With respiratory illnesses on the rise for both adults and children, many families are turning to cough medications for much-needed seasonal relief. Cook Children’s Health Care System is providing essential safety guidance regarding Tessalon Perles (benzonatate) after seeing cases of accidental ingestion. While effective for older children and adults, health experts are highlighting the importance of strict storage and dosing to prevent accidental ingestion in younger children.

 “Tessalon Perles are used to treat cough for kids over 10 but no safe dosing for younger children has been established,” said Mariana Wilson, M.D., medical director, Cook Children’s Medical Center- Prosper hospitalist. 

Because these liquid-filled capsules can resemble candy, they pose a significant risk to toddlers. Clinical data shows that even a small amount of benzonatate can be toxic to a young child; a recent tragedy in Denton County has prompted local experts to remind families of the need for secure storage.

“Unintentional poisoning can happen to anyone, at any age,” said Klaressa Broughton, poison prevention program coordinator at the Center for Community Health. Broughton explains that these incidents, affecting children from birth through age 18, primarily involved medications and unspecified non-drug poisonings.

In 2025, Cook Children’s Medical Center - Fort Worth saw an increase of poisoning encounters: 1,031 cases compared to 818 in 2024. Broughton explains that the top poisoning for 2025 involved children of all ages from birth to 18 and were related to medication and unspecified non-drug poisonings.  

“If the capsules are chewed, then release of benzonatate from the capsule in the mouth can produce a temporary numbing of the mouth and choking could occur,” explained Wilson. “If parents find a chewed capsule, even if it’s not completely consumed, they should call poison control or come to the ED,” said Wilson.

Cook Children’s experts share what care givers should know to keep their children safe.

Symptoms of Overdose

Symptoms of a benzonatate overdose can appear rapidly, often within 15 to 20 minutes of ingestion:

• Restlessness
• Tremors
• Convulsions
• Coma
• Cardiac arrest

“With technology at our fingertips, it is easy to turn to the internet browser for answers, but this can lead to unclear next steps,” said Broughton. “Calling the poison center at 1-800-222-1222 is free, confidential and all calls are answered by specially trained nurses, doctors and pharmacists.”

If a child becomes unresponsive, call 911 immediately.

Tips for Poison Prevention: 

Safe Medication Dosing 

• Follow the dosing directions listed on the medication by using the appropriate measuring items, such as a medicine cup or oral syringe.
• Double dosing is NOT twice as effective, and in many instances can cause internal damage.
• Adult medications may be too strong for children and should not be given in half doses. Only give medicine to your child that is intended for children.
• Print the medication schedule to keep the right dosage for your family. 

Safe Storage 

• Many people leave medications on bathroom and kitchen counters as well as bedroom nightstands as a visual reminder to take them. Avoid unintentional injury and store medication up high, locked, and out of reach.
• Hang purses and personal bags up high so children cannot reach prescriptions, vitamins, or other regularly used medications.
• Remember, when visiting friends and family, it is ok to have an open discussion about safe storage. 

Safe Disposal 

• DEA Drug Take Back Day is on April 25th from 10 a.m.-2 p.m.
• Visit a medication drop box at a local pharmacy. For more information on poison prevention, visit www.meddropbox.org.
• The best disposal option is to find a drug take-back location, which may be found in retail, hospital, pharmacies, and/or law enforcement facilities.
• Removing any unused or expired medication in the home can reduce the risk of access. 

 Related Stories:

• Expert Tips for a Safe Spring Break: Poison Prevention
• Know When to Use Telemedicine, Urgent Care, or the ER for Kids
• The Ultimate Holiday Safety Checklist

The Texas Department of State Health Services (DSHS) has issued a health alert for pertussis, also known as whooping cough, for the second consecutive year. From January through October, more than 3,500 cases have been reported throughout the state. Initial data indicate that 85% of cases are pediatric.

Pertussis is a highly contagious respiratory infection, according to KidsHealth, an educational partner of Cook Children’s Health Care System. In children and adults, whooping cough often presents as a common cold in the early stages, with symptoms that could include congestion, fever, and a cough.

Alice Phillips, M.D., director of Ambulatory Quality and Safety at Cook Children’s Health Care System, explains that in infants, a coughing fit may cause them to struggle to catch their breath. They breathe in as hard as they can to get oxygen, creating the characteristic “whooping” noise. 

“In Texas, as of October 2025, there have been over 3,500 cases of whooping cough reported compared to 1,907 in 2024,” said Dr. Phillips. “With most cases occurring historically in November and December, more is likely to come.”

Children less than a year old are most at risk of complications, with infants less than two months old being at the highest risk. However, immunizations can protect the most vulnerable, Dr. Phillips explains.

“Vaccination is key to protecting your child,” said Dr. Phillips.

The Tdap and DTaP (diphtheria, tetanus, and pertussis) vaccine protects people from diphtheria, tetanus, and whooping cough. Dr. Phillips explains the difference between the two: DTaP is for children younger than 7 and Tdap for patients older than 7. 

Vaccine Recommendation:

As of October 2025, Cook Children’s Health Care System had 28 admissions due to whooping cough, with seven being infants less than 2 months old.

“Because of this, it is recommended that all adults caring for newborns receive a whooping cough vaccine booster,” said Dr. Phillips.

