WHAT IS A COLD?

A cold is a viral infection of the nose and throat that causes a runny nose, sneezing, sore throat, and a cough. Coughing helps clear out the secretions. Many children with a cold will have a fever, but usually less than 102° F (32° C). Symptoms of a cold may include body aches, fatigue, headache, eye irritation, hoarseness, a little diarrhea, and a poor appetite. Many babies with colds have trouble sleeping and feeding because of a stuffy nose.

Colds usually follow a pattern: during the first few days there is a runny nose, sore throat, mild fever, and feeling ill. Later, they feel a little better and the nasal discharge becomes thicker, turning yellow or green. The cough often continues for several days, especially at night.

There are 200 different viruses that cause colds. That’s why children get colds frequently. Many children have 5-8 colds per year, but most are minor and last only a few days. Others have colds with stuffy noses and cough for up to two weeks. Children who have colds often do not usually have anything wrong with them, especially if they are growing well and have not had extremely serious infections. Colds are caught from other people, not from the cold air or draft. Running outside with wet feet and wet hair doesn’t cause a cold, colds are often passed from child to child in school or day care.

Most children get over viruses without any problem: however, some may develop an ear infection. The child will complain often of an earache, pull at his ears, become crankier and their fever often returns.

	Pneumonia is an uncommon complication. Children with pneumonia have rapid, labored breathing. The breathing rate is more than 40 breaths per minute in such cases. In labored breathing you can see the chest moving in and out. A child with pneumonia often develops a fever over 102° F and often coughs a lot.
	Children with colds often have a sore throat, but a strep throat is usually not associated with a runny nose and usually not with a cough.
	Many parents worry about a sinus infection, but these are also unusual in children. Children with sinusitis usually look more ill. Most of them are over one or two years of age and have a persistent fever, a significant headache, and have been sick for many days, usually over 10. With sinusitis, the nasal discharge is often yellow or green and thick, but often enough it can also simply be clear. The thick, yellow-green discharge does not necessarily mean a sinus or other bacterial infection is present, as long as the child is feeling okay. It more likely is the typical late stage of a cold.

IS IT A COLD OR AN ALLERGY?

Colds, especially when they occur frequently, can be hard to tell apart from allergies or hay fever. Hay fever tends to cause seasonal runny nose (i.e., every spring), coughing, lots of sneezing, and watery, itchy eyes. Children and teens with hay fever do not have fever, hoarseness, or aching muscles. Hay fever or allergies often last more than two or three weeks, whereas colds last only 5-10 days. Allergies also tend to run in families. Since treatment for allergies is different than for colds, check with us about allergy treatments.

WHEN SHOULD I CALL THE DOCTOR?

Call us at any time if:

	Your child has a fever over 104° .
	Your infant, less than two months of age, has a fever over 100.4° .
	Your child is having a great deal of difficulty breathing, even after you have cleared out the nose.
	Your child is so irritable that you cannot comfort him or her, or is very lethargic and you cannot awaken him.
	Your child has an earache or bad headache.
	Yellow discharge or pus from the eyes.
	A fever lasting more than three or four days.
	A raw, infected skin area under the nose.
	Noticeable wheezing or a change in the normal breathing pattern.
	Symptoms of the cold have lasted more than 10-14 days.

HOW CAN I TREAT MY CHILD’S COLD?

