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.

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). 

Both allergies and colds share a lot of similar symptoms:

• Sore throat
• Runny nose 
• Sneezing 
• Coughing 
• Feeling tired 
• Feeling achy

Honestly, it can be hard even for us to tell the difference when we examine kids.

HOWEVER, you don't get a fever with allergies. If you have a little fever (or a big fever), that's most likely a cold.

ALSO,  "itchiness" in general of nose and eyes, makes me think more allergies than cold.

AND, the time is important - Did  it come on really quickly? That's most likely a cold. Has it been going on for months with a slow onset? Most likely allergies.

Both allergies and colds can make you more susceptible to other problems like ear infections and sinus infections. That's why we say if your symptoms are lasting longer than 2 weeks, come in and see us so we can help.

"How do I know what to do?" Well, that depends on a lot of things.

Is your child under age 1? If so - this is more likely a cold than allergies (a child has to be alive longer than a year to develop allergies to their environment). Elevate the head of their crib. Stick a blanket under the mattress. Would you want to lay flat on your back with a bad cold? Suck out all that snot with a Nose Frida (dont knock it til you try it). Use saline drops. Tylenol (or ibuprofen if over 6 months) for the headaches and throat pain. Run a hot shower and sit in a steamy bathroom for a bit. And lots of lovins. There ain't much you can do for the tiny ones. They just have to push through it.

If they're over age 1 and they have what seems to be a cold, try some honey along with all of the above. It's been proven to help just as much as medication. There are some over-the-counter medications that have honey in them too. I wouldn't try cold medicines until they're at least 4. Studies don't even show that they help much.

If it's allergies - you have lots of over the counter options like Benadryl, Zyrtec, Claritin, and Allegra. Some nose sprays are also very helpful and we can prescribe those in the office. And there is a prescription medication called montelukast that I find can help some kids.

Also, a wise allergist once told me that if you rinse out your kid's nostrils when they come indoors, it helps a lot (it washes away all the allergens/pollens clinging to the hairs in the nose and really helps symptoms go away faster). You could also try nasal saline spray here and just have them hold their head over the sink.

Hugs!

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.

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.