Skip to main content

Search
Should Your Child See a Doctor?

Colds

|

Definition

  • Viral infection of the nose and throat

Symptoms

  • Runny or congested nose
  • The nasal discharge may be clear, cloudy, yellow or green
  • Usually associated with fever
  • A sore throat often is the first symptom
  • Sometimes associated with a cough, hoarse voice, watery eyes, and swollen lymph nodes in the neck

Cause

  • Colds are caused by several respiratory viruses. Healthy children average 6 colds a year. Influenza usually feels like a bad cold with more fever and muscle aches.
  • Colds are not serious. Between 5 and 10% of children develop a bacterial complication (ear or sinus infection).

Colds: normal viral symptoms

  • Colds cause nasal discharge, nasal congestion, sinus congestion, ear congestion, sore throats, hoarse voice, coughs, croup, and red, watery eyes. When you combine all these symptoms, colds are the most common reason for calls to the doctor.
  • Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money and help you avoid some unnecessary trips to the doctor. You can be reassured the following are normal cold symptoms and children with these symptoms don't need to be seen:
    • Fever up to 3 days
    • Sore throat up to 5 days (with other cold symptoms)
    • Nasal discharge and congestion up to 2 weeks
    • Coughs up to 3 weeks

Colds: symptoms of secondary bacterial infections

  • Using this topic, you can select out the 5 to 10% of children who have ear infections or sinus infections. Many are identified with specific symptoms and patterns. Some are suspected because symptoms last too long:
    • Earache or ear discharge
    • Sinus pain not relieved by nasal washes
    • Difficulty breathing or rapid breathing
    • Fever present over 3 days
    • Fever that goes away for 24 hours and then returns
    • Sore throat present over 5 days
    • Nasal discharge present over 2 weeks
    • Cough present over 3 weeks

Return to school

  • Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.

See more appropriate topic (instead of this one) if

When to Call Your Doctor

Call 911 Now (Your Child May Need an Ambulance) If

  • Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)

Call your doctor now (night or day) if

  • Your child looks or acts very sick
  • Not alert when awake
  • Difficulty breathing not relieved by cleaning out the nose
  • Weak immune system (sickle cell disease, HIV, chemotherapy, organ transplant, chronic steroids, etc)
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
  • You think your child needs to be seen urgently

Call your doctor within 24 hours (between 9 a.m. and 4 p.m.) if

  • You think your child needs to be seen, but not urgently
  • Earache or cloudy discharge from ear canal
  • Yellow or green eye discharge
  • Sinus pain around cheekbone or eyes (not just congestion)
  • Fever present for more than 3 days
  • Fever returns after gone for 24 hours

Call your doctor during weekday office hours if

  • You have other questions or concerns
  • Blocked nose interferes with sleep after using nasal washes several times
  • Yellow scabs around the nasal openings (Apply antibiotic ointment)
  • Sore throat present over 5 days
  • Nasal discharge present over 14 days

Parent care at home if

  • Mild cold with no complications and you don't think your child needs to be seen

Home Care Advice for Colds

Reassurance

  • Because there are so many viruses that cause colds, it's normal for healthy children to get at least 6 colds a year. With every new cold, your child's body builds up immunity to that virus.
  • Most parents know when their child has a cold, often because they have it too or other children in child care or school have it. You don't need to call or see your child's doctor for common colds unless your child develops a possible complication (such as an earache).
  • The average cold lasts about 2 weeks and we don't have any medicine to make it go away sooner.
  • However, we have good ways to relieve many of the symptoms. With most colds, the initial symptom is a runny nose, followed in 3 or 4 days by a congested nose. The treatment for each is different.

For a runny nose with profuse discharge: blow or suction the nose

  • The nasal mucus and discharge is washing viruses and bacteria out of the nose and sinuses.
  • Blowing the nose is all that's needed.
  • For younger children, gently suction the nose with a suction bulb.
  • Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).

Nasal washes to open a blocked nose

  • Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
  • STEP 1: Instill 3 drops per nostril. (Age under 1 year, use 1 drop and do one side at a time)
  • STEP 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
  • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
  • Frequency: Do nasal washes whenever your child can't breathe through the nose.
  • Saline nasal sprays can be purchased without a prescription.
  • Saline nose drops can also be made: Add 1/2 teaspoon (2 ml) of table salt to 1 cup (8 ounces or 240 ml) of warm water.
  • Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
  • Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
  • For young children, can also use a wet cotton swab to remove sticky mucus.
  • Importance for a young infant: can't nurse or drink from a bottle unless the nose is open. 

Fluids

Encourage your child to drink adequate fluids to prevent dehydration. This will also thin out the nasal secretions and loosen any phlegm in the lungs.

Humidifier

If the air in your home is dry, use a humidifier.