	Rest - If your child is very tired, has a fever, or feels ill, rest is important; however, bed rest is not usually necessary. Most children with colds will slow down by themselves until they feel better. Older children, who feel well, should be allowed to go to school unless a bad cough, a fever, or other symptoms interfere with their schoolwork. Younger children in day care should probably stay home during the first 2-3 days while they are most ill and contagious, and especially if they are running a fever.
	Fluids - Give lots of fluids to loosen secretions – this will help the cough and thin out the mucus. Don’t be upset if your child doesn’t eat solid foods. Some old-fashioned recipes like soup and honey or lemon tea can help to provide fluids. Honey is okay over age one.
	Medicine - A fever is not harmful to your child. For children over two months, if the fever is over 102° , or the child is uncomfortable, give acetaminophen (Tylenol, Tempra, Panadol, or generic brand). Remember to give only the correct dosage for your child’s weight or age every 4-6 hours. If your child has fever, or is asleep, don’t awaken him. Do not use aspirin.
	Runny Nose - You can teach your child to blow his nose. For infants, use a humidifier or a water vaporizer, which helps thin out and loosen the secretions. Salt-water (saline) nose drops can be purchased without a prescription or made at home by using ¼ tsp. of salt in 7 or 8 ounces of water. Nose drops help by loosening or thinning the mucus in the nose causing the infant to frequently sneeze. Use 5-10 drops or a good squirt in each nostril. An infant bulb syringe (aspirator) can be used gently to remove the mucus. Often you need to suction 4-5 times before mucus is retrieved. You can repeat the process as often as is needed to clear out the nasal mucus. It’s okay if your baby is having difficulty with choking, turn him or her over with head down and pat the back a few times. Be generous with the nasal drops. They can help a great deal if you use them enough. Since infants with colds often have difficulty eating or sleeping, this procedure of saline and suctioning is most helpful before feedings and before bedtime. Elevating the head of the bed by placing a pillow under the mattress might help older children.

COLD MEDICINES?

Cold medicines such as decongestants and antihistamines do not get rid of a cold. Side effects from these medicines can cause drowsiness and sometimes irritability. We do not encourage their use. Here are some general suggestions about using cold medicines:

	Generally avoid them in infants less than six months because of the side effects. Using saline drops and suctioning, along with humidifier or a vaporizer is best. Using lots of saline drops without suctioning often works too.
	The older child who is not acting very ill does not need these medications since they often have very little benefit.
	Use medicines only during times of greatest need (such as bedtime or before school).
	Use only a dosage recommended by your child’s weight or age. More is not better.
	If the medicine does not relieve symptoms after one day of use, stop using.
	Definitely stop the medicine once your child feels better.
	Avoid using the medicines more than three to five days.

There are basically four types of cold medicines (some may be in combination with others):

	Antihistamines (Benadryl, Chlor-Trimeton, Tavist) do not help the common cold, but they are helpful for hay fever and allergies. They often make children sleepy.
	Decongestants (such as Sudafed) help a little. They come in nose drops, syrup, and tablets. Some children may become somewhat hyper, excited, or irritable.
	Expectorants help very little. Oral fluids act as a good expectorant.
	Cough suppressants, such as Dextromethorphan are only mildly helpful in decreasing the cough reflex, especially if it’s a long lasting, dry, hacking cough. Antibiotics, vitamin C, multivitamins, and chest rubs do not help, treat, or prevent common colds.

MEDICINE DOSES:

Wait until six months to give medicines as follows: Sudafed is preferred for the common cold. Dimetapp has an antihistamine plus Sudafed in it. This is helpful if sneezing and itchy eyes are associated with a cold and in instances of frank hay fever. A lot of nasal discharge associated with significant cough can be somewhat alleviated by Robitussin CF. Plain Robitussin DM can help a dry, persistent cough. These syrup medicines can be dosed as follows in most instances: 6-12 months: ¼ to ½ tsp., every six hours; 1-2 years: ½ to ¾ tsp., every six hours; 3-5 years: ¾ to1 tsp., every 6 hours; over 5 years give 1 tsp. If we advise, babies less than six months can be given Pediacare drops or Sudafed drops .4 ml., in the age group of 2-3 months. The dose is 0.8 ml., every 4-6 hours in the age group 4-9 months. Do not give medicines to babies less than six months old, unless advised by our office. There are other brands and combinations of over-the-counter medicines, but the above are examples of the most familiar.

THE HALLMARK OF MANAGING A COLD is still either irrigating with saline, with suctioning, or gentle blowing and wiping the nose. Adding a vaporizer or humidifier is a good addition as well. Medicines are a last resort and only should be used when the child is miserable. Remember, a cold has to run its course and usually does so without complications.

Material taken from Schmidt – Contemporary Pediatrics, February 1990

 

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