Adults do not present the same symptoms as children, making them vulnerable to giving an infant whooping cough. The American Academy of Pediatrics (AAP) recommends vaccines for protection.

Vaccine schedule:

• DTaP for infants: receive vaccines at 2, 4, 6, and 15 months.
• DTaP for Children: receive boosters to maintain their immunity at ages 4 and 6 years.
• Tdap for Children: 11 to 12 years.
• Tdap for Adults: Recommended during pregnancy or for adults who will be around newborn babies.

Treatment: Since bacteria cause whooping cough, antibiotics are the trusted standard of care by physicians, but early recognition is important for the best response to treatment and to prevent spread.

Symptoms: Infants may experience symptoms like struggling to breathe, unexpected intervals where breathing stops, and apnea.

Prevention:  In addition to getting vaccinated, there are other ways to prevent the spread of whooping cough.

• It is recommended to stay home for at least five days after starting antibiotics or at least 21 days if not treated.
• Washing your hands.
• Cover your mouth and nose when coughing or sneezing.
• Avoid close contact with a sick person.

If you think your child has pertussis or has been exposed, contact your pediatrician. If difficulty breathing occurs, call 911 or go to the nearest emergency department.

There’s been a ton of surprises related to the COVID pandemic and skipping flu season last year was another one I never saw coming.

Masks and social distancing definitely played a role but the absolute lack of cases was still shocking.

So, will we get lucky again this year?

I doubt it.

And here’s 3 reasons why:

1. Social distancing and masking are going away or gone. And we all want to get to that place…but it does mean we’re likely to have flu cases spread among classmates and families.
2. Skipping a flu season last year may make individuals more vulnerable to flu this year. Our bodies haven’t seen flu for almost two years. And just like our other colds went wild in kids this fall, flu could do the same this winter.
3. A mild or absent flu season last year may make people more likely to skip their flu shot this year. “Do we really need one after last year?” is a common question I have been asked.

What can you do to protect your child and their friends?

Get them their flu shot. Now’s not the time to get cute. Just do it.

Start to work with your child on hand-washing and covering their coughs. We need to protect ourselves and others.

Keep your child home if they are sick. If something seems to be brewing, give it a day to develop at home.

The Centers for Disease Control and Prevention (CDC) is discouraging trick-or-treating nationwide, calling it a high-risk activity for spreading COVID-19. They’re also dissuading trunk-or-treat events (where treats are distributed from trunks of cars in parking lots), indoor parties and haunted houses.

So why are these Halloween favorites considered high-risk?

“We know outdoor activities are much safer than indoor activities,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children's. “The problem is coming in close contact with people you’re not around regularly, like family members.”

She says masks have been very beneficial in slowing the spread of COVID-19, but warns of a recent rise in cases in Fort Worth and surrounding areas.

“Tarrant County has had an increase in COVID-19 cases over the last couple of weeks, and our positivity rate is hanging around 10% or 11%, which is pretty high,” she said. “The State of Texas is several percentage points below that right now. So now is not a good time to increase face-to-face contact locally.”

As of Oct. 5, 672 people had died of COVID-19 in Tarrant County, and nearly 45,000 others have recovered from the virus. With the current uptick, Dr. Whitworth says maintaining six feet of distance from other people is critically important, regardless of the activity.

“When you talk and exhale, you have droplets come out of your mouth and your nose that you don't see. There are a lot of them and they typically fall within three feet, but not always. You may talk louder or you may cough and they might travel farther. This is why the recommendation is to stay six feet apart” Dr. Whitworth explained. “It is less risky if you're outside because most of those droplets are diffused away and diluted outdoors. Of course, it’s even safer if you can wear a mask.”

In case you’re wondering, she isn’t talking about a Halloween mask. Dr. Whitworth says typical Halloween masks have openings for the mouth and nose, which defeats the purpose of stopping the spread of droplets.

But Halloween doesn’t have to lose all of its magic. Rayne Delgado, program coordinator for the Child Life Zone at Cook Children’s, has suggestions on how to make Halloween fun and safe for children this year.

“There are a lot of things families can do instead of trick-or-treating, like scavenger hunts in the house, family movie night and games.” Rayne said. “Pinterest also has a ton of craft ideas that meet all budgets.”

Here are some specific ideas Rayne shared with us:

Sensory fun

• Make Halloween slime and add googly eyes or critters in it
• Create sensory boxes filled with Halloween candy to find
• Build sensory bins with things like fake spider webbing, dyed-spaghetti noodles, soapy water, black beans, crushed graham crackers, un-popped popcorn, dyed rice, and Halloween trinkets (If age-appropriate)

Cooking activities

• Pumpkin face homemade pizza
• Dessert pizza using Halloween candy
• Carmel apples
• Ice cream cone witches hats
• Mummy hot dogs

Games

• Play Halloween-themed bingo
• Create a family mystery game with a play on Clue.
  • Using different rooms in your house, family members are the characters. Swap weapons for costumes.
  • Try to figure out which family member stole what piece of candy from what room, while wearing which costume. (This can also be done virtually with children and their friends. Switch rooms to each other’s houses.)
• Create an escape room in the house.
  • Start with one envelope that needs to be solved. That leads to another with another puzzle and so on until you find the bucket of trinkets/candy.
• Have a costume contest
  • Find things in the house to play dress up with. Who can be the most creative or silliest?

