Constipation  and You – a healthier approach

[ The following post is for informational purposes only. This is not meant as medical advice. Please consult your physician or your child’s Pediatrician before treating any constipation symptoms. ]

I had a Gastroenterology attending who once told me from the day we are born until the day we die we all are fixated on our bowel movements. When , how , how much, how hard, how often?

Of course constipation can be a medical problem which requires immediate attention by a physician. [Any changes in your bowel habits please contact a medical professional]

The vast number of people in western cultures who suffer from constipation or are actively treating it belies the fact that this is really for the most part a man made problem. A large percentage of bowel and intestinal problems are self inflicted. Most constipation is behavioral including diet, lifestyle, and poor potty skills. To a much less extent,  especially in the elderly or patients  with chronic illness it is medical or genetic. Even colon cancer is now considered to be caused in part by your diet. Meaning the more fiber, more plant based, the faster your bm comes through the less you are constipated,  the less associated disease you may develop.

[Please consult your physician before treating any type of constipation on your own].

Is it part of our society, culture, diet , or is it a normal genetic variant as part of the human condition?

I believe that starting at birth with breastfeeding and following through with a primarily healthy plant based diet, humans would not be nearly as constipated. Ask your local neighborhood “healthy vegan” if they have problems passing stools . They will very gladly offer advice. But more than likely they will mention the virtues of fiber from plants and how they do not have to think twice about constipation quite the opposite.

What is constipation?

Reduction in normal frequency of stool to what is normal for age and individual, often accompanied by pain on defecation, hard stools,  difficulty in evacuating a stool, blood around it. No matter where you start if it becomes difficult to have a bowel movement or accompanied with pain or bleeding this is constipation or could have a medical source and need to seek advice from your physician..

Constipation by age:

Babies when breastfed can go 10 times a day or once a week . It’s the consistency that counts . Pushing for a long period of time and either not going , straining to go, or a hard stool can be constipation.

The “Potty training” age is it’s own category. Children in this stage commonly hold in their stool and have problems with self induced behavioral constipation.

Children should generally go once a day. Certainly a child with hard stools, any blood or pain, or difficulty evacuating a stool could have constipation and should be checked by their Pediatrician.

Adults- any change in bowel pattern, pain, prolonged time to go, hemorrhoids, blood, difficulty passing stool. [please consult your physician}

Foods to avoid that are responsible for a large percentage of constipation consist of low fiber, highly processed,with added chemicals. Mostly unnatural foods changed significantly from their natural state.

How much fiber do we need?

Women 21-24 gm day, men 31-38 gm a day. A child’s  general guideline is the age plus 5 gm for the total recommended grams of fiber for a day, but I believe more is probably healthier.  Once an individual is used to a whole healthy food diet they will be able to manage with more then the recommended amount of fiber.  For example a 7 year old should have a total of 12 grams of fiber a day based on this formula. Look below for some sample fiber amounts. In most cultures that are based on healthy plant based foods particularly bean based they consume much more fiber and have been shown to have better health statistics.

Dietary Culprits in constipation – foods to eliminate when you or your children are constipated

Any animal products, especially red meat and diary.

Sugary foods, fried food.

Carbs particularly processed  white carbs like pasta and white rice.

Processed low fiber breads, crackers, bagels, cakes, cupcakes, etc.

Applesauce, bananas, chopped carrots also are binding due to the breakdown in the pectin.

Best foods to treat and prevent constipation.

Whole foods are the best food source of natural fiber.

My super constipation busting smoothie

Smoothie for bowel health and treating constipation- start with a good healthy fruit base- either apple, orange, pineapple, etc. avocado for an excellent source of fat and to thicken it like a milk shake .Add vegetables to your liking the leafier the better. Spinach hides well. If the green color is not tolerable for your child go with purple, like prunes, acai, grapes, or for orange color- add oranges, sweet potatoes, squash ( but NOT pumpkin). Include figs for fiber and substance, and dates to sweeten it if needed.  Add ground flax seed or chia seed, nuts or nut butters which add  good protein, oil, and fiber . 

Juicing takes out a lot of the fiber and often defeats the purpose. So even though juice is often the go to treatment for constipation there is actually less fiber in juice than the whole fruit or smoothies.

Slowly make the change to a high fiber lifestyle. Increase the amount of healthy high fiber food gradually so you do not get cramping or bloating or pain.