Medicines for colds

  • Cold medicines are not recommended at any age. (Reason: they are not helpful. They can't remove dried mucus from the nose. Nasal washes can.)
  • Antihistamines are not helpful, unless your child also has nasal allergies.
  • Decongestants: OTC oral decongestants (Pseudoephedrine or Phenylephrine) are not recommended. Although they may reduce nasal congestion in some children, they also can have side effects.
  • Age Limit: Before 4 years, never use any cough or cold medicines. (Reason: unsafe and not approved by FDA) (Avoid multi-ingredient products at any age.)
  • No Antibiotics: Antibiotics are not helpful, unless your child develops an ear or sinus infection.

Treatment for associated symptoms of colds

  • Fever or Pain: Use acetaminophen (e.g., Tylenol) or ibuprofen for muscle aches, headaches, or fever above 102° F (39° C).
  • Sore Throat: Use warm chicken broth if over 1 year old and suck on hard candy if over 6 years old.
  • Cough: Give honey 1/2 to 1 teaspoon (2 to 5 ml) for younger children over 1 year old and use cough drops for children over 6 years old.
  • Red Eyes: Rinse eyelids frequently with wet cotton balls. 

Contagiousness

Your child can return to child care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.

Expected course

Fever 2-3 days, nasal discharge 7-14 days, cough 2-3 weeks.

Call your doctor if

  • Earache suspected
  • Fever lasts over 3 days
  • Any fever occurs if under 12 weeks old
  • Nasal discharge lasts over 14 days
  • Cough lasts over 3 weeks
  • Your child becomes worse

Extra advice – air travel with colds

  • It's safe to fly when your child has a cold.
  • He could develop temporary ear congestion or earache, but that's often preventable.
  • It's unusual to develop an ear infection, unless your child already is prone to frequent ear infections. However, that's not a reason to avoid flying.

Extra advice – prevention of ear congestion during air travel

  • Most symptoms occur during descent of the aircraft (the 15 minutes before landing)
  • Stay awake during takeoff and descent
  • Swallow during descent using fluids or a pacifier
  • Children over age 4 can chew gum during descent
  • Yawning during descent also can open the middle ear
  • Stay well hydrated throughout the flight to prevent the nasal secretions from drying out

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

References

  1. Bukutu C, Le C, Vohra S. Complementary, holistic, and integrative medicine: the common cold. Pediatr Rev.2008;29:e66-e71.
  2. Butler CC, Kinnersley P, Hood K, et al. Clinical course of acute infection of the upper respiratory tract in children: cohort study. BMJ. 2003:327;1088-1089.
  3. Gunn VL, Taha SH, Liebelt EL, et al. Toxicity of over-the counter cough and cold medications. Pediatrics. 2001; 108(3):1-5.
  4. Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25(4):115-123.
  5. Mayefsky J, et al. Families who seek care for the common cold in a pediatric emergency department. J Pediatr. 1991;119:933-934.
  6. Pappas DE, Hayden GF, Hendley JO. Treating colds: Keeping it simple. Contemp Pediatr. 1999;16(12):109-118.
  7. Schaefer MK, Shehab N, Cohen AL, et al. Adverse events from cough and cold medications in children. Pediatrics. 2008;121(4):783-787.
  8. Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won’t this child’s nose stop running? Contemp Pediatr. 2002;19(12):48-63. 
  9. Schwartz RH, et al. Antimicrobial prescribing for acute purulent rhinitis in children: A survey of pediatricians and family practitioners. Pediatr Infect Dis. 1997;16:185-90.
  10. Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007;75(4):515-20.
  11. Smukyrkou P. Efficacy of isotonic nasal wash (seawater) in the treatment and prevention of rhinitis in children. Arch Otolaryngol Head Neck Surg. 2008;134(1):67-74.
  12. Turner RB. The common cold. Pediatr Ann. 1998;27:790-795.
  13. Turner RB. New considerations in the treatment and prevention of Rhinovirus infections. Pediatr Ann. 2005;34(1):53-57.
  14. Wald ER. Sinusitis. Pediatr Rev 1993;14(9):345-351.

Disclaimer

This information is not intended to be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D. Clinical content review provided by Senior Reviewer and Healthpoint Medical Network.

Last Review Date: 6/1/2011

Last Revised: 8/1/2011 2:54:12 PM

Content Set: Pediatric HouseCalls Symptom Checker

Version Year: 2012

Copyright 1994-2012 Barton D. Schmitt, M.D.

Should your child see a doctor?

Find out by selecting your child’s symptom or health condition in the list below:

Spring 2014: Good Growing Newsletter

In This Issue

  • Cold Water Shock Can Quickly Cause Drowning
  • E-Cigs Are Addictive and Harmful
  • Bystanders Can Intervene to Stop Bullying

Download Spring 2014 (PDF)