Colds, also known as upper respiratory infections, are extremely common in children (and adults). They are caused by viruses and are usually not serious. There is no cure for a cold, and it will go away by itself in about a week.
What are the symptoms?
Symptoms vary depending on the specific virus and in each child. They can include any or all of the following:
- Runny nose and nasal congestion lasting 7-10 days.
- Cough lasting up to 2-3 weeks.
- Fever up to 102-103 or higher for the first 2-4 days (fever itself will not harm your child).
- Decreased appetite, tiredness, fatigue, crankiness.
- Sometimes sore throat, headache, hoarseness, body aches, red watery eyes, vomiting, and/or loose stools.
- Ears may feel full or stopped-up.
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 kill or treat viral infections, and there is no cure for a cold.
- The typical healthy child will have about 6 colds a year, the majority of them in the winter. Young children in preschool or daycare may have many more. Colds are very contagious and spread easily from person to person.
- Each cold usually lasts 7-10 days. These infections are not harmful, but they can be frustrating and a source of missed school or parent work days.
What should I expect?
- The nose is usually clear and very runny at first, though it sometimes starts as congestion.
- After 3-4 days, the mucous usually gets thicker and child is more congested. In younger children, it will turn green/yellow before it has a chance to come out. 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 starts to feel better.
- Many children will not eat as well but will usually drink enough to stay hydrated, and this is what matters most.
- Congestion usually lasts 7-10 days but can last up to 14 days; cough typically starts after the first few days and can last 14-21 days as well, occasionally even longer (see sheet on viral bronchitis).
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.
- Encourage plenty of fluids, especially clear liquids.
- Cough and cold medicines can be used in children 6 years and older. They may provide temporary relief of the symptoms for several hours but they will not treat the infection itself nor will they change how long it lasts.
- Treatment for a runny nose: wiping and blowing the nose. Sniffing and swallowing is fine and may be better than blowing. 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 (1/2 tsp table salt in 8 oz warm water) or saline nose drops from the drug store. Place 3-4 drops in each nostril or spray the solution in the nose; wait one minute, then blow to remove the loosened mucous.
- 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.
- A Neti pot can be used to flush out the nose as well.
- Cool-mist humidifiers may also help at night with congestion.
- Warm foods and drinks, especially chicken soup, can help congestion and sore throat.
- Decongestants can be tried in children 6 and up, though they are of limited benefit and may have side effects.
- Acetaminophen or ibuprofen can be used for fever, sore throat, headache and/or body aches. Fever should be treated only if it makes your child feel bad.
- Cough can be treated with warm drinks or soup, 1-2 teaspoons of honey, a humidifier, and washing out the nose with saline spray.
- Coughs are also sometimes relieved by sucking on hard candy or cough drops (children 4 and up).
- In children 6 years and up, you can try the expectorant guaifenesin (sold as Robitussin® and Mucinex®), and/or cough suppressant dextromethorphan (usually abbreviated as “DM”.)
- Do not use diphenhydramine (Benadryl®) for colds. It can help dry up a runny nose but it does so by making mucous thicker. It can make congestion worse, prevent the nose from draining, and increase the chance of developing a sinus infection. It also has other side effects as well and is NOT recommended for colds.
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 8 hours.
- Ear infections typically start several days to a week into the cold and are characterized ear pain, not just fullness or feeling stopped up.
- 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. Often the child will have headaches, sinus or facial pain as well.
- 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.
When should I seek further care?
Call 911 or seek immediate care if your child:
- Has breathing difficulty or labored breathing, chest retractions, grunts when breathing, or blue or purple lips.
- Is lethargic or barely responds to you or is very weak.
Call for an appointment today 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 making urine at least every 8 hours).
- Looks or acts a lot sicker or the way your child looks or feels concerns you.
Call for an appointment today or tomorrow if your child:
- Has fever (100.4 °F or higher) lasting longer than 5 days or that goes away for a day or more and then returns.
- Has ear pain (not just fullness or “popping”).
- Has congestion that lasts more than 10-12 days or that worsens after the 10th day.
- Has a severe cough or cough that lasts longer than 14-21 days or that worsens after the 14th day.
When can my child return to school?
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.
How can I prevent my child from catching colds?
- Colds are spread by saliva and secretions from the nose. This can come from direct contact with people who are sick, or with germs present on surfaces such as door handles.
- You can try to avoid exposing young children to people with colds in daycares, church nurseries, etc.
- Handwashing is the best means of prevention in older children and adults. They should always be washed before eating and before touching the eyes, nose or mouth.
- Exposure to tobacco smoke makes colds more common and more severe, so children should avoid any exposure.
Resources
Choosing Wisely: Antibiotics for Respiratory Illness in Children
Get Smart About Antibiotics (CDC): Common Cold and Runny Nose
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