Natural healthy treatment of constipation:

1.Natural fiber additives – senna. psyllium, ground flax seeds, hemp seeds or hearts. Can buy “greens” in a natural food store to add fiber

2. Vegetables all have fiber  especially the leafy green ones. Iceberg lettuce does not have enough fiber to make it worthwhile. It only has 0.5 gm fiber compared to romain which has 1.8 gm, and arugula 1.6 gm.Kale 2.6 gm fiber per chopped cup, broccoli, 3.8 gm fiber, spinach 4.3 gm cup cooked. Sweet potato has 4 gm of fiber.

3. Nuts and seeds particularly adding ground flaxseed 1.9 gm fiber per tablespoon or Chia seed 10 gm fiber per ounce can offer a good source of healthy fiber.

Almonds 1 oz -3.5gm fiber , walnuts 1 oz 1.9 gm fiber, sunflower seeds, 1 oz is 2.5 gm fiber.

4. Fruits are filled with fiber not just prunes which has 12 gm per cup of fiber.

Figs 1.5 gm for each fig, 15 gm per cup, dates 12 gm per cup, apples 4.5 gm per apple (not applesauce), blueberries 3.6 gm per cup , raisins 6 gm fiber per cup,  apricots 3.3 gm cup

5. Beans are excellent source of fiber, partially digested in your intestinal tract with both soluble and insoluble fiber. But start your bean introduction slowly. You know what they say? …One half cup of beans have 15 grams of fiber.

Red beans- kidney beans cooked has 19 gm fiber per cup, black beans 19 gms cup cooked, pinto beans 18 gm fiber cup cooked

6.Increase fluid – just water is good enough. Adults should have 8 glasses of water a day. Healthy smoothies are an excellent way to get fruits, vegetables, protein , and fiber. See above.

7.Teas – senna, peppermint , and basic green tea. The caffeine itself helps much like with your morning coffee

8. Probiotics help in those whose bowel flora has been altered by poor diet.

9. Exercise actually helps – so get moving . Like all parts of your body your intestinal system will move better if you move. There will be more blood flow to the gastrointestinal system in general, and the activity itself will cause your bowel to function better.

With any exercise make sure you hydrate well, before , during , and after.

General causes of constipation by age groups.

Baby

Breast fed babies are rarely if ever constipated .It is said that Breast milk is a laxative for babies stools but this reaction is for all intents and purposes normal or regular. Breast milk keeps the baby bowel functioning and flowing with the proper peristalsis and creating the proper bacteria flora so,a breastfed baby should not need probiotics , should not have constipation,  have better immunity , and less colic.

Formula fed babies ( particularly milk based) Are much more likely to have constipation and colic. The ingredients in formula change the bowel flora and function. It is common for breastfed babies to become constipated with transition stools when making the switch to formula or milk.

Toddler 1 – 3 year old

Not getting enough fluids, the typical western toddler diet of pasta, carbs, junk foods, low fiber ,and the age of potty training is almost guaranteed to  cause constipation. Much of the toddler diet contributes to having poor bowel habits.

Older child- poor bowel habits, not taking enough time to go to the bathroom, being too busy to go, holding it in, being painful, and the typical western diet. Biggest culprits are the most commonly eaten foods- all that cheese, pizza , milk, ice cream, macaroni and cheese, pasta, big plates of white carbs, cookies, breads, fried foods with breading .

Adult – stress, not eating enough, not getting enough fluids, not exercising, poor diet , and travel.

[Before self medicating with laxatives and pills please contact your physician or pediatrician.]

Warren Krantz MD, FAAP
HealthfulMD.com

Fever is your friend

The purpose of this post is to demystify fever in of itself and to offer a natural approach to supplement the advice and treatment you receive from your physician.

[This is not meant in any way as medical advice or diagnosis regarding fever or illness. This post is as an informational source only.  Before following any information presented here please consult with your physician or child’s Pediatrician. No part of this post is meant as a treatment for fever or the symptoms accompanying fever].

Each doctor varies slightly in their approach to fever management. Fever is only one symptom, like a warning sign in a constellation of symptoms involving a disease process whether it be a virus or bacterial infection.

As a medical doctor I recommend face to face examination of a patient with fever to be certain of what the fever represents. I keep in contact with my patient’s for any changes in both behavior and medical condition.