(We have provided templates in the 'Downloads' section of this article.)

Kids are gross.

Germs and kids are doubly gross.

As parents, we know this is true, especially during this time of year. The illness visits are piling up in my office and throughout the Cook Children's system. The days off school are starting. Missed workdays are causing stress.

We all hate this part of winter.

In my office, we're seeing lots of barky coughs from croup. We've also seen a ton of kids with sore throats from strep and viruses. Lots of fever from ear infections and flu season is just around the corner.

So what do you do? How do you survive the winter and keep your child healthy?

There's no magic vitamin. There's no magical food. There's no magical anything.

But here's something you can do: teach them not to be (as) gross.

1. Kids, stop licking and chewing stuff: Not the table, not your clothes, not your friends. There is nothing you can lick except your food, and really, you should chew it.
2. Kids, wash your hands. Several times a day. Wash them after you eat. Wash them after you go to the bathroom. Wash them just because you need to wash your hands. Get those germs off.
3. Kids, cough into the crook of your elbow. Don't cough on your classmates or your teacher (this isn't going to get you out of a test). Don't cough into your hands because then you will be spreading germs around the next time you touch someone or hand something to a classmate or sibling. 
4. Kids quit sucking your snot back up into your nose. You're driving us all crazy and making us all nauseous. It's disgusting. Really. And it's also bad for you. Get that crud out of your nose and out of your body.
5. Kids, stay home from school if you're sick. If you have a fever, it's not allergies, and no, you can't take Motrin on your way into school to make it through the day. (Ok, kids. This one was more for your parents.)

I'm sure there's more. What other lessons should we teach our kids so they won't be as gross this winter?

Stay well,

Doc Smitty

When parents report a croupy cough, it means different things. Some parents call bad/deep/dry/wet/rattly coughs croupy.

When I think of “croupy cough,” I mean “barky” like a dog or a seal. We are seeing quite a bit of croup this winter so I thought a quick update might be in order.

Age (When will my kid stop barking?)

The disease typically occurs between 6-36 months (can be as young as 3 mo but usually not older than 6 years).

Season (What time of year does my kid bark?)

Infections typically occur in the fall to mid-winter.

Time (When will my kid bark?)

Most ER admissions for croup occur between 10 p.m. - 4 a.m.. Unfortunately, things really can get worse at night.

Pathology (What makes my kid bark?)

Initially, the virus infects the nose and throat and then spreads downward causing swelling in the area just below the vocal cords. When looking with a camera at this area, there is a lot of swelling and redness (inflammation). The vocal cords themselves can also become swollen, causing them not to close as well. This is what can cause children to have a hoarse quality to their voices when they speak. The speed of the air as it travels through this area coupled with the swelling and inflammation causes the noisy breathing and barky cough.

Recurrence (Why does my kid get croup over and over again?)

Research has shown that some children are more prone to croup than others. I think that this has something to do with shape of the area around their vocal cords, consequently putting them more at risk for difficulty breathing and barky cough with any viral infection.

Treatments (What do I do for my little seal?)

All the treatments listed are intended to reduce the swelling in the vocal cords and below, helping your child to be more comfortable.

1. Warm steam – We used to put kids in croup tents where we pumped a humidifier in to get the humidity way up. To achieve the same affect, you can turn on the shower in the bathroom and just sit with the child. You can also run a humidifier in the child’s room.
2. Cold steam – Open the freezer door and put the child’s face in front of the steam the freezer emits.
3. Steroids – Giving the child steroids by mouth (or a shot in severe cases).
4. Racemic epinephrine – This is a specific breathing treatment that currently can only be given in the office or hospital.

Two take home tips:

1. The next time your child is barky, feel free to come in and tell us that your child is “croupy.” However, if your child isn’t sounding like a little seal, it’s helpful to try to find a different word to describe the sound of his or her cough, as there are many different causes for the different sounds of a cough.

2. If I start to explain this process to you in the office, stop me and say, “I got this. I read your blog about it.” Nothing would make me happier.

Effectiveness/General Use

Do they really work or is it a mind over matter thing?

I think that there are probably some uses for oils that will be studied and proven to work. I think these will be pretty rare and only a small fraction of the claims that are currently made.

So, is it mind of matter (placebo)? Here are some of the most common uses I see for oils in kids:

Teething - It’s not even clear what symptoms teething causes …fussiness, fever, runny nose, etc have all come into question. But, if you give an oil and a symptom goes away, does that mean the oil fixed it? Not likely.

Fever - Fevers come and go during the day with illness, even without medication.

Cough/congestion - The regimens I see where children have oils placed frequently basically make it impossible to know if they do anything for these symptoms. Cough/congestion will be worse at certain times of day and better at others treatment or no.

How close are we to having actual research on the use of oils?

I still think we are quite some time away. Those that are currently doing research are often biased, are not doing high-quality studies and are using small sample sizes.

Marketing

Why are they sold through multi-level marketing (MLM)?

