Advice: Common Cold

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Viral Upper Respiratory Tract Infections (Common Cold)

Common cold basics

Viral Upper Respiratory tract infections (URIs or “common colds”) are caused by a viral infection in the nose, throat and upper airway.
URIs are caused by dozens of different viruses, but symptoms are generally similar: nasal congestion, runny nose, sneezing, cough, fussiness or fatigue, decrease in appetite, and fever being the most common.
Children can expect to have 6-8 viral URIs each year. This number may be as high as 8-12 during the first year of daycare or school!
The vast majority of URIs will resolve without intervention within 3-5 days. However, bacterial infections like ear infections, pneumonias, and sinus infections can follow URIs. Signs of these bacterial infections include fever lasting longer than 4-5 days, worsening cough, increased work of breathing, lethargy, and ear pain. If these develop, see your doctor.

Treatment

Treatment for viral respiratory infections is supportive. There is no role for antibiotics or other prescription medications in the majority of cases. Pillars of supportive care include:
Fever/Pain control: Use Acetaminophen and Ibuprofen for fever control. Fevers are not dangerous, but they make your child feel bad which impacts their ability to drink and stay hydrated. Acetaminophen can be used every 4 - 6 hours (up to 4 times/day). Ibuprofen may also be used every 6 hours if your child is older than 6 months. These may be alternated or given together.
Hydration: Encourage small/frequent sips of formula/breast milk, Pedialyte and/or water (if older than 6 months). The best measure of hydration is urine output. Generally we like at at least 4 voids in 24 hours
Nasal hygiene: Frequent nasal suctioning with a bulb suction or ‘NoseFrida’, humidifiers, steam showers all help clear the nose. Post nasal drip is often the biggest cause of cough with these infections.
Cough: Honey, for children older than 1 year, is the most helpful and only recommended cough medication.

Expectations for improvement

Fever, fatigue, and changes in behavior typically resolve within 2-4 days with most URIs.
Congestion and cough, especially overnight and in the mornings, often linger for 2-3 weeks after a URI. It takes time for the body to 'clean-up' the mucus, debris, and inflammation in the nose and airways.
Your child is NOT contagious during this 'clean-up' phase and may return to school and activities

When to seek care

For most children, especially older children, URIs can be managed at home with the supportive care above. You should seek care:
If your child is less than 3 months old and has any fever.
If fever lasts more than 4-5 days.
If your child is not urinating at least 4 times/day
If your child is breathing faster than normal, harder than normal, or has retractions or breathing has worsened since your last visit
If your child develops ear pain.
If you are concerned

When to go to the Emergency Departent

If your child is in respiratory distress (nostrils flaring, ribs showing, significant belly breathing, head bobbing, grunting, or very fast breathing)
If your child is lethargic or difficult to arouse
If your child is showing signs of severe dehydration: lethargy, little/no urine output, dry lips, sunken fontanelle (soft spot)
If you are worried

Additional Resources

Potomac Pediatrics will always be fully focused on helping your child and you to overcome any healthcare hurdle, with innovative, comprehensive and compassionate care.