Cold Viruses

The common cold is a group of symptoms caused by a number of different viruses. There are hundreds of different viruses responsible for the common cold. In most cases, a specific virus causes a person to be ill only once, after which they are immune to that virus. However, because there are so many cold viruses, people may have multiple colds each year.

Children under six years average six to eight colds per year with symptoms lasting an average of 14 days. Young children in daycare appear to suffer from more colds than children cared for at home, and often are sick for most of the cough and cold season. However, when daycare children enter primary school, they catch fewer colds, presumably because they are already immune to a larger number.

Transmission

Colds are transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days. Some cold viruses can live on surfaces (such as countertops, door handles, or toys) for several days, and some can be spread when droplets containing viral particles are exhaled into the air by breathing, coughing, or sneezing, and then inhaled by another. Cold viruses are not usually spread through saliva.

COMMON COLD SYMPTOMS

The symptoms of a cold usually begin one to two days after exposure. In children, nasal congestion is the most prominent symptom. Children can also have clear, yellow, or green-colored nasal discharge. Fever (>100.4º F) is common during the first three days of the illness. Other symptoms may include sore throat, cough, irritability, difficulty sleeping, decreased appetite, and swollen lymph nodes. The symptoms of a cold are usually worst during the first 10 days. However, some children continue to have a runny nose, congestion, and a cough beyond 10 days. In addition, it is not unusual for a child to develop a second cold as the symptoms of the first cold are resolving; this can make it seem as if the child has a single cold that lasts for weeks or even months, especially during the fall and winter. This is not a cause for concern, unless the child has any of the more serious symptoms, discussed below.

COUGHS

Coughing is your body's way of clearing secretions and mucus, to keep it from 'settling' in your lungs. It serves a very useful purpose, so coughs should not be suppressed. Cough medicine is ineffective, anyway, so another reason to save your money and avoid buying cough medicine! Parents often notice that they feel 'congestion' rattling, or vibrating in their child's chest when he has a cold. The entire airway is connected from the nose to the lungs, and noise from congestion in the nose and sinuses travels all the way down into the chest, and thus seems as though it is originating in the chest. The only way to tell whether the congestion is truly in the lungs or simply being transmitted from the nose and sinuses is for a doctor to listen with a stethoscope. If your child is coughing mildly and/or infrequently with a cold virus, it is likely simply secondary to the cold. If your child's cough is persistent and bothersome, perhaps affecting his sleep, and/or if he seems to be breathing hard or fast when you observe his chest, the cough could signify a process in the lungs. If this is the case, please contact our office.

COMMON COLD COMPLICATIONS

Most children who have colds do not develop complications. However, parents should be aware of the signs and symptoms of potential complications.

Ear infection

If a child develops a fever (>100.4º F) after the first three days of cold symptoms, an ear infection may be to blame. Other symptoms of an ear infection include ear pain, irritability, difficulty sleeping or lying flat, and refusal to drink from a bottle.

Sinusitis

Children who have nasal congestion that does not improve over the course of 14 days may have a bacterial sinus infection. Doctors can't see a patients sinuses without an X-RAY, so they have to rely on symptoms to diagnose a sinus infection. If your child has had cold symptoms for over 2 weeks and other bothersome symptoms such as cough, decreased appetite, poor sleep, fatigue, and/ or fevers, it is reasonable to start antibiotics for a presumed sinus infection.

Pneumonia

Children who develop a fever after the first three days of cold symptoms may have bacterial pneumonia, especially if the child also has a persistent or deep cough, and/or is breathing rapidly.

Wheezing

Children who are prone to wheezing or asthma symptoms often are triggered by viral respiratory infections. A deep or persistent cough, chest tightness or difficulty breathing my signify that your child has developed wheezing.

COMMON COLD TREATMENT

Antihistamines, decongestants, cough medicines, and expectorants, alone and in combinations, are all marketed for the symptoms of a cold. However, there have been few clinical trials of these products in infants and children, and there are no studies that demonstrate any benefit in infants or children.

The United States Food and Drug Administration (FDA) advisory panel has recommended against the use of these medications in children younger than six. This includes prescription cough medicines. We agree with this recommendation because these medications are not proven to be effective and have the potential to cause dangerous side effects. For children older than 6 years, cold medications may have fewer risks; however, there is still no proven benefit.

Symptomatic Treatment

Fever reducers: Tylenol (acetaminophen) can be giving to a child over 2 months who is uncomfortable because of fever during the first few days of a cold. Ibuprofen (Motrin, Advil) can be given to children greater than six months of age. Aspirin should not be given to any child under age 18 years. There is no benefit of these medications if the child is comfortable and does not have a fever greater than 100.4º F (38º C), and it is not necessary for all children to be treated for fever. For instance, we don't recommend waking a peacefully sleeping child just to give a fever reducer.

Humidified air can improve symptoms of nasal congestion and runny nose. For infants, parents can try saline nose drops to loosen the mucus, followed by bulb suction. It is helpful to occlude the opposite nostril for adequate suction.

Fluids: Parents should encourage their child to drink an adequate amount of fluids. Children often have a reduced appetite during a cold, and may eat less than usual. Don’t worry as long as they are staying hydrated and urinating at least 4-6 times per day. Milk, water or other clear fluids are appropriate choices for children over one. Breast milk, formula or Pedialyte are appropriate for young infants, and infants older than 6 months can have juices as well.

Herbal and alternative treatments — A number of alternative products, including zinc, vitamin C, and herbal products such as echinacea, are advertised to treat or prevent the common cold. None of these treatments has been proven to be effective in clinical trials; their use is not recommended.

WHEN TO CALL THE OFFICE

Immediately

• Refusal to drink anything for a prolonged period, resulting in decreased urination (no urination for >6 hours in infants, >8 hours in children over one year, while awake).
• Behavior changes, including irritability or difficulty arousing. Many children sleep more when they are sick, but they should be easily aroused from sleep, without seeming confused or acting bizarrely.
• Fast, hard, or labored breathing

During Normal Office Hours

• Persistent coughing
• Fever greater than 100.4 for more than 72 hours (3 days)
• Nasal congestion does not improve or worsens over the course of 14 days
• The eyes become red or develop yellow discharge
• There are signs or symptoms of an ear infection (pain, ear pulling, fussiness, bottle refusal or difficulty lying flat)