Any fever above 102 F should be brought to the attention of your physician. Babies under 2 months any fever above 100.5F

”Fever is our friend”–without fever we wouldn’t have an important warning about an illness whether it be viral or bacterial. We would not be able to mount an immune response for this infection . Fever helps your body fight the infection particularly a virus. It helps send your fighting cells to the site of infection. Fever also builds your immune response to the particular infection so next time you are exposed to that illness it can fight it more effectively.

[Febrile seizures :High temperatures are not responsible for febrile seizures rather the cause is an unusually rapid rise in temperature from normal level to febrile. In fact most febrile seizures stop on their own and are not harmful . ( you should  seek medical care if your child has a possible febrile seizure). Febrile seizures occur from 6 months to 6 years.]

Fever symptoms- chills, aches and pains, sweating are all coordinated symptoms , not themselves harmful but are part of a response to fight the invading infection.

Fever is a sign of illness and as such any treatment should be in coordination with your physician or your child’s pediatrician

Since the middle ages we have feared fever as some mysterious evil force and sign of a terrible deadly disease.

Often the treatments born out of this fever fear were worse than the disease itself.

Some of the things we have done include the below but WE DO NOT USE THESE ANY MORE

Alcohol baths- is toxic to children by being absorbed through the skin

Aspirin – in children causes Reyes’s syndrome- injuring the liver and brain.        

Bloodletting – don’t have to discuss this one

Ice baths- not what someone needs when we are trying to be comfortable

General approach to fever after you have consulted with your physician .

Acetaminophen or ibuprofen both are useful medications to control fever and use for comfort from the symptoms of fever- including headache, chills aches, and pains. Ibuprofen is more beneficial for these symptoms that accompany fever but does have more gastrointestinal side effects.

Let your body fight the infection with fever as long as your or your child is comfortable.

Do what is reasonable when necessary with respect to any medication to get adequate sleep.

It is OK to stay with fever if you or your child is getting enough fluids, breathing comfortably, and resting comfortably. If you or your child is sleeping and have no other signs of distress  there is no major rush to wake up and give something to knock the fever down. Now you and the child  are awake and miserable.

Make sure you get more liquids, when your body has fever you require more fluid.

Only exert yourself to the point that you feel comfortable. No intense exercise or sports. It’s fine if you feel up to it to go outdoors in good weather, move around and get mobile. Fresh air is good.

If a fever does not immediately respond to fever reducers does not mean it is a worse infection or virus than a fever that drops quickly and goes back up.

Fever in general is stabilizing to the body. Higher fevers do not harm you more if your body is fighting a virus.

Treat the person or child not the fever.

Go for comfort, you do not have to follow the fever every minute.

Fever itself is just a sign that you have an illness – not the illness itself.

Make sure you are aware of the important signs and symptoms of worsening illness besides just fever-respiratory distress { any difficulty breathing}. Sore throat, not taking fluids, pain ( chest, joints), cough. These are some of the additional signs of illness that may give your physician a better idea of what this fever may represent.

Natural methods for fever control

Drink lots of fluids

Room temperature bath or wipe down with water

Wet socks, and many cultures add citrus fruit or spice balm to help a fever.

Tea

The usual healing teas are very useful here. Hibiscus , ginger and echinacea

Goji tea works very well for fever, add ginger to it

The fever tea : specifically combine these leaves or oil

chamomile

peppermint tea or oil. Caution excessive  peppermint oil can be toxic.

lemon balm

elder

Spices and herbs

Cayenne pepper- many people I know sprinkle cayenne pepper on a slice of pineapple and eat it that way for illness or fever. It helps to enhance the effect of the fever and the body’s ability to fight the infection .

Turmeric , garlic, and oregano – on food, soups. tea

Super power chicken and vegan vegetable soup- add many of the above ingredients, see post on fighting a cold.
Warren Krantz MD, FAAP

HealthfulMD

Fighting colds – a cold is a cold

[ As with any post here or online advice the content is for informational purposes only and not medical advice . Before trying anything written here please consult with your physician or your child’s Pediatrician]

“ Take my magic potion”  “ cold cure”  every day and you will better in 2 weeks.

