How to make my child cough?

Question

I have a preschooler with the common cold. She refuses to cough because it hurts her throat. I'm afraid she might get pneumonia if she doesn't cough - it happened before.

How can I make my child cough?

Answer 1

Normally, you can't make someone cough. You can encourage a child to imitate you, but inducing the act of coughing is actually very difficult. Since in many conditions (e.g. the long periods of inactivity following strokes) coughing is quite important to pulmonary health, inducing involuntary coughing has been studied. There are mechanical devices that can simulate cough, there is "pulmonary hygiene" for such situations, and there are even studies using nebulized irritants to induce involuntary coughing.

But there is no safe way to "make" your child cough, nor is it necessary or even advisable (you can check with her doctor about this), as normally healthy people do normally clear their secretions adequately. As your child grows out of toddlerhood, her risk of post-URI pneumonia falls quickly to normal adult levels. Making sure your child receives all her immunizations will help her as well.

Not all coughs are productive coughs, including the cough that comes from a sore throat. If she has a dry cough, she can cough 'til the cows come home; it won't help anything, and it will hurt her throat. People instinctively protect themselves by suppressing coughs like this.

If you think she has chest congestion, doing what you can to make moving the phlegm easier is beneficial. For example, keeping her well hydrated during a respiratory illness will also thin the mucus. Run a vaporizer by her bedside at night. You can also ask her doctor about her taking an expectorant.

To promote pulmonary health when she is congested, you can try giving her activities that cause her to take deep breaths if she is not coughing the thinned mucus spontaneously (kids don't spit, they swallow it, so sometimes it can be hard to tell). Having her make a pinwheel turn by blowing on it, blowing out candles, playing a game blowing a small piece of crumpled paper across a table into a "goal", etc. are all activities which will help clear her lungs, both by taking deep breaths and because taking deep breaths in the presence of tracheal irritation will set off coughing. Even better is making her laugh (which is why many asthmatics cough with laughing).

Coughing does hurt when the throat is inflamed. If you think she has a lot of mucus in her chest (you hear rattling or she's bringing up thick phlegm), you can help her cough once or twice a day with a planned "coughing session" (she need not cough all the time). Give her a pain medication (Tylenol, or whatever your doctor recommends) perhaps an hour before. Before you ask her to cough, give her a cough drop with local soothing properties. Then encourage the coughing by imitation or by making her laugh.

Having said all this, it's possible that your attempts to make her cough will backfire on you, making her resist all the more. Most healthy young people don't come down with pneumonia after a cold, and there is little that can be done to prevent viral pneumonia (e.g. during peak respiratory syncytial virus (RSV) season). I would recommend talking to her doctor about your fears. One episode of pneumonia in a child is not generally worrisome. Recurrent pneumonia in a child, however, is reason for a work-up for underlying illness.

Please note that common causes (Table 1 in below) are more common than uncommon causes (it sounds needless to say, but we fear the uncommon causes more).

Assessment of the child with recurrent chest infections
Understanding Pneumonia

Answer 2

My uncle was quadriplegic when I was growing up and now I have a 2 year old that has low muscle tone in the trunk so cannot cough on his own. For both, they have to be "helped" with coughing. You can pat the chest, back, and sides with a cupped hand to help loosen phlegm in the lungs. Do much lighter on the chest than the back/sides as the heart is closer to your patting there. On the sides, you pat under the arm about even with nipples. For the back, use about the same strength you use to burp a baby except you do left side and right side instead of in the middle on the spine. They also make these little compression cups with knobs that you can use instead of a cupped hand but we got those from my son's pulmonologist. But talk all of this over with your own doctor first and ask if he/she would be willing to demonstrate.