It’s a fast way to get a product out there and make a lot of money. Since I’ve been on social media, I’ve seen several of these types of MLM ideas crop up. The difference with these is I have some specific knowledge about the conditions they are being used for and specific concerns about how their use could harm a population of people that I care very much about. I know very little about bags and good smelling wax that can be melted with a light-bulb so I haven’t gotten involved until now.

In many ways, it protects the big company because they are not the ones out there making claims about the oils and what they can do. That falls to their independent distributors. If someone were to have a bad outcome because of their use of essential oils, who is responsible? If I prescribe a medicine that someone is allergic to, that responsibility falls squarely on my shoulders, not the makers of amoxicillin. If I prescribe the wrong medicine for a kids asthma and something bad happens, that responsibility falls to me.

Are they an increasingly popular trend or just something I was not aware of?

I’m not sure but it certainly does feel like they are gaining in popularity. Social media makes it seem that way at least.

Do you believe the claim that certain brands of oils are superior to others?

I’m sure there are differences but since we don’t even know what they do for the most part, it’s hard to answer this question.

Philosophy/Opinion

Regarding writing about essential oils: Are you mad, man?

Yes, in fact, I think I must be.

What’s the number one reason you see parents using oils instead of medicine?

In general, people are becoming less trusting of experts and organized institutions. Medicine and doctors are no different. The gap between what a doctor knows and what patients know shrinks every day. People can find out information about their conditions and know basically the treatment options that exist. People are looking to live more natural lives and most who use them feel that oils fit within that idea. When you combine these two issues, right or wrong, essential oils seem to step in the gap.

What is a good way to communicate with your doctor about your use of essential oils (for specific conditions and generally)?

I think it’s important to be honest with you doctor about your use of essential oils. As new information is uncovered it would be important for your doctor to be able to show you new research etc, especially if something shows a particular oil to be unsafe. They can only do this if they know about your use of them. Also, as doctors are prescribing medications, we need to know anything you might be on that could cause a drug interaction.

What is your take on the potential political barriers to the study of essential oils given that they are not backed by super profitable pharmaceutical companies?

Young Living is a very profitable company. They are big and profitable and will only continue to be more profitable. There is no reason that they could not start testing their own products or set up independent testing.

After your research as a pediatrician, would you use them on your children?

People will read all of this information or even do further research and come to different conclusions from me but here are two reasons I won’t:

1. I do not treat my kids with unnecessary medications. Since they are recommended for symptoms and given with the hopes of reliving those symptoms, I consider these oils to be medication.

2. I believe that, due to the lack of good studies, the use of them in children should be considered experimental at this point.

Summary

• The use of essential oils seems to be growing.
• The evidence for their use in children is slim.
• Talk with your doctor about the products you are using so that they can be aware of potential safety issues and medication interactions. 

Previous articles on this topic:

• New York Times Report: Are Essential Oils Safe For Kids?
• Essential oils and their use on children
• How safe are essential oils for children?

Lots of RSV. Last week of the 422 kids tested at Cook Children's, 137 had RSV and six had Flu A. 

So there's probably lots of coughing at your house as you prepare for your Thanksgiving travels. But keep this in mind: Coughing is good. GOOD! Here's why:

1. We need it! Coughing helps us to perform the "clean-up" process with each and every cold. If you don't cough, the mucus gets in the chest, and that's how pneumonia happens. So...most of the time, cough is Ok! And you can expect it for at least 7-10 days with colds.

2. Sometimes if kids have a hard cough, they gag and puke. While this is scary, it's OK and sometimes a normal part of the process. Always let us know if this seems to be worsening/happening more often though. Or if your kiddo has a new fever with it, or seems more fatigued.

3. Coughing with viral illnesses (colds) tends to happen more at night and first thing in the morning. This has to do with the physics of the postnasal drip when we lay down, and in the mornings we do a lot of hacking to clean up all the sludge that settled in the airways overnight.

4. Sometimes, people worry about "feeling the cough in the chest". This is often due to how air rolls over mucus in the nose and tree trunks that go to the lungs (bronchi) and doesn't necessarily mean anything is wrong. If your kiddo is happy and playful and otherwise well, let it be.

5. Don't be frustrated if your kiddo coughs up some wet stuff, and then swallows it. People try really hard to get their kids to spit it out - it's OK if they don't. We cough, swallow that mucus, and then poop it out. This is why many people get looser stools with colds (adults and kids). 

It hasn't always been easy for us this year. At 4 a.m. or so during Thanksgiving, I heard the telltale "croup cough" coming from my daughter's monitor. It's such a scary sound - that weird bark coming from deep inside your child's chest. They panic, and you panic. They were fine earlier...now this? I took this photo of her at a golf course near our house a mere hours before bed.

The hoarse cry, the worry in her eyes, the sometimes high fever (hers was 102 and making her feel miserable), and a cough that rivals any seal's bellow. And it's always in the middle of the night. Why can't croup make its appearance at lunchtime? 

I remembered the most important thing to do is to keep her calm, and comfortable. The coughing, the gagging, the throat pain - croup is really mean.

I gave her a dose of Motrin, laid down in bed with her (for any of you who know me....you know this is waaay outta the norm for Dr. Diane, Captain Strict of Sleepland), ran my fingers through her curls, and propped her up on me to help her cough. In the morning, we will take a steamy shower with a bunch of toys, and take it easy.

