biology, physiology, and science. Before we can have a meaningful conversation about the usefulness of cough for your child’s health, we need to review how your children’s lungs manage to stay so healthy most of the year. Let’s start with some terminology. Your child’s nose, sinuses, trachea, bronchioles and even the air sacks called alveoli are lined with cells known as epithelial cells. These cells are filled with mucous that, when your child is healthy, is slowly released and swept toward their throats by millions of beating brooms called cilia. This “River of mucous” as I call it, washes away stray bacteria, dust, and pollen that your child has inhaled and manages to get into their noses, throats, and lungs.  Without this constant cleansing of their lungs by the river of mucous, every child would get pneumonia quite frequently. Remember this Doc Smo pearl, “Healthy lungs are healthy for a reason.”  In other words, this protective mucous flow along with a strong cough and immune system prevents your children from clogging up their lungs with pneumonia. So now imagine that a nasty respiratory virus (like influenza and RSV) infect and damage a lot of the epithelial cells of your child’s lungs. As the epithelial cells and cilia are shed, they let go of all of their mucous and flood your child’s bronchioles with thick sticky mucous. Instead of the normal trickle of mucous, the child is now faced with a tsunami of secretions. No cilia to sweep out the mucous plus buckets of mucous present this child’s lungs with a serious dilemma-how to get this stuff out of the air spaces of the lung? Here is where the cough comes into play and thank goodness it does.

The Cough Dissected

A cough is an amazingly strong reflex, expelling the amount of air equal to about 3/4 of a 2 liter coke bottle with each cough, at speeds of up to 50 miles per hour. The mucous droplets in a human cough (about 3000/cough) have been found to travel several feet from the child who is coughing, and creating a noise as loud as 90 decibels!  That’s a forceful, loud, and violent reflex. And it has to be to keep a child’s lungs clean during a severe viral illness. Clearing the mucous and dead cells from their lungs during a respiratory viral infection is the essential function of a child’s cough. As I said before, “Your child’s cough is the only thing standing between them and pneumonia.” 

Cough Medicine, Yes or No?

Now you can see that thank goodness your child has a strong cough. Without it, your children couldn’t keep their lungs free of pneumonia. Giving them cough medicines that dampen this vital reflex just doesn’t make any sense. Would they sleep better if you gave it to them, probably yes. Would it work, maybe a little?  Is it recommended by experts, definitely no. So the next time your child struggles with a nasty chest cold, give them honey, slather them down with an approved chest rub, give them plenty to drink, maybe spend a little time in a steamy shower, and pull out that humidifier if you want, but don’t give them cough medicine Remember, your child’s cough is helping them.

Warning Signs with Cough

Before we leave the subject of cough, I need to remind you that there are some situations where a cough may signal serious trouble. Cough can signal serious trouble if it is associated with wheezingshortness of breathbreathlessnesslabored breathinghigh feverchest, back, neck, or abdominal paingrunting while awake or asleep, or any situation where your child just looks really sick. If you see any of these things or are just worried, by all means, get them checked out as soon as possible!


Well that’s today’s installment of Portable Practical Pediatrics. If you enjoy discussing child health and wellness with pedcasts, please take a minute to write a review on iTunes or share a few episodes with family or friends. That’s why I go to all the effort to make them, to empower as many parents as I can. Oh, and don’t forget to subscribe at so I can notify you of all my new content. This is Doc Smo, hoping that your child’s hack, helps them get their good health back. Until next time.

Musical Outro

Edited by Dr. Monica Miller-Thanks Monica

Smo Notes:

Speed of cough