Quick facts about colds/coughs:

• Best treatment:  Water, Water, Water
• Saline to the nose with suctioning for young children/infants (see our Websites page and look under "Health" for a suggested aspirator and a video on how to use saline irrigation)
• Saline irrigation and nose blowing for those able
• Increase fluid intake
• Add water to the air with a vaporizer or humidifier (without added medications)
• Elevate the head about 45 degrees for sleep
• Menthol vapor products have been shown to INCREASE mucus and are never recommended
• No decongestants are recommended in children
• No cough suppressants until 12 years are recommended (they haven't been proven to work in any person, but have been shown to be dangerous in children)
• Antibiotics do not cure colds or most coughs
• The color of nasal drainage does not indicate if it is a sinus infection
• Nasal saline with xylitol may help reduce bacterial sinus and ear infections
• See treatment below for more details

Why does my child always have a cold?

Kids get 8-15 colds/year and each cold lasts 7-21 days
Kids typically have up to 140 days of cold symptoms a year (about 1/3 of the time!)
They spread each virus for up to 3 weeks, starting even before symptoms start
Kids may always be contagious!!!
Read on for more details...

What are the Symptoms?

Symptoms vary, but can include any of the following:

• runny nose (any color discharge)
• congestion
• scratchy/sore throat
• tiredness
• postnasal drip
• headache
• cough
• sneezing
• loss of appetite
• fever (usually less than 103°F.)
• body aches
• irritability
• problems sleeping
• eye drainage (mucus or watery eyes, but the white of the eye is not red)
• hoarse voice
• many children will vomit from the mucus gagging them

The cough is wet sounding, often the vibration can be felt in the chest.  This does not mean it has settled in the chest.  If your throat is cleared, you can feel the vibrations in the chest.  This is similar to noisy breathing from the throat with a cold.  If it settles in the chest, most children will suck in their ribs/belly or breathe faster than normal (60 or more breaths/minute in infants, 50 breaths per minute in older children).

At the beginning of a cold, there is a clear nasal discharge, swelling of the nasal passageways, throat irritation, and sneezing.  After about 2 days, the nasal discharge becomes thicker and discolored.  Changes in color from yellow to green are typical in the course of a cold and do not signify a bacterial infection, sinus infection, or anything more serious.  Antibiotics are not helpful against colds, even when the mucus is green or yellow.

What causes a cold?

There are over 100 viruses that can cause a cold.  They are spread by contamination of the hands from nasal secretions.  Sneezing, wiping the nose, blowing the nose, or any other action that gets nasal secretions on the hands, toys, doorknobs, or other objects is how most cold viruses are spread.  Some viruses can survive on objects for several days.  Interestingly, coughing and saliva do not contain much virus, and are not a major source of transmission.  Still, cover your cough with your arm (not a hand that will touch everything) to prevent potential spread.  The incubation period of most cold viruses is 1-7 days.  We shed the virus mostly in the first 2-3 days of symptoms, but for up to 3 weeks.  Children tend to shed the virus longer than adults.  They do not wash hands as well or as often as adults.  Therefore, they tend to spread more infection than adults.  If you would like to see a video with great graphics on how viruses are spread, click here.  (It will take you off our site, and we cannot be responsible for other websites.)

What does not cause a cold?

Weather changes, cold weather, being outside without a coat or hat, and drafts are all blamed falsely on causing colds.  Colds are caused by viruses, and are common in the winter months, even in climates that remain warm in those months.  Wearing warm clothing does not protect against colds.  Hand washing is the best defense against catching a cold.

What are complications of upper respiratory infections or colds?

Colds can trigger asthma exacerbations and pneumonias.  They can be a set up for an ear infection or non-infected fluid in the middle ear causing temporarily decreased hearing and fullness in the ear.  Sinus infections may start with a cold virus.  A sinus infection that requires antibiotics must be present at least 10 days.

When should I bring my child in with a cold?

