# Acute cough and chest cold in children - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Cough: Evaluation and Management - StatPearls (NCBI Bookshelf NBK493221) - https://www.ncbi.nlm.nih.gov/books/NBK493221/ · Upper Respiratory Tract Infections With Focus on The Common Cold - StatPearls (NCBI Bookshelf NBK532961) - https://www.ncbi.nlm.nih.gov/books/NBK532961/ · Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child-full.txt) · Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child-clinical.txt) · MSF Essential Drugs 2024 - Paracetamol = acetaminophen (oral) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (dextromethorphan monograph) - Verified date: 2026-08 ## Verified against - Cough: Evaluation and Management - StatPearls (NCBI Bookshelf NBK493221) - https://www.ncbi.nlm.nih.gov/books/NBK493221/ - Upper Respiratory Tract Infections With Focus on The Common Cold - StatPearls (NCBI Bookshelf NBK532961) - https://www.ncbi.nlm.nih.gov/books/NBK532961/ - Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child-full.txt) - Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child-clinical.txt) - MSF Essential Drugs 2024 - Paracetamol = acetaminophen (oral) - Egyptian National Drug Formulary - Respiratory Medicines 2026 (dextromethorphan monograph) ## Treatment metadata - Supportive care, fluids and honey from the first birthday (no drug therapy) - Referral & safety-netting (no drug therapy) - Paracetamol — 120 mg — oral.liquid ## Complete treatment card ```text ACUTE COUGH AND CHEST COLD IN CHILDREN Sources: Cough: Evaluation and Management - StatPearls (NCBI Bookshelf NBK493221) - https://www.ncbi.nlm.nih.gov/books/NBK493221/ · Upper Respiratory Tract Infections With Focus on The Common Cold - StatPearls (NCBI Bookshelf NBK532961) - https://www.ncbi.nlm.nih.gov/books/NBK532961/ · Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child-full.txt) · Acute cough and chest cold in children - disease-level clinical article (acute-cough-bronchitis-child- clinical.txt) · MSF Essential Drugs 2024 - Paracetamol = acetaminophen (oral) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (dextromethorphan monograph) Review status: REVIEWED against 6 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Cough, dry or productive, lasting under 3 weeks, often starting after a cold [cough] - Cough is called acute under 3 weeks, subacute from 3 to 8 weeks, and chronic beyond 8 - or beyond 4 weeks in a child of 14 or younger [cough] - A subacute cough usually follows a respiratory infection and is kept going by inflammation left behind in the airway or the sinuses [cough] - Red flag: coughing up blood, breathlessness, low oxygen, weight loss and fevers, abnormal vital signs, or a struggling heart or lungs [breathlessness · coughing up blood · weight loss] - In a child, recognising and treating it early is what prevents progression to bronchiectasis, and some of the damage may still be reversible - A cough that becomes chronic costs sleep, quality of life and school or work, and travels with anxiety, low mood and social isolation [anxiety · cough · low mood] SIGNS - what you find (1) - Wheeze and rhonchi are heard, and they typically resolve after coughing [cough · wheeze] TESTS (6) - Rapid antigen or NAAT COVID-19 testing is used when the result changes treatment or isolation decisions - Acute bronchitis and most viral upper respiratory infections are diagnosed clinically, without routine imaging or labs - A pneumonia work-up typically includes a chest x-ray and full blood count, with CRP checked selectively - A CRP over 30 mg/L in the right clinical setting raises the likelihood of pneumonia - In children 14 and younger with no red flags, work-up starts with spirometry and exhaled nitric oxide testing when available - An FeNO of 25 ppb or higher in a child supports asthma and a 2-week treatment trial IF NOT THIS - what else fits (7) - Bronchiolitis mainly affects children under 2, starting with cold-like symptoms then wheeze, crackles, fast breathing, and retractions - Foreign body aspiration causes sudden cough, stridor, and focal wheeze; severe cases show respiratory distress or cyanosis - Pertussis worsens after a catarrhal phase into paroxysmal fits with an inspiratory whoop and vomiting after coughing - Asthma causes episodic cough, wheeze, or breathlessness set off by cold air, exercise, infection, or allergens - Allergic rhinitis brings a runny itchy nose, sneezing, cough, and allergic conjunctivitis, with pale swollen nasal lining on exam - Acute decompensated heart failure causes breathlessness, orthopnea, crackles at the lung bases, leg swelling, and a third heart sound - An acute cough is usually a respiratory infection that settles by itself, but an asthma or COPD flare, pneumonia, a pulmonary embolism or heart failure can all present the same way Source StatPearls "Cough: Evaluation and Management" - disease-level clinical article Status traced to the source above 1. SUPPORTIVE CARE, FLUIDS AND HONEY FROM THE FIRST BIRTHDAY (NO DRUG THERAPY)[1st line] Adult Source Acute cough and chest cold in children - disease-level clinical article (acute-cough- bronchitis-child-full.txt) Why The article's whole answer for this illness is supportive care: an acute cough from an upper respiratory infection is managed mainly by supporting the patient through it. The one household remedy it endorses by name is honey - it cuts how often the cough comes and how bad it is, most clearly in children and possibly in adults too, and the article offers it from the age of 1 upwards. Caution NEVER UNDER ONE YEAR. The article puts the gate positively: honey eases how often and how badly a child coughs, may help adults too, and is an option from age 1 upwards. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) Below the first birthday honey must not be given, because of the risk of infant botulism. This is an absolute age gate, and honey is in every Egyptian kitchen. NO HONEY DOSE IS PRINTED HERE. Both articles state honey as an option and neither states a quantity, a frequency or a duration, so no dose claim can be quoted from an opened document and none is invented. It is a spoonful given by a parent, not a prescription. SALINE, STEAM AND SUCTION ARE THE REST OF IT - a cool-mist humidifier, and sterile saline drops or spray, moisten the nose and help clear it. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) TELL THE FAMILY HOW LONG IT WILL LAST, OR THEY WILL BUY AN ANTIBIOTIC - a cold itself runs about 7 to 10 days, though the cough can drag on for weeks afterwards. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) In children it is reasonable simply to wait and watch for 2 to 4 weeks, since most of these coughs follow a virus and settle on their own. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) A COUGH IS ONLY CHRONIC IN A CHILD AFTER FOUR WEEKS - by duration, a cough counts as acute under 3 weeks, subacute from 3 to 8 weeks, and chronic beyond 8 weeks - or beyond 4 weeks in a child aged 14 or under. NOTHING SHORTENS A POST-VIRAL COUGH - inhaled steroids, bronchodilators and oral medicines all fail to help a cough left behind by an infection. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) KEEP THE SMOKE OUT OF THE HOUSE - press the family hard on keeping the child away from tobacco smoke. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) AND MENTHOL RUBS ARE NOT FREE OF HARM - rubs made with menthol, camphor and eucalyptus may ease cough and blockage, but they can irritate the skin, the eyes and the nose. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Acute cough and chest cold in children - disease-level clinical article (acute-cough- bronchitis-child-clinical.txt) Why Carries the two things that make this consultation safe: the features that mean the cough is not a chest cold, and the list of cough medicines that must not be given to a child, each refused in the words of the document that refuses it. Caution ANTIBIOTICS DO NOT WORK HERE, AND THAT IS THE WHOLE MESSAGE - they do nothing for a common cold, yet they are handed out in something like 30% to 40% of these self-limiting infections, and that is a major driver of resistance. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) The chest is no different: acute bronchitis is nearly always viral and is managed supportively, with neither antibiotics nor antivirals shown to help. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) WHEN AN ANTIBIOTIC IS ACTUALLY INDICATED - group A beta-haemolytic streptococcal pharyngitis; severe acute otitis media; sinusitis running beyond 10 days; or sinus symptoms that worsen again after first improving. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) Nothing else listed here is an antibiotic indication. NO COUGH SYRUP IS PRINTED HERE. Cough and cold preparations sold over the counter do not work in children under 12, and have killed children under 2 by overdose; decongestants and antihistamines are therefore not advised below 12. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) The common-cold article sets its own floor lower still: these medicines should not be given at all below the age of 4, for safety and for lack of any benefit. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) WHY THEY ARE DANGEROUS, NOT MERELY USELESS - below the age of 6, both prescribed and over-the-counter cough and cold medicines carry real risk, and an overdose of an antihistamine or a decongestant can kill. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) CODEINE - do not use it in children. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) DEXTROMETHORPHAN - THE DOCUMENTS DISAGREE, AND BOTH ARE ON THE CARD. The clinical articles find no proven benefit in children for either dextromethorphan or codeine as cough suppressants, whether alone or combined with guaifenesin, and no definite benefit in adults either. The Egyptian formulary allows the syrup from 6 years and contraindicates it below that age; the tablets are contraindicated below 12 years altogether. It is not offered as a row here because no opened document shows a benefit in a child. BENZONATATE - its safety and effectiveness are not properly established, and it is not advised below the age of 10. (Upper Respiratory Tract Infections With Focus on The Common Cold, StatPearls/NCBI Bookshelf, NBK532961) RED FLAG - THE FEATURES THAT MEAN THIS IS NOT A CHEST COLD: abnormal observations, low oxygen, blue lips, a change in consciousness, vomiting, pneumonia that keeps coming back, a weakened immune system, trouble swallowing, and a child who has gone off food. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) RED FLAG - INHALED FOREIGN BODY: a story of choking, in a child above all, should put inhalation of a foreign body on the list. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) A cough that started in one second, in a well child, is a foreign body until a chest is imaged. RED FLAG - PNEUMONIA: where pneumonia is suspected the usual work-up is a chest X-ray and a full blood count, with CRP checked selectively - a CRP over 30 mg/L in a fitting clinical picture makes pneumonia more likely. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) Otherwise these are clinical diagnoses needing no imaging or blood tests unless something warns of a complication - that covers acute bronchitis, most viral infections of the upper airway, acute rhinosinusitis and allergic rhinitis. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) UNDER TWO WITH WHEEZE AND FAST BREATHING IS BRONCHIOLITIS, NOT THIS - bronchiolitis mostly strikes below age 2. It opens with upper-airway symptoms, then wheeze, crackles, fast breathing, indrawing, and sometimes fever. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) A WET COUGH THAT WILL NOT STOP IS A DIFFERENT DIAGNOSIS - protracted bacterial bronchitis is a wet cough going on 4 weeks or more, with normal spirometry and a chest film that is normal apart from possible peribronchial cuffing, and it clears on 2 weeks of the right antibiotic. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) That two-week course is a decision made after four weeks of cough, not at the first visit. THINK OF PERTUSSIS IN THE PAROXYSMAL COUGH, and of asthma in the child who coughs at night and on exercise - asthma is the commonest cause of chronic cough in children. REVIEW BEFORE ESCALATING - in children of 14 and under with no warning signs, the article's stepwise plan opens with spirometry and, where it can be done, a measurement of exhaled nitric oxide, and only then a chest X-ray. (Cough: Evaluation and Management, StatPearls/NCBI Bookshelf, NBK493221) None of that belongs to a first presentation of an acute cough. 3. PARACETAMOL [add-on - not a substitute] Adult Not applicable - pediatric entry - According to clinical response Peds 15 mg/kg/dose [child max 500 mg] (A child of 1 month and over takes 15 mg/kg given 3 or 4 times daily, to a maximum of 60 mg/kg daily; under 1 month it is 10 mg/kg given 3 or 4 times daily, to a maximum of 40 mg/kg daily. By the MSF weight table, the 120 mg/5 mL suspension is given as 2.5 mL three times daily at 4 to under 6 kg, 4 mL at 6 to under 10 kg, 6 mL at 10 to under 15 kg, 8 mL at 15 to under 20 kg and 12 mL at 20 to under 30 kg; from 30 to under 50 kg the same table switches to one 500 mg tablet three times daily, which is the single-dose ceiling shown above.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - Paracetamol = acetaminophen (oral) Why The indication is stated by the cough article, which names the drug rather than a class: taken briefly, paracetamol or an NSAID relieves the fever, the headache, the aching muscles and joints, the ear pain and the malaise, the two working about as well as each other and both tolerated well. That article prints no dose, so the dose comes from a second opened document, the MSF monograph for the same drug under its Egyptian register name; its indications are mild pain and fever, and its paediatric dose is 15 mg/kg given 3 or 4 times daily for a child of 1 month and over, capped at 60 mg/kg daily. It is here for the fever and the misery, not for the cough, which it does not touch. Caution IT DOES NOT TREAT THE COUGH. Paracetamol has no anti-inflammatory action. It is given for fever and discomfort, and a child who is comfortable without it does not need it. MIND THE OTHER BOTTLE IN THE HOUSE. Many Egyptian cold preparations already contain paracetamol; a parent giving a combination syrup plus a paracetamol syrup can pass the daily maximum without knowing. REDUCE IT IN THE MALNOURISHED CHILD - in severe acute malnutrition give 10 mg/kg, and no more than 3 doses in 24 hours. AND IN DENGUE WITH WARNING SIGNS - for a child, 10 mg/kg given 3 to 4 times a day. LIVER - use it carefully in anyone whose liver function is impaired. Intravenous N-acetylcysteine is the antidote in paracetamol poisoning. SAFE WHERE ASPIRIN IS NOT - paracetamol is the preferred choice for anyone allergic to aspirin, for those with a history of stomach trouble, in pregnancy and breastfeeding, and in children. Egypt CETAMOL 120MG/5ML PEDIATRIC SYRUP 120 ML MEMPHIS 8.50 EGP PARAGESIC BABY 120MG/5ML 120ML SUSP. AMRIYA 36.00 EGP PARAMOL 120MG/5ML SYRUP 125ML MISR 36.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral liquid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral liquid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)