Coughs: Herbal Treatment of Children

2015

A cough, nature’s way of cleansing the air passageways, is a reflex response to anything that threatens to block the throat or bronchial tubes, whether it be an irritant inhaled from the atmosphere, a piece of food going down the wrong way or an infection causing irritation and phlegm. For this reason it may not be advisable to give cough mixtures which suppress the cough reflex, since they prevent this protective action by the body and may predispose to further infection.

Congestion, irritation and infection in the chest, as elsewhere in the respiratory tract, can be related to poor digestion, toxins in the bowel, poor elimination via other pathways (skin, bowels and urine), lowered vitality, poor diet, lack of fresh air and exercise, insufficient sleep or stress. When the vitality of a child is already lowered, it is easy for the child to become affected by changes in the weather, from warm to cold or from dry to damp, and to succumb to a cough or cold, and it will be blamed on the weather, or the child getting chilled, and the more long-term causes may be ignored. It is important to consider both when treating children. After immunizations, the child’s immune system may be more vulnerable to infection and more prone to colds and coughs at this time, often coupled with a fever and malaise.

Emotional factors also play a considerable part (grief is the emotion which is traditionally connected to the lungs), and this can be related to moving from one school to another, one house to another, from loss of total attention once a baby brother or sister is born, or through parents arguing or divorcing, for example. If you feel that emotional stress plays a part, use supportive measures for the nervous system even before any physical symptoms arise.

Mucus-producing foods are best kept to a minimum during the winter months, particularly cow’s milk products, sugar and refined carbohydrates. Should a cold or cough develop, omit these completely from the diet. Chronic catarrh that may be linked to an excess of these foods can provide a hospitable environment for micro-organisms that affect the respiratory tract. Adding mild spices to a child’s diet may improve digestion, clear mucus and enhance immunity to infection (see also Immune System).

The herbal treatment of coughs will depend entirely on the type of cough a child has.

1. A cough with a fever may accompany an infection, such as bronchitis or pneumonia.

2. A loose cough with catarrh. There may be catarrh in the nose or throat which starts watery but then thickens as the infection resolves. The child coughs up copious mucus and tends to be worse at night when lying down.

3. A dry, irritating or croupy cough which often accompanies laryngitis, croup and tracheitis. It often starts at night with coughing bouts, during which it is hard for the child to draw air. The coughing may make the throat or trachea sore and the child distressed or irritable. The irritation in the throat or chest which produces a dry cough may also be caused by mucus draining from the back of the nose during a cold, with catarrh or from infected sinuses, which trickles down and irritates the throat. Other factors to be considered include chemicals in the atmosphere (passive smoking, paint fumes, and so on), irritation in the digestive tract or nervousness causing constriction in the throat area. It may also be related to a need for more attention.

4. An intermittent, chronic cough can continue between acute infections. There may be associated lethargy or debility, poor appetite, thick phlegm in the chest, swollen neck glands, and a generally catarrhal condition.

Bronchitis

Acute bronchitis can develop from a cold or sore throat, or as a complication of measles and whooping cough. Infection can either be viral or bacterial or more unusually, fungal. As the body rallies its defences to throw off the infection, the temperature rises and the child feels unwell.

Chronic bronchitis may develop after repeated bouts of acute bronchitis, by which time the child’s vitality is lowered and resistance to infection is reduced. This requires examination of the child’s constitution and background factors to lowered immunity including digestion and elimination, diet, exercise, allergies and the child’s emotional environment. In chronic bronchitis there is a low-grade infection or inflammation of the bronchial tubes, causing intermittent coughing and general debility. A chronic cough, can also involve allergy to certain foods or environmental pollutants (see Allergies).

