Colds and Coughs

A cold is a viral infection of the nose and throat. The first signs of a cold usually include: a scratchy throat and a stuffy or runny nose(viruses can cause clear, yellow, and green drainage from the nose). Later signs of a cold include: cough, sore throat, hoarseness, watery eyes, fever, headache, body aches, and chilliness. Colds (caused by viruses) are spread by hand contact (touching contaminated objects), coughing and sneezing. Colds can occur anytime, but are more frequent in the fall and winter. Children may get about 6—12 colds per year. Most colds have fever at the beginning for 1—2 days along with nasal congestion for 7—10 days and cough for up to 2—3 weeks.

Colds are caused by viruses. Antibiotics are not helpful against viral illnesses and should not be used.

In general, cold medicines are not helpful and sometimes may worsen the situation. We generally do not recommend decongestant medications for children. Cough medications are safe and sometimes helpful for decreasing cough at night. Only use for children over age 2. Avoid antihistamines for colds, but can be considered useful for congestion caused by seasonal seasonal allergies (hay fever).

Call immediately if:
  • Child has difficulty breathing, and it does not improve after clearing the nose
  • Child is acting very sick
  • Child is refusing fluids for several hours, very inactive, or fever over 104°F (40°C)
  • Child is less than 6 months old and has fever greater than.

Call during office hours if:

  • Fever lasting more than 3 days.
  • Earache
  • Sinus pain
  • Severe sore throat
  • Poor fluid intake
  • Repeated vomiting
  • If cold lasts more than 10—14 days

Home care

Increase fluid intake

Saline nose drops (especially before feeding or sleeping)

  1. Two drops each nostril with a dropper (with child laying down)
  2. Wait one minute and repeat as needed

Remove secretions by:

  1. Rubber suction bulb for infants
  2. Blowing nose for older kids
Saline nasal solution can be purchased over the counter or made at home by combining 1/2 tsp salt in 1 cup water. Be sure to make a new batch each day.
  • Cold water humidifier
  • Sleeping with the head of the bed elevated (for infants: pillow under mattress, no pillows in bed with baby)
  • Good hand washing, especially after blowing nose
  • Acetaminophen (Tylenol©) may be used for: fevers that are higher than 102°F, or for significant body aches
  • Petroleum jelly in nose openings (thin layer) helps protect them from irritation

Cough

Like colds most coughs are due to a viral infection. Other causes include: croup, flu, pneumonia, asthma, bronchitis, allergies, or if child accidentally inhales a small object (like a peanut). If your child has been previously diagnosed with asthma, cough is often a sign of asthma symptoms even though there is no wheezing.

When to call

  • Any infant under 2 months old with persistent cough
  • Any child with difficulty breathing
  • If cough is painful, persistent, and there is also whooping, vomiting, or turning blue
  • If cough lasts more than one week
  • If cough appears suddenly, and there is a fever
  • If cough starts after child has had a choking episode (choking on food, or any object)
  • If child has nonstop (continuous) coughing

Home care

  • Use measures outlined above for cold symptoms
  • If your child has asthma begin albuterol inhaler as needed for cough
  • Cough is important to clear mucus and protect lungs from pneumonia. The goal is the child’s comfort and being able to rest, not to stop cough completely.
  • Corn syrup is a great soother for cough in kids over age one (use 1/2 to 1 tsp)
  • Cough drops can be used after age four
  • Warm liquids such as lemonade, apple juice, broth (usually help relax the airway and loosen the mucus)
  • Avoid all exposure to cigarette smoke
  • Milk does not need to be eliminated

When is it more than “just a cold”?

Pneumonia

Pneumonia is a lower respiratory infection (lungs) caused by viruses and bacteria. The kind seen in young children is “typical” pneumonia accompanied by high fever and rapid breathing. This kind is often bacterial and needs evaluation by physician. It is not contagious, but rather is a complication of a bad cold in the same way ear infection and sinus infection are. Another kind, sometimes called “atypical” or “walking pneumonia” is contagious and usually seen in school age and older children (as well as adults). This is contagious and considered a cause of cough when symptoms are persistent for greater than 3 weeks.

Ear Infection

Ear infection is a complication of a cold when infection settles in the middle ear. Usually diagnosed when there is ear pain accompanied by signs of ear inflammation (redness) of the middle ear that the doctor can see during an exam. Ear infections are usually caused by bacteria thus antibiotics are usually prescribed. Good long term medical studies have shown that since a lot ear infections go away on their own, antibiotics are most helpful for the young child (under two) or if symptoms are persistent or severe.

Sinus Infection

Sinus infections are complications of colds and are diagnosed when the cold doesn’t seem to be going away. There is no specific physical finding the doctor can see in the office but rather the diagnosis is based on symptoms present, how long and how bad. Color of the nasal drainage does not predict whether a bacterial sinus infection is present. It is considered when symptoms are persisting for greater than 10 days without sign of improvement especially if accompanied by night cough, fatigue, decreased appetite, and intermittent fevers.

Asthma

Asthma is a chronic inflammatory disease of the lungs. Colds and similar infections are very common triggers for asthma symptoms. A cough is more likely a sign of asthma if it dry, worse at night, accompanied by wheezing, triggered by exercise, and comes in “spells” of repeated coughing. Suspicion is heightened in anyone with history of asthma difficulties in the past.

Croup

Croup is a viral respiratory infection that involves the area just below the voice box. This occurs more often in younger children. Symptoms include hoarse voice, harsh and “barky” cough and sometimes stridor. Stridor is noisy breathing heard primarily on breathing in. Sometimes this can lead to labored breathing. Initially steaming up the bathroom or cold night air can be helpful. If those measures don’t improve the noisy, labored breathing than call your provider.

For further information

Excellent information from American Academy of Pediatrics web site at www.aap.org/topics.html.