Just a reminder that we are parents, too. We worry just as much as you do, and are losing just as much sleep But as my arm burned up with her fever heat, as my neck grew cramped from laying on 3 unicorns instead of my favorite pillow, I realized she won't always need me like this. In fact, one day, she'll probably kick me out of her room and tell me to leave her alone.

So I bent my pediatrician sleep rules a little bit. Parenting really turns you into a softie, doesn't it? 

Dr. Diane

Yep, it’s possible and it’s probably true. It might make you anxious. But, it might not mean there is anything to worry about.

Most children with a cough that lasts one week or less have viral infections which do not require antibiotics.

But what about when the cough lasts longer?

In a recent study of nearly 900 children seen for upper respiratory infections (most commonly cough and congestion), 3 out of 4 children continued to have cough at one week. We already know that, early in life, children have an average of 10-12 respiratory infections per year. Combine that with this new data and it’s possible your child could have some amount of cough nearly half of the time and still not have a significant underlying condition.

So, how long until you should be concerned?

In this study, 1 out of 4 children with upper respiratory infection continued to have cough at 4 weeks. Those children were evaluated by a pediatric pulmonologist and, at that point, were much more likely to be diagnosed with a bacterial infection or an underlying lung disease (such as asthma).

So, should you wait four weeks? Not necessarily. Consider these features which might mean that a trip to the doctor for cough is warranted:

1. Does the child have a history of respiratory illness such as asthma?

2. Is the child showing any signs of difficulty breathing?

3. Is the child drinking OK or otherwise acting sick with symptoms such as: fever, decreased activity or other symptoms?

4. Is the cough worsening after the first week?

If the answer to any of these questions is “Yes,” give your pediatrician a call.

It can be really hard to determine the cause of a cough just because of the sound. But here are some different types of coughs and the clues that might help you or the doctor know what is going on.

1. Short time period: Most coughs that last a few days are due to infection, most commonly viruses.
2. Long time period: Coughs that last longer bring up other possibilities, including sinus infections, allergies, asthma, or reflux.
3. Wet cough: Wet coughs with congestion can caused by a variety of reasons but are more commonly infections (most of which are viruses) or allergies. The presence of fever points towards infection while itchy or watery eyes suggest allergies.
4. Tight cough: A tight sounding cough can often be a sign of asthma. If your child has a history of wheezing or the cough is associated with exercise or weather change, think asthma.
5. Cough after eating: Yes, reflux can be a cause of chronic cough and it’s actually more common than you might think. Pay attention the timing and if certain foods might be triggers.
6. Barky cough: Think like a dog or seal. Croup is the most common cause of this type of cough. Usually the child will have runny nose and they can have fever as well. Steam is a good way to treat this cough so use a humidifier or the bathroom with the shower going. If severe or difficulty breathing, the doctor can provide steroids and other treatments.
7. Whooping cough: This cough is severe and comes in terrible spells that end in a whooping sound as the child breathes in. It requires a doctor’s visit and treatment so get it checked out soon.
8. Annoying, chronic throat clearing cough: This can be caused by many reasons but an important one to think about is tics. Children can have vocal tics that sound like throat clearing or even a mild cough.

There are lots of reasons why a child might be coughing but hopefully some of these tips will help you determine what you need to do next.

“Despite being a staple in pediatric care for decades, cough medicines don’t work,” said Justin Smith, M.D., a Cook Children’s pediatrician. “Since being first approved for use in children in 1976, they have failed to prove their effectiveness for acute cough.”

This message is echoed in a new video released by the American Chemical Society. In it, the narrator explains how antitussive drugs are supposed to block the body’s cough reflex. But most studies have found no evidence that over-the-counter medications actually work. Often, they proved no different than a placebo.

Not only do they not work, they can have serious side effects. Thousands of children are sent to the emergency room every year due to accidental overdoses on cough medicine. More than half of those are children under the age of six.

“I don’t give my children cough medicine and I don’t prescribe it for my patients,” said Dr. Smith. “Instead, parents need to know that keeping a child hydrated can help with a cough. By drinking plenty of fluids, kids are able to thin out any extra mucus triggering their cough.”

Dr. Smith says humidifiers are also helpful for children. You can place one in their bedroom while they’re sleeping to ease their breathing.

“In medicine, you have to weigh the risk with the reward. For cough medicines, there are numerous risks and possibly zero benefit.”

About the Source
Justin Smith is a pediatrician and the Medical Advisor for Digital Health for Cook Children's in Fort Worth, Texas. He has an active community on both Facebook and Twitter as @TheDocSmitty and writes weekly for Cook Children's checkupnewsroom.com. His interest in communications started when he realized that his parents were relying more on the internet for medical information. He believes that strategic use of social media and technology by pediatricians to connect with families can deepen their relationship and provide a new level of convenience for both of their busy lifestyles. Dr. Smith’s innovative pediatric clinic, a pediatric clinic “designed by you,” is set to open in Trophy Club in 2017.

Currently, I am the lone survivor of the war on Smith-Summertime-Flu-Like-Illness-2015.

You name the symptom and someone in my family has had it: fever, cough, runny nose, congestion, headache, sore throat, vomiting ... I could go on.