Pneumonia

Pneumonia involves inflammation and infection of the lungs, usually by a virus or bacteria, sometimes a mycoplasma fungus. In children it occurs most often as a sequel to another respiratory infection such as a cold, flu or bronchitis. It may also be caused by the inhalation of irritant vapours or chemicals or by a foreign body, such as food or pus, which has carried pathogenic micro-organisms into the lungs. Pneumonia is an infection that indicates that the natural defences of the respiratory system are significantly compromised. The causes of lowered resistance include the effects of lifestyle – poor diet, weak digestion, lack of fresh air and exercise, pollution (from passive smoking, for example). It may also occur if a child is weakened by other pathology – cystic fibrosis, for instance – or poor nutrition as in malabsorption or if the lungs have been weakened by chronic problems, such as asthma, whooping cough or measles.

The alveoli of the lungs react like the rest of the respiratory system when irritated: they fill up with fluid, in this case exudate from the surrounding blood vessels. Now, instead of containing air, the affected alveoli are full of fluid, which reduces the available space in the lungs for breathing and exchange of oxygen and carbon dioxide. This causes shortness of air and produces breathing difficulties.

Herbal treatment of coughs

The herbal treatment of coughs is always aimed at assisting the homoeostatic mechanisms of the body. This includes helping the chest to clear itself of phlegm, inflammation and infection while, at the same time, using herbs to enhance the immune system. It is important at the same time to address underlying imbalance contributing to lowered immunity, particularly diet, digestion and elimination.

Cough with fever

Bronchitis and pneumonia produce coughs with a fever, as the body tries to throw off the infection. The fever tends to be at its highest while the cough is still dry and harsh, and comes down as the child perspires and the cough becomes looser and more productive. Herbs can be used as an adjunct to antibiotic treatment should this be necessary.

Herbs to help the body’s fight against infection and to resolve inflammation in the chest include echinacea, elecampane (Inula helenium), garlic, hyssop (Hyssopus off.) and thyme. One or two of these can be combined in a tea with diaphoretic herbs to bring down fever, such as chamomile, catnip (Nepeta cataria), elderflowers, hyssop, limeflowers (Tilia europea) and yarrow, and given every 2 hours. If the fever is high, use herbal teas separately to bring down the fever, and give them as frequently as you can (see Fever Management).

To help loosen and expel mucus and to soothe irritated bronchial tubes, expectorant herbs can be given, such as coltsfoot (Tussilago farfara), slippery elm (Ulmus fulva), liquorice, marshmallow (Althea off.), white horehound (Marrubium vulgare) or mullein, which are soothing for a dry cough, or ginger, aniseed (Pimpinella anisum), elecampane, hyssop (Hyssopus off.) or thyme, which are more stimulating for a productive cough. Elecampane root tea, with a small amount of ginger and liquorice and sweetened with honey, is pleasant tasting and I have found it generally effective for chest infections.

Garlic can be given as capsules every 2 hours, or as a honey, which is a useful way to give garlic to children. To make garlic honey cover four cloves of sliced or chopped garlic with 3 fl oz (100 ml) of runny honey. Leave overnight and then strain off the juice. Give in teaspoon (5 ml) doses several times a day. The honey itself has antimicrobial qualities.

Essential oils can be used for inhalations, baths, chest rubs, hand and foot baths and massage. Choose from eucalyptus, rosemary, lemon, lavender, pine and thyme, and dilute in a carrier oil such as sesame oil, 1-2 drops per 5 ml of carrier.

Catarrhal cough

Once a dry, irritating cough has become more loose and productive, expectoration of phlegm is required. A catarrhal cough can arise not only after a dry cough with fever but also with a cold, sore throat or influenza, which produces copious catarrh. Herbal treatment is aimed at clearing phlegm while enhancing the efforts of the immune system to fight off the infection.

Many herbs contain antimicrobial volatile oils and possess expectorant properties helping to loosen and expel phlegm. These include aniseed, rosemary, cinnamon, rose, ginger, hyssop and thyme, which can be taken in hot infusions, three to six cupfuls daily. Coltsfoot and horehound are also effective expectorants. Alternatively, thyme tea spiced with a little powdered ginger, cinnamon and cloves makes a stimulating and drying mixture. Garlic can be taken as capsules or in honey every 2 hours in the acute phase and three times daily until the cough has cleared.

