The Common Cold: What to Do, When to Worry

by: Michelle Place, CRNP-CP
They do not call it the common cold for nothing. It is the illness that children suffer from most frequently. Unfortunately there is no easy fix for the common cold. The good news is that although the symptoms cause discomfort and can be extremely irritating they are usually self-limiting and not dangerous to your child’s health. Treatment mainly consists of easing the symptoms in order to make your child more comfortable (and to allow everyone to get as much sleep as possible).
Fever: This is the symptom which causes many parents to panic unnecessarily. When your child starts to heat up, take a deep breath and stay cool. In infants less than 3 mos old you do not need to worry until they develop a temperature of 100.4 or higher. Remember that babies who are under 1 year should always have their temperature measured rectally. For children older than 3 mos it is not worrisome until the thermometer reading reaches over 101. In the context of a cold, it is very common for children, especially young children, to have fever for the first 3 days.
What to do: If the fever is making your child miserably uncomfortable it can be treated with acetaminophen (tylenol) or ibuprofen (in children 6 mos and older). If your child feels warm but remains playful and continues to drink well, it is not necessary to treat the fever. Fever is the body’s way of fighting infection so, as much as possible, we should let it do its thing.
When to worry: There is really no number on the thermometer at which you should panic. Even temps as high as 104-105 will not fry your child’s brain or cause other irreparable damage. Give tylenol or ibuprofen and wait 30-60 minutes. If your child does not perk up or does not drink enough to produce urine at least 4 times in 24 hours, call your doctor. How your child looks is much more important than what you see on the thermometer.
Another time fever should prompt you to visit the doctor is if it lasts for more than 5 days. Cold viruses often cause the body to run at a higher temperature for up to 4 days but if it continues beyond that someone should take a look to make sure nothing else is going on. (For more information on fever see our previous blog “Flaming Fever Facts”)
Nasal Secretions: This is the hallmark of the common cold and usually begins about 2 days following exposure to the virus.
What to do:

  • Maintain Adequate Hydration: This helps thin secretions and soothes the respiratory mucosa
  • Drink Warm Fluids: Grandma’s chicken soup can help enhance the removal of nasal discharge by  loosening secretions, increasing the flow of mucus, and soothing the lining of the nasal passages as well as the throat. It also helps with hydration.
  • Nasal Saline and Suction: In infants, this can be accomplished with nasal saline drops and a bulb syringe. For older children a nasal saline spray or irrigation system can be used along with encouragement to “blow your nose!” Studies have shown that this simple intervention results in a modest improvement of symptoms, decreased use of other therapies, decreased recurrence of symptoms, and decreased school absence.
  • Cool Mist Humidifier:  Adding moisture to the air helps to loosen nasal secretions. The humidifier/vaporizer should be cleaned after each use as recommended to decrease the risk of infection or inhalation injury. Warm/hot mist is not recommended as there has been no added benefit seen with warming the air but there is increased risk of accidental burns from scalding.
  • Raise the Head of the Bed: It is not just your imagination, these symptoms do worsen at night. When your child lays down the small advantage gravity was giving them in controlling the flow of nasal secretions is lost. Sleeping while propped up may offer some relief. For infants, a roll can be placed under one side of the mattress. Placing your infant on a pillow or using extraneous blankets in the bed can increase the risk of suffocation.

When to worry: The huge amount of mucus that can be produced by such a small person can be astounding. These secretions can range from thin and clear to very thick and yellow or even green. The color of these secretions is no cause for alarm. Generally they are thicker and darker first thing in the morning or after a nap when they have been sitting around for a while. Once your child is up and moving things become looser and clearer. You should, however, call the doctor if the congestion is preventing your child from drinking adequately or if there is any difficulty breathing. Signs of respiratory distress are:

  • sustained rapid breathing (tachypnea)
  • nostrils become very wide with each breath (nasal flaring)
  • ribs are clearly visible with every breath (retractions)
  • can not eat/drink and breathe at the same time

If you see any of these symptoms, call our office at (301) 279-6751 right away.
Cough: This is arguably the most annoying of all symptoms. It keeps everyone in the house awake, is disruptive in the classroom  and can last up to 4 weeks until post-nasal drip completely resolves. As a result, many parents look for something, anything to suppress this annoying reflex, however, coughing is the body’s way of protecting itself from having those secretions end up in the lungs so suppressing it is rarely the optimal choice.
What to do:

  • Honey: A study published in the journal “Pediatrics” found that a single dose of honey given at bedtime resulted in a reduction in cough compared to no treatment. The dose of honey can be repeated as often as needed and is safe in children older than 1 year of age. Children less than one year old should not be given honey due to the risk of botulism.
  • Lozenges/hard candy: The AAP recommends the use of lozenges to reduce irritation and to coat the throat in children over 6 years of age keeping in mind that they could be a choking hazard.
  • Vapor Rub: A small study published in the journal “Pediatrics” indicated that applying vapor rub to the chest and neck may provide some relief compared to the application of vaseline or no treatment. The results of this study may be the result of the placebo effect as it was difficult to blind parents to which product they were applying. Some children also complained of irritation caused by the treatment.

When to worry: Vomiting following cough can occur especially first thing in the morning. If this happens now and then and contains mostly mucus there is no need for concern. In fact, it is a very effective way the body has of clearing itself of these annoying secretions. If your child is vomiting continuously, call your doctor. Another reason to call is if the cough persists for more than 4 weeks or if it seems to be worsening rather than getting better.
The Common Cold – What NOT to do:

  • OTC Cough/Cold medicines: These have not been shown to be effective and can have some dangerous side effects in children less than 6 years of age. (see previous post for more information).
  • Antibiotics: These medications are useful against bacterial infections but have no effect against any of the myriad viruses which cause cold symptoms. Antibiotic use does not prevent the development of secondary infections such as ear infections, sinusitis or pneumonia. They can cause harmful side effects and using them unnecessarily results in resistance which will render them ineffective when your child really does need them.
  • Antiviral Therapy: Unfortunately, there is no antiviral therapy available for any of the viruses that cause the common cold.
  • Zinc: Studies have not proved any efficacy in the use of zinc in decreasing the  duration of cold symptoms in children. Use of homeopathic nasal zinc preparations may lead to loss of  the sense of smell that can become permanent.
  • Echinacea: Research has shown that there is no difference in the severity or duration of cold symptoms with the use of echinacea. There is, however, increased incidence of rash following its use.
  • Vitamin C: No change in cold symptoms has been found after many, many studies looking at the relationship between vitamin C and the common cold.

If your child’s symptoms fall into any of the “When to Worry” categories listed above, call us at (301) 279-6750 and we will be happy to see your child as soon as possible.