Colds
DEFINITION
- Viral infection of the nose and throat
Symptoms
- Runny or congested nose
- The nasal discharge may be clear, cloudy, yellow or green
- Usually associated with fever
- A sore throat often is the first symptom
- Sometimes associated with a cough, hoarseness, watery eyes, and swollen lymph nodes in the neck
Cause
- Colds are caused by viruses. Healthy children average 6 colds a year. Influenza usually feels like a bad cold with more fever and muscle aches.
- Colds are not serious. Between 5 and 10% of children develop a bacterial complication (ear or sinus infection).
Colds: Normal Viral Symptoms
Colds cause nasal discharge, nasal congestion, sinus congestion, ear congestion, sore throats, hoarseness, coughs, croup, and red, watery eyes. When you combine all these symptoms, colds are the most common reason for calls to the doctor.
Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money and help you avoid some unnecessary trips to the doctor. You can be reassured the following are normal cold symptoms and children with these symptoms don't need to be seen:
- Fever up to 3 days
- Sore throat up to 5 days (with other cold symptoms)
- Nasal discharge and congestion up to 2 weeks
- Coughs up to 3 weeks
Colds: Symptoms of Secondary Bacterial Infections
Using this guideline, you can select out the 5 to 10% of children who have ear infections or sinus infections. Many are identified with specific symptoms and patterns. Some are suspected because symptoms last too long:
- Earache or ear discharge
- Sinus pain not relieved by nasal washes
- Difficulty breathing or rapid breathing
- Fever present over 3 days
- Fever that goes away for 24 hours and then returns
- Sore throat present over 5 days
- Nasal discharge present over 2 weeks
- Cough present over 3 weeks
Return to School
- Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.
See More Appropriate Topic (instead of this one) If
- Runny nose caused by allergies, see HAY FEVER
- Cough is the main symptom, see COUGH
- Yellow or green eye discharge, see EYE – PUS OR DRAINAGE
- Over age 5 and pain around the eye or over the cheekbone, see SINUS PAIN OR CONGESTION
WHEN TO CALL YOUR DOCTOR
Call 911 Now (your child may need an ambulance) If
- Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Not alert when awake
- Difficulty breathing not relieved by cleaning out the nose
- Fever over 104° F (40° C) and not improved 2 hours after fever medicine
- Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
- You think your child needs to be seen urgently
Call Your Within 24 Hours (between 9am and 4pm) If
- You think your child needs to be seen, but not urgently
- Earache or cloudy discharge from ear canal
- Yellow or green eye discharge
- Sinus pain around cheekbone or eyes (not just congestion)
- Fever present for more than 3 days
- Fever returns after going away for 24 hours
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
- Blocked nose interferes with sleep after using nasal washes several times
- Yellow scabs around the nasal openings (Apply OTC antibiotic ointment)
- Sore throat present over 5 days
- Nasal discharge present over 14 days
Patient Home Care If
- Mild cold with no complications and you don't think your child needs to be seen
HOME CARE ADVICE FOR COLDS
For a Runny Nose With Profuse Discharge: Blow or Suction the Nose
- The nasal mucus and discharge is washing viruses and bacteria out of the nose and sinuses.
- Blowing the nose is all that's needed. For younger children use nasal suction.
- Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).
Nasal Washes To Open a Blocked Nose:
- Use saline nose drops or spray to loosen up the dried mucus. If not available, can use warm tap water.
- STEP 1: Instill 3 drops per nostril. (Age < 1 year, use 1 drop and do one side at a time)
- STEP 2: Blow (or suction) each nostril separately, while closing off the other nostril. Then do other side.
- STEP 3: Repeat nose drops and blowing (or suctioning) until the discharge is clear.
- Frequency: Do nasal washes whenever your child can't breathe through the nose.
- Saline nasal sprays can be purchased OTC
- Saline nose drops can also be made: add 1/2 tsp of table salt to 1 cup (8 oz) of warm water
- Reason for nose drops: suction or nose blowing alone can't remove dried or sticky mucus.
- Another option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
- For young children, can also use a wet cotton swab to remove sticky mucus.
- Importance for a young infant: can't nurse or drink from a bottle unless the nose is open.
Humidifier: If the air in your home is dry, use a humidifier.
Medicines for Colds:
- Cold medicines are not recommended at any age. (Reason: they are not helpful. They can't remove dried mucus from the nose. Nasal washes can.)
- Antihistamines are not helpful, unless your child also has nasal allergies.
- Decongestants: OTC oral decongestants (Pseudoephedrine or Phenylephrine) are not recommended. Although they may reduce nasal congestion in some children, they also can have side effects.
- Age Limit: Before 4 years, never use any cough or cold medicines. (Reason: unsafe and not approved by FDA) (Avoid multi-ingredient products at any age.)
- No Antibiotics: Antibiotics are not helpful, unless your child develops an ear or sinus infection.
Treatment for Associated Symptoms of Colds:
- Fever or Pain - Use acetaminophen (e.g., Tylenol) or ibuprofen for muscle aches, headaches, or fever above 102° F (39° C).
- Sore Throat - Use warm chicken broth if over 1 year old and hard candy if over 6 years old.
- Cough - Use cough drops for children over 6 years old, and honey (2 to 5 ml) for younger children over 1 year old.
- Red Eyes - Rinse eyelids frequently with wet cotton balls.
- Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.
Expected Course: Fever 2-3 days, nasal discharge 7-14 days, cough 2-3 weeks.
Call Your Doctor If:
- Earache suspected
- Fever lasts over 3 days Any fever occurs if under 12 weeks old
- Nasal discharge lasts over 14 days
- Cough lasts over 3 weeks
- Your child becomes worse
Extra Advice - Air Travel With Colds:
- It's safe to fly when your child has a cold.
- He could develop temporary ear congestion or earache, but that's often preventable.
- It's unusual to develop an ear infection, unless your child already is prone to frequent ear infections. However, that's not a reason to avoid flying.
Extra Advice - Prevention of Ear Congestion During Air Travel:
- Most symptoms occur during descent of the aircraft (the 15 minutes before landing)
- Stay awake during takeoff and descent
- Swallow during descent using fluids or a pacifier
- Children over age 4 can chew gum during descent
- Yawning during descent also can open the middle ear
- Stay well-hydrated throughout the flight to prevent the nasal secretions from drying out
Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.
Author and Senior Reviewer: Barton D. Schmitt, M.D.
Last Reviewed: 9/15/2011
Last Revised: 8/1/2011
Content Set: Pediatric HouseCalls Symptom Checker
Copyright 1994-2012 Barton D. Schmitt, M.D.
