Colds

• Runny or stuffy nose
• Usually associated with fever and sore throat
• Sometimes associated with a cough, hoarseness, red eyes, and swollen lymph nodes in the neck
• Also called an upper respiratory infection (URI)

Similar Conditions

Vasomotor rhinitis. Many children and adults have a profusely runny nose in the winter when they are breathing cold air. This usually clears within 15 minutes of coming indoors. It requires no treatment beyond a handkerchief and has nothing to do with infection.

Chemical rhinitis. Chemical rhinitis is a dry stuffy nose from excessive and prolonged use of vasoconstrictor nose drops (more than 1 week). It will be better within a day or two of stopping the nose drops.

Cause

A cold or URI is a viral infection of the nose and throat. The cold viruses are spread from one person to another by hand contact, coughing, and sneezing; not by cold air or drafts. Since there are up to 200 cold viruses, most healthy children get at least six colds each year.

Expected Course

Management of colds is helped by understanding the usual course of the common cold.

A cold lasts 10-14 days in children and adolescents.  As shown in this diagram, fever occurs during the first few days; a sore throat peaks about day 2-3.  A runny nose usually lasts 10-14 days with a peak about day 7, and coughs start a few days into a cold and can last 2-3 weeks.  The mucus usually starts as clear and thin and turns thick and yellow or green in color.  As the cold resolves, the mucus becomes thing and clear again.

The goal of treatment is to feel better, not to lessen or eliminate symptoms.  Given this goal, we recommend a cool mist humidifier in the room, nasal saline spray with suctioning in young children, and plenty of fluids.  Tylenol (Acetaminophen) or Advil/Motrin (Ibuprofen) can reduce fever and the achy feeling associated with a cold.  Benadryl (Diphenhydramine) at bedtime decreases the runny nose and can make the child sleepy.  Cold and cough medications are not very effective and they have side effects that can be troublesome.  We do not routinely recommend these medications.  It is okay to give Tylenol or Advil/Motrin and Benadryl at the same time as they are different medications.  Avoid giving medications with more than one ingredient.

A cough may last 2-3 weeks. The main things to watch for are secondary bacterial infections such as ear infections, yellow drainage from the eyes, sinus pressure or pain (often indicating a sinus infection), or difficulty breathing (often caused by pneumonia). In young infants, a blocked nose can interfere so much with the ability to suck that dehydration can occur.

Home Care

Not much can be done to affect how long a cold lasts. However, we can relieve many of the symptoms. Keep in mind that the treatment for a runny nose is quite different from the treatment for a stuffy nose.

Treatment for a Runny Nose with Profuse Discharge: Suctioning or Blowing. The best treatment is clearing the nose for a day or two. Sniffing and swallowing the secretions are probably better than blowing because blowing the nose can force the infection into the ears or sinuses. For younger babies, use a soft rubber suction bulb to remove the secretions gently.

Nasal discharge is the nose’s way of eliminating viruses. Medicine is not helpful.

Treatment for a Stuffy or Blocked Nose with Dried Yellow-Green Mucus: Warm-Water or Saline Nose Drops and Suctioning (Nasal Washes). Most stuffy noses are blocked by dry mucus. Blowing the nose or suction alone cannot remove most dry secretions. Nose drops of warm tap water are better than any medicine you can buy for loosening dried mucus. If you prefer normal saline nose drops, mix 1⁄2 teaspoon of table salt in 8 ounces of water. Make up a fresh solution every day and keep it in a clean bottle. Use a clean dropper to insert drops. Water can also be dripped or splashed in using a wet cotton ball.

For the younger child who cannot blow her nose: Place 3 drops of warm water or saline in each nostril. After 1 minute use a soft rubber suction bulb to suck out the loosened mucus gently. To remove secretions from the back of the nose, you will need to seal off both nasal openings completely with the tip of the suction bulb and your fingers. You can get a suction bulb at your drug store for about $2.

For the older child who can blow her nose: Use 3 drops as necessary in each nostril while your child is lying on her back on a bed with the head hanging over the side. Wait 1 minute for the water or saline to soften and loosen the dried mucus. Then have your child blow her nose. This can be repeated several times in a row for complete clearing of the nasal passages.

Errors in using nose drops: The main errors are not putting in enough water or saline, not waiting long enough for secretions to loosen up, and not repeating the procedure until the breathing is easy. The front of the nose can look open while the back of the nose is all gummed up with dried mucus. Obviously, putting in nose drops without suctioning or blowing the nose afterward is of little value.

Use nasal washes at least 4 times per day or whenever your child can’t breathe through the nose.

The Importance of Clearing the Nose in Young Infants.

A child can’t breathe through the mouth and suck on something at the same time. If your child is breast or bottle feeding, you must clear the nose so she can breathe while sucking. Clearing the nasal passages is also important before putting your child down to sleep.

Treatment for Associated Symptoms of Colds

• Fever: Use acetaminophen or ibuprofen for aches or mild fever (over 102°F [38.9°C]).
• Sore throat: Use hard candies for children over 4 years old and warm chicken broth for children over 1 year old.
• Cough: Cough drops or honey for children over 4 years old and corn syrup for younger children. Run a humidifier.
• Red eyes: Rinse frequently with wet cotton balls.
• Poor appetite: Encourage fluids of the child’s choice.

Prevention of Colds

A cold is caused by direct contact with someone who already has one. Over the years, we all become exposed to many colds and develop some immunity to them. Since complications are more common in children during the first year of life, try to avoid undue exposure of young babies to other children or adults with colds, to day care nurseries, and to church nurseries. A humidifier prevents dry mucous membranes, which may be more susceptible to infections. Vitamin C, unfortunately, has not been shown to prevent or shorten colds. Large doses of vitamin C (e.g., 2 grams) cause diarrhea.

Common Mistakes in Treating Colds

Most over-the-counter cold remedies or tablets are worthless. Nothing can shorten the duration of a cold. If the nose is really running, consider a pure antihistamine (such as Benadryl). Especially avoid drugs that have several ingredients because they increase the risk of side effects. Avoid oral decongestants if they make your child jittery or keep her from sleeping at night. Use acetaminophen or ibuprofen for a cold only if your child also has fever, sore throat, or muscle aches. Leftover antibiotics should not be given for uncomplicated colds because they have no effect on viruses and may be harmful.

CALL OUR OFFICE IMMEDIATELY if:

• Breathing becomes difficult and no better after you clear the nose.
• Your child starts acting very sick.

Within 24 hours if:

• The fever lasts more than 3 days.
• The nasal discharge lasts more than 10 days.
• The eyes develop a yellow discharge.
• There is any suggestion of an earache or sinus pain.
• You have other questions or concerns