Urgent appointment needs:  If your child is breathing more than 60 times in a minute, ribs are going in and out with breaths, or the belly is sucking in and out with each breath, your child needs to be seen in the office, at urgent care or an ER, depending on time of day and your location.  Another complication that kids must be seen for is dehydration.  Dehydration may be present when the child is unable to take in enough fluids to make urine at least 4 times a day for infants, twice a day for older children. 

Routine office visits:  If your child has ear pain, trouble sleeping, or general fussiness, he should be seen during regular office hours.  If the cold is worsening after 10-14 days, bring your child in during regular office hours.

Treatment Options for the Common Cold:

Water, Water, Water:  The best treatments.

• Wash with soap and water.  The most important thing to do with a cold is to prevent its spread and wash hands after wiping a nose, sneezing, or touching objects likely to have virus on them.  Treating symptoms is the mainstay of treating a cold.
• Drink water or other fluids.  Encourage plenty of fluids to keep the body hydrated (or it will suck moisture out of mucus, which then makes it more sticky and more likely to plug up airways/sinuses/ears.)
• Saline can thin secretions and make them easier to get out of the nose/sinuses.  Saline can be bought at any pharmacy or made at home.  Flushing the saline into the sinuses with enough force to come out the opposite nostril is most beneficial.  This can be done at any age with enough cooperation.

• Adding water to the air during the cold/dry months with a vaporizer or humidifier can also help thin the secretions.  When the air conditioning is on, it is not recommended to use a vaporizer or humidifier because the AC removes moisture from the air and would counteract the humidification.  We do not recommend any menthol products in the vaporizer.

Other treatments:

• Elevating the head about 45 degrees helps with drainage.  This can be done by elevating the mattress or sleeping in a car seat for infants or having older children sleep on extra pillows.
• No cough and cold medications are recommended in children.  The reason cough and cold medicines should be avoided in young children is there are reports of serious illness and death in infants and young children with these products.  Most adverse reactions were from overdose of these products.
  

We do not routinely recommend cough and cold medications for children, but they are discussed below.

Antihistamines:

• First generation antihistamines (diphenhydramine, hydroxyzine, chlorpheniramine, brompheniramine, and clemastine) can help dry mucus membranes, but make people drowsy.  They should be used with caution in children with asthma because they thicken secretions and can make them harder to clear.
• Second generation antihistamines (terfenadine, astemizole, loratadine, and cetirizine) do not cause drowsiness, but do not help with common cold symptoms.

Decongestants (pseudoephedrine, phenylephrine, oxymetazoline) decrease nasal congestion by constricting the blood vessels in the nasal passageways.

• May cause tiredness or excitability, dizziness, fast or irregular heart rate, dry mouth, blurred vision, or urinary retention.
• If topical decongestants are used (i.e., medicated nose drops) they may cause a rebound congestion and should be avoided, especially in infants.
• The most beneficial decongestant, pseudoepedrine, was taken out of most cold remedies because it can be used to make methamphetamine.

Antitussives (cough suppressants):

• Studies in children do not show any benefit in cough suppression over placebo for any type (narcotic or non-narcotic) cough medication.  They are not recommended in children.
• All cough suppressants should be used cautiously in children with asthma.
• Narcotic cough suppressants (prescription only) contain codeine or hydrocodone, which act on the brainstem to inhibit the cough.  They have side effects of respiratory depression (which can lead to stopping of breathing), nausea, vomiting, constipation, dizziness, heart beat irregularities.
• Non-narcotic cough medications (both OTC and prescription) usually contain dextromethorphan.  In adults it has been shown to suppress cough as effectively as (not better than) codeine, but studies in young children fail to show any benefit.  It can cause respiratory depression (decreased breathing) in overdose.  It is not recommended in any child.

Expectorants:  The most common expectorant is guaifenesin.  Studies have not shown it to be effective.

Fever Reducers/Pain Relievers:  Acetaminophen and Ibuprophen are used to control fever and aches associated with illness.  Some studies show that they suppress the adult host's immune response and prolong the duration of the virus.  There are no studies in children.

Zinc, Echinacea, Vitamin C:  Studies in children are lacking.  Overall, there is no evidence that they help.