Colds, also known as upper respiratory infections, are extremely common in children (and adults); in fact, they are the most common infection. Fortunately, they are usually not serious. Infants, however, are at higher risk of complications such as dehydration or difficulty breathing, and have to be watched more carefully than older children. Colds will go away on their own in about a week.
What are the symptoms?
Symptoms will vary depending on the child and the specific virus. They can include any or all of the following:
- Runny nose and nasal congestion lasting 7-10 days, and cough lasting up to 2-3 weeks
- Fever up to 102-103 °F or higher for the first 2-4 days (remember fever itself will not harm your child)
- Decreased appetite, tiredness, fatigue, crankiness
- Sometimes red weepy eyes, vomiting, hoarse voice, loose stools and vomiting
- Some children will have a sore throat and act like it hurts when eating or drinking
- Some children wheeze with colds, and some cold viruses cause wheezing
What causes colds?
- Colds are infections of the nose, sinuses, throat and upper airways. They are caused by viruses, and there are over 200 common cold viruses! Antibiotics will not treat viral infections and can cause harm. There is no cure for colds.
- The typical healthy child will have about 6-8 colds a year, most of them in the winter. If the child is an infant or toddler in preschool or daycare, she may have many more. These infections are not harmful, but they can be frustrating and a source of missed school or parent work days. Unfortunately, there is no cure for a cold or any vaccine to prevent them.
- Colds are very contagious and spread easily from person to person. Handwashing, good hygiene and avoiding exposure to sick people are the best ways to prevent colds.
What should I expect?
- The nose is usually clear and very runny at first, though sometimes starts as congestion.
- The mucous will get thicker and the child will be more congested. In younger children, it may turn green or yellow. This is normal and a sign the cold is getting better.
- The worst day of the cold is usually around the 4th day. Fever should be resolved by the 5th day and the child will start to feel better.
- Most children with colds will not eat well but will usually drink enough to stay hydrated, and this is what matters most.
- Many infants spit up more due to thick post-nasal drainage and coughing.
- Congestion usually lasts 7-10 days but can last up to 14 days; cough typically starts after the first few days and can last up to 2-3 weeks.
How do I treat my child’s cold?
There is no cure for the common cold; antibiotics will not treat it at all and can make things worse. Cough and cold medicines do not work in infants and may be harmful. There are things you can do to help your child feel better until his body fights off the infection:
- Treatment for a runny nose: wiping, and suctioning with a soft rubber suction bulb.
- If the skin around the nose becomes raw and irritated, Vaseline can be put on the skin.
- Treatment for a congested, stuffed up nose:
- Use nose drops of warm tap water, homemade saline (½ tsp table salt in 8 oz warm water) or saline drops from the drug store. Place 1 drop in each nostril and after 1 minute remove mucous with soft rubber suction bulb. Children may cry, cough, or sneeze in this process. Repeat until nose sounds clear. This process will need to be repeated 4 or more times a day.
- Cool-mist humidifiers may also help at night with congestion.
- Infants need to breathe through their nose. You may need to clear their noses with saline and suction before each feeding and before putting the child down to sleep.
- Fever (temperature 100.4º F or higher) should only be treated if it makes your child uncomfortable or fussy.
- Do not treat fever in infants less than 3 months old without seeing a doctor first.
- Babies 3-6 months old may use acetaminophen (Tylenol®) for fever.
- Babies older than 6 months old may use acetaminophen or ibuprofen (Motrin®/ Advil®).
- Do not alternate medications; choose one and give according to instructions.
- Cough and cold medicines do not work in children less than 6 years old and can have dangerous side effects in children this age. They should not be used. Diphenhydramine (Benadryl®) should not be used to treat colds.
- Children 12 months and up can try a teaspoon of honey for cough. Vicks VapoRub sometimes helps with congestion or cough.
What complications should I look for?
- Dehydration can occur if fluid intake is inadequate. A poor appetite is normal, but be sure child is drinking adequate fluids and urinating at least once every 6 hours.
- Ear infections typically start several days to a week into the cold and are characterized by a return of fever, plus crankiness especially at night and pulling on the ears.
- Sinus infections start when the cold starts to go away. The congestion will be thick, will worsen after the 7-10th day instead of getting better, and will last longer than 10-14 days.
- Pneumonia usually starts several days into the cold when the child should be getting better. Usually, a fever develops, along with a worsening cough. The child may have more rapid breathing and shortness of breath.
- Some cold viruses cause wheezing (especially in winter), and some children tend to wheeze when they get colds.
- Some cold viruses cause croup, a hoarse, barking , seal-like cough. Your child needs to be seen if this develops.
How can I prevent my child from catching colds?
Colds are spread from person to person through direct contact, and from toys and other objects contaminated with mucous and saliva containing the virus. Avoiding exposure to adults and children with colds, particularly in daycare and nurseries, can reduce the number of infections. Handwashing is the most effective means of preventing the spread of germs, including cold viruses. Avoid exposure to cigarette smoke. Breastfeeding also helps prevent infections.
When can my child return to daycare?
Your child can return to school when there has been no fever in 24 hours and your child is drinking well and feels well enough.
When should I seek further care?
Call 911 or seek immediate care if your child:
- Has breathing difficulty or labored breathing, has chest retractions (skin pulling around ribs when breathing), grunts when breathing, has blue or dark purple color to lips, or stops breathing for more than 10 seconds.
- Is lethargic and/or barely responds to you or is very weak.
Call us for an appointment the same day or seek after-hours care if your child:
- Does not smile or play some at least a few minutes every four hours.
- Starts to wheeze or has worsening wheezing, or develops a barking cough.
- Is not drinking enough fluid (not having urine/wet diapers at least every 6-8 hours).
- Is inconsolable and cannot be calmed down at least a few minutes every hour.
- Looks or acts a lot sicker or the way your child looks or feels concerns you.
- Is less than 3 months old and has a fever (a rectal temperature greater than 100.4 °F).
Call us for an appointment today or tomorrow if your child:
- Has a fever that lasts longer than 3 days or has a fever that goes away for 24 hours or more and then returns.
- Has signs of an ear infection (is cranky or fussy, especially at night, is pulling at the ears, and usually has fever).
- Has congestion that lasts more than 10-12 days or that worsens after the 10th day.
- Has severe cough or a cough that lasts longer than 14-21 days or that worsens after the 14th day.
Resources
Choosing Wisely: Antibiotics for Respiratory Illness in Children
Get Smart About Antibiotics (CDC): Common Cold and Runny Nose
FDA: Colds in Infants and Young Children
References
Thompson, M., Vodicka, T.A., Blair, P.S., Buckley, D.I., Heneghan, C., Hay, A.D., 2013. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 347, f7027. doi:10.1136/bmj.f7027
De Sutter, A.I.M., van Driel, M.L., Kumar, A.A., Lesslar, O., Skrt, A., 2012. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev 2, CD004976. doi:10.1002/14651858.CD004976.pub3
Smith, S.M., Schroeder, K., Fahey, T., 2014. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev 11, CD001831. doi:10.1002/14651858.CD001831.pub5
Committee on Drugs, American Academy of Pediatrics, 1997. Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children. Pediatrics 99, 918–920. doi:10.1542/peds.99.6.918