Essential oils can be used for baths, inhalations, for massage to the throat, chest, back and feet, or used as hand and foot baths. Eucalyptus, ginger, lavender, pine, lemon or thyme are all suitable diluted in a base oil such as sesame.

Dry cough

A dry cough needs to be soothed and loosened by herbs with relaxing and demulcent properties, which also help to expel the loosened mucus. The following herbs can be taken in infusions or syrups: coltsfoot; slippery elm; linseed; liquorice; marshmallow; mullein or wild cherry bark (Prunus serotina).

If the child becomes distressed during the coughing bouts, it may make the cough worse. Relaxing herbs can be added to the prescription which will also help the child to relax and sleep at night, when a dry cough tends to be worse. Useful herbs include: chamomile, catmint (Nepeta cataria), cowslip flowers (Primula vera), lavender, melissa (Melissa off.) and limeflowers (Tilia europea).

As the cough improves it will begin to soften and the phlegm will become looser and easier to expel. You can now give the child expectorant herbs such as angelica (Angelica archangelica), aniseed, coltsfoot, elecampane, horehound, hyssop and thyme. To make thyme more palatable for small children, it can be given as a syrup. This is an effective remedy for relief of coughs, catarrh and sore throats. Take three handfuls of finely chopped thyme, cover them with runny honey and leave to macerate for a few hours. Alternatively, infuse one handful of chopped thyme in one cup of boiling water, until cool. Strain and add honey. This should be kept in a refrigerator and consumed within a few days. Give 1 tsp (5 ml) of either three or four times daily.

Another useful recipe for dry coughs is to add ½ – 1 tsp (2.5-5 ml) of a mixture of aniseed, coltsfoot, horehound, mullein and wild cherry to each cup of boiling water. Give this three to six times daily. Sweeten with honey if preferred.

Any of the above herbs can be used as strong infusions to add to bath water, especially for babies and small children, who will find it difficult to drink infusions. They can also be used for hand and foot baths, and as hot compresses applied to the chest and throat.

Essential oils can also be used in the bath, for hand and foot baths, steam inhalations, vaporizers and massage to chest, back or feet. Chamomile, eucalyptus, lemon, rosemary, lavender, pine and thyme are all applicable. Dry, croupy coughs respond well to steam and to humid atmospheres.

Frequent drinks of lemon and honey can also be given, to soothe the tickly cough. Garlic capsules, juice or honey can be given regularly three times a day until the child is completely recovered.

Chronic coughs

If a child’s vitality and resistance is lowered, chronic coughs can linger after an acute infection. This is more likely if a child has not rested sufficiently or if the acute infection was not treated correctly, or after antibiotics. Alternatively, it can develop after immunizations, notably whooping cough and polio. In any chronic condition the underlying causes of lowered vitality always require investigation, whether it is caused by weak digestion, poor diet, insufficient elimination of toxins, fresh air and exercise, emotional problems or overuse of antibiotics. It could also be related to pollution or allergy (see Immune System).

Herbal treatment needs to include remedies to enhance the digestion and the immune system, such as echinacea, garlic, rosemary, thyme and turmeric as well as general tonics for convalescence, including ashwagandha, cat’s claw (Uncaria tomentosa), marshmallow (Althea off.), astragalus (Astragalus membranaceus), burdock, liquorice, marigold and nettles. Resistant mucus can be expelled with the help of expectorant herbs such as aniseed, coltsfoot, elecampane, horehound, hyssop, liquorice, mullein and thyme. This may aggravate a chronic intermittent cough temporarily, but it becomes more productive and indicates that the child is more able to throw off the illness. Coltsfoot tea is considered the remedy of choice for chronic cough, as it contains bitter tonics as well as soothing and expectorant properties.

Hot lemon and honey drinks can be given regularly through the day. Supplements of garlic capsules, vitamin C and hemp seed oil can be taken to help the immune system. In acute infections, one or two garlic capsules and 100 mg vitamin C (chewable for children) can be taken every 2-3 hours; in chronic conditions, give three times daily. In either instance 1 tsp (5 ml) of hemp seed oil can be taken daily.

Blackcurrant tea can be effective for sore throats, coughs and catarrh.

