Upper Respiratory Infections (Colds)

 For additional information on this topic:

• Why does my toddler have so many colds from fall to spring, even when he's been on antibiotics?
• My child has had a cold for 3 days and his mucus is already green, does he need antibiotics?
• Runny Nose
• Antibiotics

Call the office or ER immediately if:

• Your child is having difficulty breathing that doesn't get better after you clear the nose.
• Your child has a fever >105 F (40.6 C).
• Your child starts acting very sick.
• Your child is <3 months with a fever >100.4 F rectal.
• Your child's lips turn blue during coughing spasms.

Your child needs an appointment within 24 hrs if:

• Your child's cough is continuous or persists more than 3 weeks.
• Your child has an earache or pain over the sinuses.
• Your child has a fever >3 days.
• Your child has a fever that came back after being gone for >24 hours.
• Your child has thick yellow scabs (not dried mucous) under the nasal openings.
• Your child has had thick nasal discharge more than 10 days which is not getting better.
• Your child has a marked sore throat.
• Your child's eyes have a yellow discharge or matting.

Please call the office, 778-6762, for help in deciding if/when your child needs to be seen.

What is a cold? A VIRAL infection of the nose and throat (upper respiratory system) that can cause:

• runny or stuffy nose (Click here for more details on Runny Nose.)
• with clear, cloudy, yellow or green nasal discharge
• often associated with fever, sore throat, fussiness or irritability, achiness, headache, decreased appetite, and a cough
• sometimes associated with hoarseness, red eyes, sneezing, and swollen lymph nodes in the neck.

A baby or toddler with a cold is a miserable creature. S/he can't tell you exactly what's wrong, but the symptoms of colds: achiness, headaches, stuffy &/or runny nose, scratchy sore throat and annoying coughs; make your child uncomfortable and thus fussy, unable to sleep well, and not as hungry as usual. The postnasal drip of mucus from a runny or stuffy nose will make your child cough and often gag and vomit. It decreases the appetite and can cause loose bowel movements. When a baby can't breathe adequately through his or her nose alone, it can be hard to take a bottle or even sleep.

Colds can vary in severity and duration:

• Anywhere from a mild runny nose and slight discomfort for a week;
• to severe for up to 3 weeks: Fever for 3 days, miserable nasal congestion and sore throat for 5-7 days, and then slowly improving nasal congestion and/or cough for 1-2 more weeks.
• The more severe colds are called viral upper respiratory flus.
• People’s immune systems vary - within a family, one child may have mild symptoms for a short duration while another child may suffer more severe symptoms for a longer length of time.

What causes colds?

• VIRUSES, not bacteria. There is no cure for the common cold. Antibiotics do not treat colds.
• Cold viruses are spread from one person to another by hand contact, coughing, and sneezing -- not by cold air or drafts. Cold viruses can survive for a short time on toys, telephones, door knobs, drinking fountains, etc.
• Children exposed to 2 nd Hand Smoke will experience more than the usual number of colds each year.
• Many colds that “last too long” are actually two colds back to back.
• Colds are very contagious. The usual incubation period is 2-5 days. Your child is contagious from about a day before the start of the runny nose until any fever is gone for more than 24 hours.

How many colds should a healthy child get each year?

There are hundreds of different viruses that can cause similar cold symptoms. It is "normal" for the average preschooler to get 6-8 colds each year and for older children to get 4-6 colds per year. These tend to occur mostly in the fall-winter-spring months, which means that during these months, your child may get about one cold per month. Viral infections can also weaken a child's ability to fight the next cold, so it is not uncommon for a child to have a series of 2-3 "colds" in a row. Exposure to 2 nd Hand Smoke will cause a child to get more than the usual number of colds each year.

How can colds be prevented?

Cover your mouth when coughing or sneezing. The most important way to prevent the spread of colds is to wash your hands after sneezing, coughing, or wiping a nose or face.

If your baby is under 3 months, keep him/her away from people with colds. Taking your baby to the grocery store, etc., exposes her/him to colds. If you must take your baby shopping, keep a light baby blanket over his/her infant seat to protect from droplets spread in coughs and sneezes from others.

Don’t forget the basics of “eat right, drink plenty of water, and get enough sleep” ! ! And avoid 2 nd Hand Smoke!

What complications can occur?

Complications from colds are more common in children during the first two years of life. Try to avoid exposing your baby to other children or adults with colds.

The main complications are secondary bacterial infections such as ear, eye, and sinus infections, and pneumonia. These may occur in 5% of colds. Children exposed to 2nd hand smoke have a higher rate of complications.

Why not antibiotics?

One might think that at least an antibiotic will prevent a secondary infection. However, taking antibiotics when they are not needed can be harmful. Each time you take an antibiotic, you are more likely to carry resistant bacteria in your nose and throat. These resistant bacteria cannot be killed by common antibiotics and then you may need more expensive antibiotics, or antibiotics given by a shot, or even need to be put in the hospital for IV antibiotics.