Granny Clampett

There are no magic potions, lotions, herbs, unapproved tinctures, or anything that will cure a cold or short cut your body’s immune fight with a cold virus. There is no pill to make the cold go away immediately. Only the basics of your body’s natural defenses fighting an illness ; with fever, congestion, and coughing. Your system learns to recognize the cold virus and builds an immune reaction to defeat the cold this time and in the future.

My main medical focus is to help your body physiologically mount a strong response to the illness by  supporting and boosting  your own immune system . Secondly to make you comfortable to be able to fight the virus,by helping you sleep and rest. And finally by keeping the inflammatory response, that is responsible for your misery, to a minimum, while maximally fighting the virus.

Standard medical natural-physiological advice

For babies and those of us that still act like babies:

Nose suctioning: Do not use the blue suction bulb given to you at the delivery.It goes too far into the nasal canal.  Use a nasal aspirator which doesn’t go all the way in the nose but uses a vacuum to gently suction out loose secretions.Start with two drops of sterile saline drops or spray. [ can buy these at most pharmacies] Tilt your child’s head back to put the drops then gently suction the mucus four or five times a day.There’s a new Suction apparatus which has two tubes to go in separately into a container that doesn’t directly apply suction to the nose

Stop frequently when you feed your baby so they can catch their breath and not end up choking

Steam: Hold the child ( over 6 months) in the bathroom ( not in the shower)  and turn on the shower to reasonably hot  only for a few minutes to breathe in the steam.

Humidifier with eucalyptus oil ( five to ten drops) a couple times a day. You can also put some eucalyptus oil on the floor of the bathroom shower. 

NOTHING directly on the body. You should not put any eucalyptus oil or menthol  directly on a baby. You can put it on a cloth near the baby or somewhere on the bed so they get the benefit without irritating the skin or absorbing it.

We do not use any decongestants or medication for a baby.

Consult your Pediatrician before trying any remedy.

Elevate the head at night by putting something underneath the mattress NEVER using a pillow for the baby. You usually end up holding the baby or driving in the car seat or use the stroller to keep the head elevated.

On the feet with socks included here for guidance only: Only over a year. ( not medical and not wholly recommended by Pediatricians please check first)- Many people place Eastern spices and herbs , or very small amount menthol or eucalyptus oil on the soles of the feet then cover with socks.(be careful of allergic reactions) . Studies have actually shown that this does help drain some of the mucous by dilating blood vessels away from the sinuses . This has temporary relief but tradition is hard to sway. What is most interesting is that almost every culture from every part of the world uses this method for aiding cold symptoms. When something spans a wide range of global behavior there generally is some validity to its use. Caution with anything you put directly on a child’s skin.

NO over the counter cold MEDICATION FOR BABIES and very little recommended for any child under 4. Please consult with your physician before treating any cold with any meditation .

HealthfulMD:See below for the natural treatments of a cold.

Breastfeeding: If mom has the cold -wear a surgical mask, wash your hands and continue breast feeding.

Breast milk – for babies under a year breast milk is by far the best source of immune supporting antibodies to fight a cold. .  

The following is for over 6-8 months of age and teas should be decaffeinated for children

Teas

HIbiscus tea with ginger and add echinacea tea to it for the first two to 3 days , 3 -4 cups a day, continue the same tea without the echinacea after that.Can add a teaspoon of organic honey particularly Manuka honey but only if your child is over a year. I also add turmeric particularly at the first sign of a cold.

Green tea ( matcha) with ginger, honey-only over a year of  age, and echinacea as above. Add ginseng if elevated blood pressure is not an issue.

Goji berry tea- as above one of my favorites

Chamomile tea- has anti inflammatory properties and settles the stomach . Add any of the same ingredients from above.

Rose hip tea-is high in vitamin C

Soup

My superpowered immune building grandma’s chicken and unchicken vegan soup

Take grandma’s base of chicken soup or vegetable soup base

Make sure to add lots of green leafy vegetables as tolerated

Add sweet potatoes

Oregano

mushrooms, any will do, but shitakke preferred

lots of garlic

turmeric- kids will not notice the yellow color here

red pepper chili or cayenne , or a milder version for your child’s taste.

thyme

ginger

red onions

nutritional yeast

Spices – same health spices but  I double the amount of turmeric I add to food and tea. I also increase the cayenne pepper and chili pepper to the point I can tolerate when I feel like I am getting sick or already congested. Make a big emphasis to add all these ingredients to the level you can tolerate without giving you indigestion: turmeric,  garlic, oregano / oil, cayenne pepper or chili pepper  , cinnamon, thyme. Add to vegetables, soups , and sauces.