Dilute essential oils can be used in baths, hand and foot baths, for inhalations, vaporizers, and chest massage. Choose from eucalyptus, lavender, rosemary, rose, lemon, pine and thyme.

A useful recipe to help ease bronchial congestion is onion syrup. Slice an onion into a small bowl and drizzle honey over it. Cover and leave to stand over-night. The child can be given a teaspoon in acute infections every 2 hours and in chronic coughs two or three times a day.

Ayurvedic approach

Coughs can be Vata type, Pitta type and Kapha type. They come in stages: first Vata type, then Vata and Kapha and when Pitta is involved there is accompanying infection.

Causes (Nidana)

According to Ayurveda a cough can be caused by Vata blocking Vata, for example dust, unwanted particles or something else causing constriction or obstruction of Prana and Udana Vayu. Vata derangement is caused by, for example, suppression of natural urges such as sneezing (which deranges Udana and Prana vayu), excess dry foods, irregular eating, fasting, overwork, exhaustion, stress, worry, fear, grief and dry cold weather.

The function of Udana Vayu is to exhale. The body has to collect energy to clear the obstruction, hence the cough. Secondary doshas can be involved and obstruct Vata. Kapha as phlegm can be involved, as symptoms occur in the chest which is the main Kapha site.

Pathogenesis (Samprapti)

Low digestive fire and ama causes Sama Kapha and disturbed Vata. This leads to constriction and drying in the mouth, throat and respiratory tract. Sama blocks Udana Vayu and Vata starts overworking to clear the obstruction. Vata comes up in bouts with force and friction causing coughing as it rushes against the vocal cords. The direction of Prana Vayu is changed though not as much as in asthma. Instead of coming in it comes out. Coughing should not be suppressed as it is a natural urge. Also when downward movement of Apana Vata is obstructed, as in constipation / wind, it begins to move upward to the chest and throat and eventually to the head. This affects the eyes, back, chest, ribs and eventually comes out of the mouth as a cough.

Prodromal signs include throat irritation, loss of taste and appetite, erratic / slow digestion, tickly cough, lethargy, insomnia and anxiety which indicate accumulation of Sama Kapha and derangement of Vata.

Signs and symptoms (Rupa)

Vata type: as chaya / accumulation of Vata increases into prakopa / aggravation, dryness is produced in the chest, throat, mouth, ribs, heart and head and results in a dry cough with violent bouts. There might also be mental agitation, pain or loss of voice.

Pitta type: bitter taste in the mouth, fever, dizziness, vomiting, thirst, hoarseness, acidity, continuous coughing and yellow phlegm.

Kapha type: mild pain in chest and head, heaviness, throat coughing, debility, runny nose, vomiting, loss of appetite and taste, thick, sticky white or clear mucus is expelled.

Vata type cough

In treatment of Vata type cough, Vata is reduced using ghee, oil enemas, a wholesome diet with basmati rice, whole wheat, barley gruel with bilva, ginger, Dashmul, chitrak (Plumbago zeylanicum), jaggery and black salt, warm and moist vegetables and sesame oil.

Ghee is mixed with Vata reducing herbs and formulae. These include ashwagandha, ginger, pippali, liquorice, calamus (Acorus calamus), chitrak, Dashmul, kapikachu (Mucuna pruriens), bala, guduchi, Triphala, Trikatu, gokshura (Tribulus terrestris) and shatavari. These herbs promote digestion and relieve coughs. Raw honey and sugar cane can be mixed with the herbs chosen and barley. Ghee should be taken before meals unless there is upper body dryness. For a Vata cough with phlegm: ginger, pippali, asafoetida, barley powder with ghee can be used.

Other therapies include massage and oil fomentations. For constipation and gas retention digestive herbs and bowel-cleansing herbs or enemas are recommended.

Other useful formulae

• Sitopaladi churna: Contains sugar, vamshalochan (Bamboo), pippali, cardamom, and cinnamon; 3-6 g in a teaspoon of honey and a little warm water to be taken am and pm.

• Talisadi churna can also be used in the same dose (see Asthma).

