Dr Phil Kieran: What is the best treatment for a teen with a hacking cough?

If you think your child is significantly unwell and needs a doctor’s intervention, you are probably right, and if you think they are doing OK and you can manage them at home, you are probably correct too.

My 15-year-old son has a stubborn hacking cough. He took two days off school last week, which helped, but he hasn’t fully shaken it off yet. I’ve given him a cough bottle, but it doesn’t seem to be making any difference. At what point should I bring him to see a GP?

Respiratory infections are arguably the most common infections, and most, if not all, will include some degree of coughing. It is common for children to get over six viral respiratory infections per year.

Before we dig too deeply into why and when you should see your doctor, I would like to repeat something I tell every parent who asks me that question: trust your instincts. 

So, if you think your child is significantly unwell and needs a doctor’s intervention, you are probably right, and if you think they are doing OK and you can manage them at home, you are probably correct too.

We differentiate between viral and bacterial infections in medicine for practical reasons. Antibiotics target specific parts of bacterial metabolism, and therefore, we can use them to treat illness in certain cases. Viruses hijack human cells to reproduce, so we don’t have specific metabolic targets we can attack with medication. This means that for most viral illnesses, all we can do is support the immune system, which controls and then eradicates the infections.

Antibiotics in this setting are not only ineffective but can also wipe out the healthy bacteria in your system, which play a helpful role in your immune system.

In this particular case, I would say that if your 15-year-old is showing signs of improvement, there is almost certainly no benefit to bringing him to see his GP.

It is completely normal for a cough to take up to three weeks to settle down after an infection has passed. So you have the infection for three to four days, and the cough takes three weeks to settle. We are talking about 21-26 days of a cough.

As for cough bottles, I don’t use them and don’t usually recommend them. A 2023 review comparing honey to common ingredients in anti-cough medications found that honey is as effective for children over the age of 12 months.

You should go to your GP for a review if the cough has been going on for more than three weeks, if it is getting worse rapidly or if you are having trouble with your breathing.

These features may mean that we need to intervene to support the patient until they recover.

I would also say if you notice that your child gets a cough when they don’t have a cold, or at night, or with exercise, you should go to your GP. This cough could be asthma and would benefit from treatment.

• If you have a question for Dr Phil Kieran, please send it to [e-mail]