All of these symptoms are annoying. Running to grab the “puke bowl” when your 4 year old is “frowing up” is not my idea of a fun nor peaceful Wednesday evening. Trying to discern if his “headache” is really a headache, or fever or the early stages of some terrible bout with meningitis is not good for this pediatrician’s soul (nor his wife’s after she read this. It’s not meningitis, babe, I promise).

But the most annoying of all these symptoms for me is cough. When I have a cough, I generally try my best to keep it in for as long as I can, and let it go just before I feel like I’m going to drown in post-nasal drip. When my 6 year old has a cough, I’m pretty sure he feels like it is his duty to release that cough every five seconds. I think he does this just to remind me that he’s not feeling well and I haven’t given him anything to help.

Why don’t I give my kids cough medicines?

I don’t give cough medicine to my kids because they don’t work.

They really don’t.

Really.

The hard thing about this fact is that they were a staple of pediatric care for decades. Cough and cold medicines were first approved for use in children in 1976. There were no studies done to determine if they worked or what the appropriate dosing should be. I think the process back then went something like this:

“Why not give half the adult dose for children 5-12 and a quarter for the adult dose for children age 2-5?”

“Sounds good to me, let’s do this.” (Or maybe “Right on!” or “Groovy!” I don’t know, it was the 1970s.)

Since 1976 there have been several studies looking at the use of cough and cold medicines. The most recent review of the 25 best studies done stated this as a conclusion: “There is no good evidence for or against the effectiveness of OTC (over the counter) medicines for acute cough.”

I don’t give cough medicine to my kids because they can cause problems.

Side effects, even serious, even fatal ones, can occur as a result of giving kids (especially those under 6) cough medicines.

If you want to read some scary stories read these case reports from Pediatrics:

1. 3 year old ends up in ICU after becoming lethargic, having a slow heart rate, fast breathing and high blood pressure. Diagnosed with toxicity from Dimetapp (in this one we don’t know how much mom gave-could have been too much).

2. 3 year old being treated for pneumonia develops a fast heart rate, so fast that it start to interfere with the heart’s ability to work right. Parents were thinking they were giving Tylenol but ends up they were giving Tylenol Cold (acetaminophen, chlorpheniramine and dextromethorphan).

3. 9 month old boy is discharged from the ER with a diagnosis of pneumonia, doing well. Returns 12 hours later after being found cold, blue and not breathing. Unfortunately he dies after he is unable to be resuscitated. Toxicology on autopsy finds acetaminophen, pseudoephedrine, chlorpheniramine and dextromethorphan in the blood and heart tissue.

It is estimated that about 7.000 children are treated nationwide for toxicity related to cough and cold medicines and 64 percent of those are children under 6 years of age.

Everything in medicine is about weighing whether something works and if it could be harmful.

Cough medicines do not work and could cause harm, so my kids will pass.

P.S.

So will my patients because I don’t prescribe them either.

Are we there yet? “No. 5 more minutes.”

Are we there yet? “No. I will tell you when we get there!”

Did anyone hear this or something like it last week?

We’ve been asking a similar question to our favorite Cook Children’s microbiologist, Morgan Pence, Ph.D.

Is it here yet? No.

Flu season should be just around the corner, but it’s not here yet. Currently, there are only two regions showing Influenza activity across the state of Texas. Tarrant County is not one of those regions.

Flu season usually starts sometime in late October or November but occasionally we have later seasons. It appears that we are going to (knock on wood) make it till December before we see our first case at Cook Children’s this year.

There are few theories about why flu follows a seasonal pattern:

1.As weather gets colder and people are trapped indoors, the virus can more easily spread from person to person.

2.Colder temperatures lead to drier air. Dry air causes our noses to be drier which may make their defense against flu weaker.

3.Cold temperatures may allow the flu virus to live longer on surfaces.

Based on these theories, it’s possible that our warmer fall has caused a delay in the onset of flu season. With the colder temperatures last week, we may be reporting our first case soon.

Dr. Pence reports that our lab tested 74 specimens last week but none were positive for flu. She states, “Currently we are mostly seeing children with rhinovirus and RSV.” Rhinovirus causes the common cold. RSV can cause cold-like symptoms as well, but can be more severe in babies, especially those who were born premature.

What does this mean for you and your child?

1.If you haven’t yet, there’s still time to get your flu shot. (Even if the year starts late, it could still be a bad one).

2.Continue to teach your children to cover coughs and to wash hands.

3.Be aware if your child tests positive with a rapid flu screen, it may not be correct until flu activity is higher.

For now, Dr. Pence will still have to play the role of lab-mom.

Is it here yet? “No.”

Is it here yet? “No, probably 2-3 more weeks.”

Is it here yet? “No, but you’ll be the first to know!”

What should you do?

In today's My Kid Minute, Doc Smitty explains the most common causes of a cough and when you should be concerned. Take a minute and learn about your kid's cough.

Here's why:

There has been an outbreak of severe flu among dogs in the Midwest. Cases of the H3N2 strain have now been seen in dogs in Texas.

Most dogs have cough, runny nose and fever, but it has been severe and resulted in death in some.

So you may be wondering, “Is my child at risk if our dog has this flu?”