Healing smoothies and juices – similar ingredients to above

Preferred to blend in the fruits in a smoothie to get the pulp rather than juice.

Could also start with high vitamin C anti-inflammatory juices : fresh squeezed orange, tomato, pineapple, or dark juices blueberry, or pomegranate .

Or start with a blended fruit as above or healthy plant milk like almond, hemp, soy.

Add high vitamin C fruits papaya, strawberries,  citrus fruits- pineapple, oranges, lemon,

Sweet fruits to make it taste good especially for children, apples for quercetin with red skin, peaches, pears, bananas.

Dark fruits for maximize vitamin C and anti inflammatory fighting – blueberries, blackberries, black cherries, pomegranate, acai, goji berries

Vegetables as tolerated and rich in  vitamin C and antioxidants- bell peppers, broccoli, brussel sprouts, cauliflower, and kale.

Foods and other extras to help your immune system fight a cold

Supplements such as vitamin c, are not as effective as the real food source for the vitamins and herbs.

Zinc in natural sources are healthier: Following are good zinc food sources .

Dark chocolate( greater than 70%), garlic ,sesame seeds, wheat germ, lentils, chickpeas, and pumpkin seeds. Zinc lozenges also have some benefit if you or your child can not eat enough of the foods that contain it.

Foods with high vitamin C also have natural healing anti inflammatory properties with the  understanding that most of the symptoms of the cold are our body’s inflammatory response to the cold virus . Eat more of these  vitamin C rich foods ( also review my vitamin C post.  http://healthfulmd.com/2016/08/vitamin-c/

Fruits – Papaya, strawberries, oranges, blueberries, blackberries,  pineapple, etc.

Greens greens greens- as usual your dark green inflammation fighting vegetables are at their best when you need them for colds. Kale, spinach, broccoli, sprouts, Swiss chard, collard greens, and any dark green vegetable you like and Jerusalem artichokes are also known to help immunity fight a cold. Do not forget the bell pepper which has a high vitamin C rating. 

Mushrooms of any type – need to be cooked- have immune supporting properties

Nutritional yeast– also helps support your immune system

Manuka honey purported to help stop a cold but is expensive, and has a milder glycemic index ( has to be authentic) rise. ( honey is only safe over a year of age)

Echinacea -I use tea instead of the drops. But there are enough supporters of the drops to try them if you prefer but for a short time only.

Fish oil is considered to be helpful as well if it is not contraindicated for any other health reasons.

Probiotics are known to help your immune system particularly when you are ill. Not generally necessary for children and adults who maintain a healthy diet of natural plant foods.

Rest – get as much rest as possible . The only time I recommend any medication is to help you sleep from a cold and then generally only a antihistamine.Contact your physician for their guidance regarding cold meditcation to help you sleep.

Get mobile – don’t over do it but exercise thins and mobilizes the congestion. If you exercise regularly lower the intensity of the workout.Contact your physician before any exercise particularly during an illness . If there is fever or lethargy , difficulty breathing refrain from any exertion and contact your doctor.

Relax– as in all things ,stress has a negative impact on your psyche and your immune system. As I tell adolescents don’t get angry and stressed that you are sick it only makes it worse. You are sick now what. Accept it and do what you have to fight it. Meditate, walk, take quiet time with the above teas. Take an extra long hot shower with eucalyptus oil and lavender. Take a break from your  work, study, hustle and bustle, and anger. Put your body in the best position to focus on the job it has to do fighting the cold.

Homeopathic remedies have been reported to have anecdotal benefit but not consistently research proven . The following besides echinacea are widely used and  generally not harmful if you follow the directions

Immunoberry supplement

Astragalus and Elderberry

Oscilllococcinum has been proven with substantial research to not be of value besides acting as a placebo

Limit foods that have a negative impact on cold fighting

Sweets- sugar tends to feed a virus.

Fatty foods, cause inflammation and don’t allow your body or immunity to do its best in fighting a virus.