• Eladi gutika: Contains cardamom, cinnamon, pippali, sugar candy, liquorice, grapes (Vitis vinifera).

• Khajoor (Phoenix dactilifera) is recommended for chronic and dry cough; 1-4 tablets to be sucked slowly.

Pitta type cough

The traditional approach to treating Pitta would involve purgation using, for example, castor oil. To clear phlegm, Ayurvedic doctors administer emetics with ghee, liquorice and sugar cane. However, in the West we use expectorants to clear phlegm. After the doshas are cleansed, the child is put on Pitta reducing foods and liquids, i.e. those with cooling and sweet properties. Expectorants and Pitta reducing herbs can be used, including: lotus seeds (Nelumbo nucifera), pippali, musta (Cyperus rotundus), liquorice, fresh ginger, amalaki, sandalwood, bibhitaki, vamsha lochana (Bambusa bambos), gokshura, mixed with ghee, sugar cane and honey. For thick phlegm, dry and cooling foods and drinks are recommended. Neem and honey are added to the above herbs. Grape juice mixed with sugar cane, sugar cane water and milk is traditionally used in India.

Kapha type cough

In India, in the treatment of Kapha type cough, Ayurvedic doctors first administer an emetic if the child is strong, with barley and pungent herbs such as pippali. Here again expectorants are used in the West. Then castor oil is given as a purgative. Foods eaten by the child should be light, including vegetable soup, pippali, and a little ghee, sesame oil, mustard oil, honey and bilva fruit. Herbs including sandalwood, vasak (Adhatoda vasica), tulsi, apamarga (Achyranthes aspera), amalaki, musta, haritaki, calamus, bala, chitrak, punarnava (Boerhavia diffusa), amlavetasa (Garcinia pedunculata), bibhitaki, gokshura, ginger and black pepper mixed with raw honey are recommended.

Useful formulae

• Trikatu, taken with honey or hot water

• Lavangadi vati: contains cloves, black pepper

• Khadira (Acacia catechu) is prescribed for bronchitis, cough and phlegm.

Kapha / Vata type cough

Herbs used include pippali, ginger, musta, hari-taki, amalaki, made with honey and ghee.

Kapha / Pitta type cough

Pitta reducing herbs, i.e. bitters such as guduchi, chiretta (Swertia chireta) are recommended as well as vasak, turmeric, vamsha lochana, cardamom and honey.

Whooping cough

A child will be prone to pertussis infection if tired or run down, particularly if this is due to recurrent respiratory infections, with coughs, or if there is a history of asthma. A robust child should throw off whooping cough more easily than a child whose immunity is compromised. If there is weakness in the chest and a tendency to chronic catarrh, or congestion in the digestive tract, with a history of constipation, diarrhoea or tendency to tummy upsets, a child may be more susceptible and find the infection harder to fight off. It is important to work preventatively, to support the immune system, resolve tendencies to infection, catarrh or digestive disturbances as they arise, so that a child is able to withstand infection, by whooping cough or other respiratory infections, as best as possible (see Immune System). Infusions of antiseptic and decongestant herbs such as echinacea, coltsfoot, elderflowers, elecampane and thyme can be given as preventative medicine three times daily. These will help to strengthen the chest and clear phlegm as well as any digestive congestion. Garlic and vitamin C are useful supplements.

Although whooping cough can be a very distressing illness for both parents and children, the more reassuring aspect is that the onset is gradual. At the first signs of possible infection herbal treatment can be started immediately. There are from 10 days to 2 weeks to treat the child, before the coughing becomes more serious, and the whooping begins.

Herbal treatment of whooping cough

At the first signs of a cold or slight cough, infusions of sundew, coltsfoot, elecampane, and thyme can be given, sweetened with liquorice, and / or honey if necessary. Up to 4-6 cups a day is recommended.