Antibiotics are not without side effects which can include: nausea, diarrhea, and stomach pain. Some people may have an allergic reaction that causes a rash, itching, or hives. In severe cases, some people may have trouble breathing. Antibiotics will also kill “good” bacteria that help our bodies. When this happens the helpful bacteria are replaced by bacteria and yeast that can cause diarrhea, yeast diaper rashes or thrush (yeast in the mouth).

What treatments can be done for a cold?

There is no cure for the common cold! Treatments help relieve symptoms, but they do not shorten the length of the cold or flu.  

Encourage Fluids: Be sure your child drinks plenty of fluids. Water is best, but diluted juices are OK.

Warm baths and showers are also helpful: Just keep the bathroom warm enough so your child doesn’t “catch a chill.” The humidity from a bath or shower helps to loosen and thin nasal mucus. They are also just enjoyable!

Elevate the head of the bed: Never put your baby on a pillow or use a pillow to prop his/her head up.

• Put the head end of the crib mattress one notch higher than the feet end, so that the entire sleeping surface is sloped.
• Or, in a bassinet, elevate the head end using a large book, so that the entire sleeping surface is sloped.
• Children in beds also do better if you wedge the mattress at an angle rather than have them sleep on multiple pillows.  

Cool Mist Humidifiers: Most coughs with a cold are caused by postnasal drip of thick mucous, or from a dry throat due to mouth breathing because of a clogged nose. This is why cool mist humidifiers can help decrease a cough.

• Moist air will prevent dry mucous membranes in the nose which are more swollen and more susceptible to infections.
• Moist air can help keep nasal mucous more liquid and thus less likely to block nasal passages which will allow babies and children to breathe more comfortably and awaken less often.
• Dry air tends to make coughs worse, whereas moist air can loosen a dry cough.
• Some coughs are caused by bronchitis or underlying asthma and the humidifier may worsen these coughs.
• Humidifiers can cause problems if they put too much moisture in the air and allow mold to grow in the room or in the humidifier itself.
  • Empty all water each morning and allow the humidifier to dry thoroughly between nighttime usages.
  • Use a bacteriostatic solution in the water (available at most drug stores, Kmart, and Walmart).
• Do not add medication to the water in the humidifier because it can irritate the lungs in small children.
• Hot water vaporizers are not recommended as they can cause serious scalds or burns.

Any Cigarette Smoking must be done Outside: Smoke will irritate and prolong and/or worsen mild cold symptoms. Children exposed to second hand smoke experience both more colds and more secondary complications. If you must smoke, always smoke outside of your house and car.

Rubber Bulb Syringe for Nasal Suctioning: --- A young infant prefers to breathe through his/her nose and thus may awaken from sleep and be quite fussy when nasal passages are blocked. --- S/he may have trouble nursing or taking a bottle when unable to breathe well through his/her nose. --- You can clear your infant’s nose with a rubber bulb syringe. Remember to squeeze the bulb part of the syringe first, gently stick the rubber tip into one nostril far enough to make a seal, then slowly release the bulb, and then withdraw it.  

Nasal Saline Drops: If the nasal secretions are especially thick, you may use saline nasal drops (can be purchased or home-made: 1/4 tsp salt per 1 cup water): 3 drops in each nostril, wait one minute and then suction with a soft bulb syringe. Do this only as needed, usually before feedings and at bedtime. This works best in infants under 6 months of age. Overuse can irritate the nose.

Triaminic Vapor Patch or Vicks VapoRub for children over 1 year of age. These medicines contain camphor and menthol (also eucalyptus in the VapoRub) . They help to decrease nasal stuffiness and relieve a nighttime cough. Be careful in using these as children’s skin, eyes, and lungs can be quite sensitive to their fumes. Vapor Patches can be applied every 8 hours: ½ patch for 1-2 year olds; 1 patch for 2-6 year olds; 2 patches for 6-12 year olds.

Throat Lozenges: Children over 4-5 years of age can use throat lozenges to help relieve a scratchy sore throat or to lessen a dry, irritated cough. Robitussin Honey Lemon Cough Drops are mildly flavored and usually well-liked.

My child has had a cold for 3 days and his mucus is already green, does s/he need antibiotics?

Green mucus from the nose does not necessarily mean your child has a sinus infection. When germs that cause colds (viruses) first infect the nose and sinuses, the nose makes clear mucus. This helps wash the germs from the nose and sinuses. After two or three days, the body's immune cells fight back, changing the mucus to a white or yellow color. As the bacteria that live in the nose grow back, they may also be found in the mucus, which changes the mucus to a greenish color. This is normal and does not mean your child needs an antibiotic. Often, the mucus may be thick and green in the mornings or after a nap, but then runs clear or cloudy the rest of the time. Sinus infections can complicate colds, but they are not common. They usually do not start before 5-7 days after the cold started. Symptoms of a sinus infection are: facial pain, postnasal drip, bad breath, and constantly thick green mucus. Fever may or may not be present. If you suspect your child has a sinus infection, your child will need an appointment with a pediatrician.