Warren Krantz MD, FAAP

HealthfulMD.com

Author of “Start healthy, stay healthy”

Cough-a natural defense a natural treatment

When we cough it serves a purpose. For the most part we have been programmed to fear the cough for the worse possibility , pneumonia, bronchitis,  asthma. But the vast majority of coughing is a result of a mild cold or allergies. Nowadays  doctors and patients just want something to quell the cough automatically when it starts regardless of the etiology. However, like most of the things we’ve been discussing the over reaction and quick treatment of coughing is much worse than the actual disease associated with the cough. When you reflexively treat to suppress the cough you are not letting the body do its job of protecting the lungs by bringing up phlegm and keeping the bronchioles open. Suppressing it can lead to the mucous dripping down to the lungs and settling where it shouldn’t including bacteria that we naturally carry in our upper respiratory system.  If you’re asthmatic not being allowed to cough in order to  keep your bronchioles open can lead to an asthma attack . So the misinformation of what we think we know about a symptom and the fear of unknown can lead to more problems than the natural course of the disease itself. ( not to mention the side effects of the medication ) Treat a cough only at the direction of your physician. Treating coughs with cough suppressants, mucus thinners, and expectorants are more often than not the cause of complications and delay the healing rather than a cure. It is common for a cough to seem worse at the very end of a cold or virus as the mucous and congestion starts to drain . Especially when you lay down at night and wake up after a night of mucous dripping down the back of your throat. Any cough should be observed closely and a cough accompanied by fever breathing distress, prolonged,  painful , or any additional symptoms always needs to be brought to the attention of  your physician. There are numerous over the counter products to help suppress the cough but we know they are only to help sleep not treat the condition and we do not recommend cough suppressants for children under 4. Everyone is now turning to natural organic homeopathic cough syrups, since they think this is less harmful and natural means safer. But once again like all the natural products they are not reviewed,licensed by the FDA, or researched. There is no substantive evidence that any of the natural , homeopathic, or naturopathic products have any benefit, and certainly there is always the  possibility of them causing harm.   If you or your child have a chronic condition such as asthma, bronchitis, allergies, or sinus infections then you should automatically notify your physician and not self medicate with cough syrup. For everybody else there are options that are both natural non harmful and beneficial for the typical non infectious cold cough, when used after consulting with your physician.

Natural physiological methods are the best in a alleviating symptoms and helping the body fight the underlying source of the cough. It is always better to enhance the body’s own defense mechanisms to help fight an infection than go against it. My motto is to help the body fight the source of infection in any way you can naturally and physiologically  but only treat the symptoms when necessary in order to help a patient be comfortable enough to sleep ( since we do need sound sleep to maximize our immune system and heal ourselves).

Cough – Home treatment

General congestion and cough advice

Steam, saline washes in the nose, eucalyptus oil in a humidifier or steam shower , eucalyptus oil on the pillow or clothes. Not directly on a child.

Lots of dark fruits and vegetables ( see my fighting cold section)

Superpowered chicken and non-chicken soup. With immune enhancing foods.

Move- don’t just lie there if you are able, mobilize the mucous, walk, expand your lungs and thin the mucous by exercise-approved by your doctor.

Good teas with anti-inflammatory properties to help fight the cold and drain your sinus.

Turmeric tea

Hibiscus tea with ginger

Green tea with honey and ginger

Peppermint tea

Natural ingredients which have been found to help a cough.

( If you buy a product you should look for these natural ingredients for effectiveness)

Honey- tablespoon, raw, organic ( not for any child under 1 year of age). Manuka works the best.

Teaspoon of GInger

Peppermint oil. Steam and breathe in the oil..

Apple cider vinegar mixed to make it tolerable has many vascular and health healing effects

Almonds

Pineapple with its bromelian ingredient ( supplements not for children) helps mobilize immune system and mucous.

Natural home cough treatments ( may adjust some ingredients for children due to taste)

Homemade cough syrup

1/4 teaspoon cayenne pepper

1/4 tablespoon ground ginger

I tablespoon honey ( raw , only children over a year)

1 tablespoon apple cider vinegar

2 tablespoons water

Thyme tea specifically for cough

2 teaspoons of crushed thyme leaves to one cup boiled water, steep for 10 minutes.

Add 2 teaspoons organic raw honey ( over one year of age )   

Lemon wedge.

1/4 teaspoon of ground ginger

[ All contents here are for informational purposes only and not intended as medical advice. For any symptoms including cough please contact your physician first ]
Warren Krantz MD, FAAP