The answer, according to the CDC:

“To date, there is no evidence of transmission of canine influenza viruses from dogs to people and there has not been a single reported case of human infection with a canine influenza virus.”

That’s fortunate, but what are some health dangers associated with pets?

Bites

I’ve seen too many severe dog bites in my training to not mention bites first. The most common statement I hear about the dogs who bite is, “We just never thought he/she would do that.”

Dogs can be a great addition to a family but use caution:

• Be careful of rough play. Even a playful snip can be dangerous if it happens near the eye or a fingertip.

• Stay away from dogs when they are likely to be defensive: when they are eating, sleeping or taking care of puppies.

• Stay away from unfamiliar dogs or dogs that seems scared or anxious.

Here are some more tips from the ASPCA on how to avoid dog bites.

Allergies/Asthma

This is actually one of the most common questions I get regarding animals. It’s very intuitive. People can be allergic to dogs and cats, so wouldn’t owning one increase my child’s risk for allergies?

I have seen several studies that suggest the exact opposite. Often by having animals in the house early, kids may have slightly decreased risk of developing allergies. That said, if your child has frequent allergy and asthma symptoms, it may be reasonable to attempt to isolate the animal from the child for a bit to see if symptoms improve.

Infections

Infectious diseases are transmitted through animals frequently; think about the number of diseases that tics and mosquitoes can carry. Although it can happen, they are less frequently transmitted from pets.

Here is a list of pets and some of the diseases they can transmit:

Cats

Cat-scratch fever:

This disease is caused by bacterial infection (Bartonella) of an open wound or a bite that results in the breaking of skin. It is more commonly transmitted by kittens than older cats. Symptoms of the infection in humans are fever, headache and fatigue. There is often a large and tender lymph node near the site of the bite.

Toxoplasma:

Toxoplasma is usually a foodborne illness, but can be transmitted from cat feces. In people with normal immune systems, there are often no symptoms of toxoplasmosis. Pregnant women (and fetuses) are especially susceptible and, for that reason, should not handle cat litter boxes.

Dogs

Hookworms:

Dogs infected with hookworms can have bloody stools; which in severe cases can lead to anemia. Humans are infected by walking barefoot on contaminated soil and develop an interesting rash which consists of red, squiggly lines where the larvae have migrated under the skin.

Reptiles

Salmonella:

Salmonella is one of the most common pet-associated infections. It is estimated that 70,000 people will contract salmonella from pet reptiles. Salmonella generally causes bloody stools but in children and in people with weakened immune systems can be serious. The CDC recommends that houses with children less than 5 and with any household members with weakened immune systems not own reptiles as pets.

Many Animals

Campylobacter:

Ingesting food contaminated with the bacteria transmits most infections of campylobacter, but cases can occur from the handling of dog or cat feces. The main symptom of campylobacter infections is diarrhea (which can be bloody) and usually lasts about one week.

Ringworm:

The fungus that causes can be transmitted from many different animals but most commonly occurs from puppies and kittens. The appearance of the rash on human skin is a circular rash with a raised edge. It can be difficult to distinguish from eczema which sometimes causes circular patches as well.

Pets can be great additions to your family and, in most cases, will not cause any harm to your children. Be aware of the specific risks associated with certain types of pets and take caution to protect your children when appropriate.

Unfortunately, for many children, allergies are simply a way of life in Texas. Usually, allergies occur in kids beginning at the age 2 years and older.

Physicians don’t know why some children suffer reactions when exposed to allergens such as pollen, ragweed and mold that can cause allergic symptoms, while others experience no problems at all.

Sometimes parents aren’t sure if their child has a cold or allergies. Some say you can tell by looking at the mucus. That’s not really the case. The only way to tell for sure is by seeing your pediatrician. But if your child develops cold-like symptoms at the same time every year (now for instance), he or she probably suffer from seasonal allergies.

Symptoms of allergies are often times similar to a cold – sneezing, itchy nose and/or throat, nasal congestion, clear, runny nose and coughing. With a cold, the symptoms run its course over a matter of days. With an allergy, the symptoms last as long as the child is exposed to allergens.

Parents should be especially careful that their child doesn’t develop wheezing and/or shortness of breath. That may mean your child’s allergies have progressed into asthma.

It’s possible to relieve allergy symptoms by eliminating or reducing a child’s exposure to allergens. A key, as you hear so often with colds and flu, is for your child to wash his or her hands often. Also, children should change clothing and shower after playing outside. Please don’t let your child mow the lawn during this time of year if they suffer from allergies.

Educating your child early about what causes allergic reactions and allergy symptoms is a crucial step in helping your child reduce or prevent allergic reactions.

Sometimes no matter how much you try to prevent allergy symptoms in your child, they still occur. Fortunately, various treatments are available to help your child when an allergic reaction happens, including:

• Over-the-counter medications. Some decongestants, antihistamines and nasal sprays can be purchased without a prescription. But even if you are thinking about picking up something from the drug store, please do not do so without contacting your pediatrician.
• Prescription medications. Those with more severe allergies might need stronger versions of over-the-counter medications prescribed by their pediatrician.
• Immunotherapy. Also known as allergy shots, these injections of allergens into the body help patients build tolerance to help relieve symptoms.

Eventually, your child might grow out of his or her allergy. However, until he or she does, talk to a pediatrician or allergy specialist to determine the best treatment option for your child.

