• Cough may be related to the disease, the treatment or may be unrelated
  • Cough can be a distressing symptom for the patient and interfere with sleep
  • Using cough suppressants (e.g. codeine, morphine) can bring symptomatic relief and improve quality of life
  • Coughing can be very exhausting for both the child and the family


(see Foreword)

  • A good clinical assessment is important to try and identify the underlying cause of the cough (e.g. pneumonia, CHF, pleural effusion, asthma, etc.)
  • Investigations to consider may include
    • Chest x-ray to assess possible cause


  • Consider treatment of the underlying cause (e.g. oncological treatment of tumour, draining of pleural effusion, treatment of infection, gastroreflux disease)

Consider if patient is well enough to benefit
  • Simple measures such as moist inhalations or nebulized 0.9% saline can be helpful
  • Simple cough suppressant may be tried
  • A weak opioid such as codeine 15-30 mg q4h PO or dextromethorphan 30 mg (or higher doses) q4h PO can be used to suppress cough
  • Morphine should be used if the cough is not suppressed by codeine or other means. The initial starting dose will depend on the patient’s previous exposure to opioids
  • Also consider a trial of dexamethasone 8 mg qAM PO
  • Inhaled corticosteroids or sodium cromoglycate may be helpful
  • For refractory symptoms consider nebulized local anaesthetics such as lignocaine/lidocaine 5 ml of 2% solution (without adrenaline) prn
  • If tenacious secretions are difficult to clear with coughing:
    • Consider using moist inhalations
    • Nebulized hypertonic saline can be effective
    • Try normal saline if this is not available
  • Children with persistent non productive cough (like adults) will benefit from opioids
  • Codeine
    • Children more than 6 months: 0.5-1.0 mg/kg q4h PO (max 60 mg/dose)
  • Morphine
    • Starting doses for opioid naïve infants less than 6 months: 0.01 mg/kg q4h SC/IV, or 0.02 mg/kg q4h PO
    • Starting dose for opioid naïve infants/children more than 6 months: 0.02 mg/kg q4h SC/IV or 0.04 mg/kg q4h PO



In patients in the final terminal phase, i.e. hours to days, antibiotics will make little difference to the course of events


  • A bedtime dose of codeine or morphine can help suppress the cough and allow for an undisturbed sleep


  1. Donaldson SH, Bennett WD, Zeman KL, Knowles MR, Tarran R, Boucher RC. Mucus clearance and lung function in cystic fibrosis with hypertonic saline. N Engl J Med 2006;354(3):241-250.
  2. Dudgeon DJ. Managing dyspnea and cough. Hematology-Oncology Clinics of North America 2002;16(3):557-577.
  3. Muers MF, Round CE. Palliation of symptoms in non-small cell lung cancer: a study by the Yorkshire Regional Cancer Organisation Thoracic Group. Thorax 1993;48(4):339-343.
  4. NHS Clinical Knowledge Summaries. Palliative cancer care – cough - management. [Online]. Available from: URL:
  5. Twycross R. Palliative care formulary. 2nd ed. Oxford:Radcliffe Publishing; 2002. p. 59-61.

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