Cough & Cold Medications:

These medicines will not cure a cold or shorten its duration. They will relieve symptoms only for the duration of their dosage interval (for example, a medicine to be dosed every 4 hours, will relieve symptoms for about 3 hours).

• Cough and cold medications are not recommended for use in children under two years of age.
• Many cold medications contain alcohol as a cough suppressant. These are not recommended for children.
• Do not use a medicine dropper from one brand of medicine to dose another brand.  The concentrations and measurements can vary.
• Do not use combination cold and fever preparations.  Fever or pain medication is not always needed and dosage errors are more likely to occur.
• Be careful when using VapoRub type medications as they can irritate the lungs, nasal passages, and eyes of young children.
• Expectorants (guaifensin) are usually not needed in young children. They taste awful and can cause refusal to take the medicine or even can trigger a gag and vomit. However, here in dry Nevada, they can help when combined with a decongestant to lessen the drying effect of the decongestant. They can also help when combined with a cough suppressant to relieve a cough that results from a thick, dry stuffy nose.

Cold and cough medicines do have side effects!

Before giving your child a cold medicine, ask yourself which is worse: your child's cold symptoms or using medication and the side effects that may occur. If your child has a mild runny or stuffy nose with an infrequent cough, but is basically happy and playful and eating and drinking adequately, it is better to use the natural remedies already listed. However, if your child is coughing frequently; and/or his/her nose is so runny that you are constantly wiping it; and/or her/his nose is so stuffy that s/he is miserable, then a cold or cough medication may help relieve symptoms enough to allow him/her to rest more comfortably and eat or drink better.  

Generics

Generics are as good as brand name. Just check the small print or Active Ingredients list for the scientific names, mg. amounts, and alcohol content. Also, compare concentrations and dosage recommendations as these may vary slightly.

Fever or Pain Medicines (Acetaminophen or Ibuprofen):

• Use for a child with a cold only if s/he also has a fever, sore throat, head ache or muscle aches.
• Do not use combination cold and fever preparations: Fever or pain medication is not always needed and dosage errors are more likely to occur.  

Decongestants (phenylephrine):

• Decongestants decrease nasal and sinus congestion. Use for a stuffy or runny nose.
• Use only in children older than 2 years and only if really needed.
• Side effects: jitteriness, irritability, inability to sleep, rapid heart beats, dry mouth. Some children get drowsy. Nasal decongestant drops or sprays have less side effects, but are addictive if used for more than 3 days in a row.

Cough Suppressants (Dextromethorphan - DM):

Example brand names: Robitussin Pediatric Cough Suppressant, Triaminic Thin Strips (Red)

• Use to suppress dry coughs due to a dry or irritated throat; also for chest pain from coughing spasms.
• Use only in children over 2 years of age.
• Side effects: drowsiness
• A cough that is persistent or recurrent and not always related to other cold symptoms may be due to asthma.  

Decongestant and Cough Suppressant Combinations

• Use for a mucousy or phlegmy cough with a runny or stuffy nose.
• Use only in children over 2 years of age.
• Side effects: jitteriness, irritability, inability to sleep, rapid heart beats, dry mouth. Some children get drowsy.  

Antihistamines (chlorpheniramine, brompheniramine, diphenhydramine):

Example brand names: Children’s Dimetapp Cold & Allergy Elixir, Triaminic Cold & Allergy, Triaminic Soft Chews Allergy (these examples are antihistamine and decongestant combinations).

• Use only at bedtime to relieve a runny or stuffy nose, especially with a scratchy sore throat.
• Use only in children over 2 years of age.
• Side effects: drowsiness (some children become hyperactive or irritable). Dry mouth and nose, fatigue, dizziness, spaciness, ringing in the ears.
• Using them “around the clock” can dry and thicken mucous and thus block nasal passages, predisposing your child to a sinus or ear infection. It’s best to use them only at bedtime and again in 4-6 hours if symptoms recur at night.

Combinations of Decongestant, Antihistamine and Cough Suppressant:

Example brand names: Children’s Dimetapp DM - Cold & Cough Elixir, Triaminic Cold & Cough Liquid or Softchews (Red), Triaminic Night Time Cold & Cough (Purple)

• Use only at bedtime to relieve a runny or stuffy nose with a mucousy or phlegmy cough.
• Use only in children over 2 years of age.
• Side effects: drowsiness (some children become hyperactive or irritable. Dry mouth and nose, fatigue, dizziness, spaciness, ringing in the ears.
• Using them “around the clock” can dry and thicken mucous and thus block nasal passages, predisposing your child to a sinus or ear infection. It’s best to use them only at bedtime and again in 4-6 hours if symptoms recur at night.