The flu season is upon us once again ... what do you need to know as a parent?

1.What are symptoms of the flu?

The flu may start like the common cold with symptoms of cough, congestion and runny nose, but may also be associated with prolonged fever, muscle and body aches and fatigue. It is spread from person to person when an infected person, coughs, sneezes or talks and droplets are released into the air. It can also be spread less often from touching surfaces where drops are present. The flu virus is contagious from up to 1 day before the person presents with symptoms and up to 5-7 days after the symptoms resolve.

2. How can you protect yourself?

The best way to protect yourself is by getting the flu vaccine as soon as it becomes available. Most doctors’ offices and clinics currently do have the flu vaccine available. Last year, flu activity peaked at the end of December to the beginning of January, but you may start seeing it as early as September-October this year.

Other means to protect yourself are effective hand washing and wiping down surfaces with anti-bacterial/viral cleansers.

3. Why get the flu vaccine?

In the United States each year, more than 200,000 people are hospitalized from seasonal flu-related complications. Last year, there were more than 105 pediatric flu related deaths in the United States. On average the effectiveness of the flu vaccine last season was about 61 percent.

4. Who should get the flu vaccine?

• Everyone over the age of 6 months.
• Higher risk populations include those between the ages of 6 months to 5 years, children with asthma or other chronic disease, pregnant women, people with immune problems and adults  more than 65 years old.
• Children under the age of 8 MAY require 2 doses of the vaccine 4 weeks apart from each other depending on their previous immunization status.

5. Which flu vaccine is recommended?

There are several options for flu vaccines this year. For 2014–15, U.S.-licensed influenza vaccines will contain the same vaccine virus strains as those in the 2013–14 vaccine.

Trivalent flu vaccine protects against two influenza A viruses (an H1N1 and an H3N2) and an influenza B virus. This is only available in the injectable form.

The quadrivalent flu vaccine protects against two influenza A viruses and two influenza B viruses. The quadrivalent form is available as an injection and a nasal spray.

Specific Age Recommendations

• 6 months to 2 years: injectable flu vaccine only.
• 2 years to 8 years: nasal form is preferable according the Centers for Disease Control and Prevention (CDC). There was 50 percent more effectiveness with the nasal form vs. the injectable form in this age group. If the child is between the ages of 2 and 4 and has asthma or wheezed in the last year, then the injectable form is recommended.
• 8 years and above: either form is acceptable.

6. What happens if you get the flu?

See your health care professional as soon as possible because if it is treated with anti-viral medications in the first 48 hours, the duration as well as the severity of the illness can be decreased. The CDC does not recommend treatment of healthy individuals with anti-viral drugs, but certain high risk populations will benefit from treatment.

I must get this question three to four times a day in the office and it's one of those things that keeps you up all night wondering what you should do. The answer, "There is no fever you should go to the ER for..."

That doesn't mean that children with fever don't sometimes need to go to the ER, but the height of the fever is not an indication that a late night drive and time in the ER wait is the right thing to do.

We always want to take the fever into the context of the following questions:

1) What are the other symptoms that the child is having?

• Runny nose, cough? Probably not.
• Abdominal pain? Depends on severity an location.
• Vomiting? Not if can keep some liquids down and still peeing.

2) What is the child's behavior like? Lethargic or active. Is the child laying around all day, not even really wanting to wake up to drink or do they perk up and act like they feel better at times (especially when their fever is down). If they are lethargic, bring them in.

3) Is the child drinking and peeing?  If so, then we will almost always recommend a call to the office over an ER trip.

Common fever myths:

"The child's brain will be fried if the temperature is over 105." Ummm. No. Temperatures that the body is generating on their own as a response to illness will not cause brain damage or any of the other things that your grandmother/neighbor/best friend said they would. We commonly have children with 105-106 temps walk in and out of our office smiling cause they got their stickers for being a good boy/girl.

"If the fever gets above 103 they will have a febrile seizure." Wrong again. In fact, most febrile seizures occur when the temperature is between 102 and 103. We don't know exactly why this is but it is thought that it is related to the rate that the temperature rises and not the absolute number that the temp gets to.

"The baby felt warm so she had a fever" or "The baby was really hot so the temperature must've been about 104." Sorry to the back of grandma's hand, but judging the temperature especially trying to put a number on it by touching a child's head is incredibly unreliable. I would prefer an axillary or temporal thermometer, or in the babies less than 3 months, I'll commonly ask for a rectal temp.

"He had a low grade temp of 99" or "99 is hot for him because he usually runs 96." “Low grade temp” should really be taken out of our vocabulary. They have done studies where they took children's temperatures several times a day and have found that any temp <100.5 in a child less then 3 months and <101 in an older child should not be considered fever. These are normal temperatures that can occur during the course of the day for any child who is healthy and has no reason to be running fever.

So, what temps should I call for?

• Any temp over 100 in a baby less than 3 months.
• Any temp in a child who is not drinking well and with decreased urine.
• Anything else that has you concerned.

The ultimate point is that we should not be afraid of fever. Fever is just another symptom in a long list of possible symptoms a child can have when they are sick. It means that we need to think about what is going on and watch the child close but resist the urge to panic!

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.