Sundew (Drosera rotundifolia) is an effective herb against a number of infecting organisms (Streptococcus, Staphylococcus and Pneumococcus) as well as whooping cough. It contains a substance called plumbagin, which appears to be responsible for much of its beneficial effect. It also has a relaxing effect on the muscles in the bronchi, preventing spasm in a coughing bout. It is best used in small doses, and its effect has been confirmed to be most effective in whooping cough, especially when used with thyme.

Elecampane (Inula helenium) is a specific for irritating coughs in children, and particularly useful where there is profuse mucus as in whooping cough. It is relaxing to the bronchial muscles while, at the same time, stimulating the expulsion of mucus. It has an antibacterial action and is used effectively in bronchitis and pneumonia as well as whooping cough.

Coltsfoot (Tussilago farfara) relaxes and soothes the chest. With a demulcent and a gentle expectorant action, it helps to loosen and expel the mucus. It is a particularly good remedy for persistent coughs.

The volatile oils in thyme have an antiseptic action, which helps to resolve infection. Thyme is also a relaxant, reducing spasm in the bronchii while, at the same time, its expectorant action helps to loosen and expel mucus. Thyme can be used for any cough with spasm, combined with other herbs or simply as thyme tea or syrup.

If they are treated properly at the onset, the symptoms of whooping cough can be prevented from worsening to the point where the distressing coughing begins. If, however, serious coughing sets in, the same herbs can still be used, every hour or so, and one or both of the following herbs can be added to the prescription: wild cherry bark (Prunus serotina) (this has a powerful sedative action on the cough reflex, which is vital in the whooping stage) and wild lettuce (Lactuca villosa). A sedative and muscle relaxant, wild lettuce is especially useful where there is much fear and panic (it may be useful for parents as well). Tension will only aggravate the spasm in the bronchi, so it is most important that the child is kept as relaxed as possible. Red clover (Trifolium pratense) helps to relax bronchial spasm while, at the same time, it stimulates expectoration.

Herbs can be given in the following ways:

• Teas – to be taken as often as possible, sweetened with liquorice, honey or aniseed.

• Tinctures – easier because they are more concentrated. Between five and ten drops of a prescription can be given in thyme syrup or a drink every 2 hours. If the condition becomes more serious, they can be given every hour if necessary.

• Hand and foot baths – using teas or tinctures, diluted in water, these can be administered two or four times daily.

• Inhalations or baths using strong infusions or tinctures in hot water.

• Essential oils – choose from basil, cypress, eucalyptus, lavender, marjoram or thyme and use them as inhalations, in vaporizers, diluted in massage oils for the chest, feet or abdomen. A few drops can be put on the pillow at night, on a damp towel on the radiator or used in a plant spray to spray the room.

• Compresses – teas, tinctures or oils in warm water can be applied frequently to the chest.

Garlic, with its antiseptic action in the chest, is useful in the treatment of whooping cough. It relaxes the muscle in the bronchial tubes and helps expectoration. It can be given in capsules or juice, or in the following recipe:

Chop three heads of garlic and pour over ½ pint (300 ml) of boiling water. Cover. Leave to macerate for a day. Strain. Give 1 tbsp (20 ml) every one or two hours. Store in a refrigerator and use within 3-4 days.

Slippery elm (Ulmus fulva) food, made into a gruel and given three times daily, is also useful as it relaxes and soothes the chest, while being light, nutritious and easy to digest.

A child with whooping cough should eat only a light diet, with no milk products, no sugar, no starchy foods and plenty of soups, grated vegetables, fresh fruit, chicken or fish. Supplements of hemp seed oil (1 tsp / 5ml) daily, vitamin C (200 mg three times daily) and garlic juice, honey or capsules (every 2 hours) can be given.

It is important for the child to rest as much as possible to give the body a chance to rally its defences. Chamomile tea will help a child rest and sleep. Exertion can bring on coughing and deplete the child’s energy, so the child needs to be kept calm. Parental reassurance during coughing fits will probably be needed, as fear and panic will only serve to aggravate breathlessness and coughing.

If the child vomits after coughing, once the coughing bout has stopped, herb teas sweetened with honey can be given to prevent dehydration. Fresh air is always beneficial in the room, while chemicals and cigarette smoke may further aggravate coughing.