As the winter season approaches more and more of our children will inevitably be afflicted by upper respiratory tract infections - fevers, runny noses, sore ears and throats, and coughs that seem to never end. These are unfortunately extremely common. So how will you know whether your child's cough is one to worry about, or whether it is one that will run its course? What should you give your child to try and ease his symptoms?

During the winter season most coughs will be due to viral infections - these are many, from the common cold virus to more aggressive viruses including adenovirus or influenza. Most children will be mildly to moderately unwell with their cough, although some may be really quite ill.

A viral cough is usually accompanied by a runny nose, watery eyes, sore ears, sore throat and enlarged glands in the neck. Your child may be wheezy and feel short of breath. Your child may also have a fever (which can be high) and may have lost his appetite. He may be really miserable and out of sorts. He may also have a red blanching rash over his cheeks or chest and back; in viral illnesses these rashes often appear as the fever goes away, although they may be present throughout the course of the illness. This should run its course in about 4-7 days, and by this time your child should start to feel better. Be aware though that the cough itself can last for much longer than this, even 3 or 4 weeks.

It is hard to comfort a child who is coughing away through the night feeling thoroughly unhappy, so start with the simple things such as plenty of cool drinks (making sure there is some energy in them). Don't worry if your child won't eat - he will as soon as he feels better. Regular Paracetamol and/or Ibuprofen are excellent for fever and pain control. If your child is coughing and also wheezy, you may consider asking your GP to prescribe an inhaler (often with a spacer for smaller children) to relieve the tightness in the chest. Make sure you ask your GP to demonstrate its use and to give you clear instructions on how, when and how often to use it - and when to seek further medical help if your child is not improving (or indeed getting worse). Do not be tempted to rush to your GP for a course of antibiotics - these do not work for viruses!

As for linctuses...there are two different types of linctuses: antitussives (aim to inhibit the cough reflex) and expectorants (loosen up the mucus in the chest so that is can be coughed up).

Antitussives are the most popular and are generally used for dry coughs. They contain opioids (members of the morphine family) which stop the coughing, but also have the effect of making children sleepy - both of which can be seen as an advantage, particularly at night time. Studies however have shown no significant difference between antitussives and placebo, and have infact highlighted the fact that using antitussives may prevent mucous from being cleared and may put certain children (those with pre-existing lung conditions) at risk of the mucous becoming infected with bacteria. Overall, aside from tasting pleasant and giving the impression of delivering some form of valid treatment, there is no good evidence for or against the use over the counter cough suppressants. In addition antitussives are not generally recommended for use in children, and certainly not for use in little ones under the age of one.

Expectorants are less popular but may be of more use clinically - they are generally used for productive coughs. They may help make the mucous thinner and easier to cough up. They also actually provoke cough, forcing the sputum to be expelled from the chest. Although not as pleasant as a cough suppressant, they may actually help symptoms by allowing clearance (if temporary) of the mucous plugged airways, thus helping in the overall work of breathing. Again though, there is no good evidence that these expectorants do work.

Unfortunately there is no current evidence that any brand name cough medicine works compared to placebo - but if a medication is sought then the best choice would be a non-active "simple linctus".

It is important though to consult your doctor if you are particularly worried about your child; just as most of these coughs are due to viral upper respiratory tract infections, some may be due to bacteria and may need antibiotic treatment or even a visit to the hospital.