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, hoarseness, watery eyes and swollen lymph nodes in the neck

Cause

• Colds are caused by 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).

Return to school

• Your child can return to day 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.

Colds: Normal viral symptoms

• Colds cause nasal discharge, nasal congestion, sinus congestion, ear congestion, sore throats, hoarseness, 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 guideline, 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

When to Call Your Doctor for Colds

• 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
• Fever over 105° F (40° C)
• Fever over 104 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.)

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

• You think your child needs to be seen
• 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 going away 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 OTC 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

1. 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 use nasal suction.
   • Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).
2. 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 2-3 drops per nostril. (Age less than 1 year, use 1 drop and do one side at a time)
   • STEP 2: Blow (or suction) the nose each nostril separately.
   • STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
   • Saline nasal sprays can be purchased OTC
   • Saline nose drops can also be made: add 1/2 tsp of table salt to 1 cup (8 oz) 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.
3. Humidifier: If the air in your home is dry, use a humidifier.
4. 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.
5. Treatment for Associated Symptoms of Colds:
   • Fever: Use acetaminophen (e.g., Tylenol) or ibuprofen for muscle aches, headaches, or fever above 104° F (39° C).
   • Sore Throat: Use warm chicken broth if over 1 year old and hard candy if over 6 years old.
   • Cough: Use cough drops for children over 6 years old, and honey (2 to 5 ml) for younger children over 1 year old.
   • Red Eyes: Rinse eyelids frequently with wet cotton balls.
6. Contagiousness: Your child can return to day 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.
7. Expected Course: Fever 2-3 days, nasal discharge 7-14 days, cough 2-3 weeks.
8. 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

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

References

1. 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.
2. Gunn VL, Taha SH, Liebelt EL, et al. Toxicity of over-the counter cough and cold medications. Pediatrics. 2001; 108(3):1-5.
3. Kelly LF. Pediatric cough and cold preparations. Pediatr Rev. 2004;25(4):115-123.
4. Mayefsky J, et al. Families who seek care for the common cold in a pediatric emergency department. J Pediatr. 1991;119:933-934.
5. Pappas DE, Hayden GF, Hendley JO. Treating colds: Keeping it simple. Contemp Pediatr. 1999;16(12):109-118.
6. Schaefer MK, Shehab N, Cohen AL, et al. Adverse events from cough and cold medications in children. Pediatrics. 2008;121(4):783-787.
7. Schoem S, Josephson GD, Mendelson LM, Wohl DL. Why won’t this child’s nose stop running? Contemp Pediatr. 2002;19(12):48-63.
8. Schwartz RH, et al. Antimicrobial prescribing for acute purulent rhinitis in children: A survey of pediatricians and family practitioners. Pediatr Infect Dis. 1997;16:18
9. Simasek M, Blandino DA. Treatment of the common cold. Am Fam Physician. 2007;75(4):515-20.
10. 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.
11. Turner RB. New considerations in the treatment and prevention of Rhinovirus infections. Pediatr Ann. 2005;34(1):53-57.
12. Turner RB. The common cold. Pediatr Ann. 1998;27:790-795
13. Wald ER. Sinusitis. Pediatr Rev 1993;14(9):345-351.

Disclaimer

This information is not intended 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.

Last Reviewed: 1/4/2010

Last Revised: 16/12/2009 12:53:49 PM

Copyright 1994-2010 Barton D. Schmitt, M.D.