Children and Teens Medical center

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The Common Cold
The common cold (viral upper respiratory infection or URI) is the most common infectious illness of childhood. Most children will have 5 to 6 colds each year. It is caused by a respiratory virus and spread by hand and mouth contact. Often, it is most contagious the day before symptoms develop. Colds are most prevalent in the winter months when the humidity is low and in situations where groups of children are together indoors, such as the classroom or daycare center. Contrary to popular belief, it is not caused by exposure to cold weather.

Symptoms typically last for 8 days, but have a range of up to 3 weeks. Congestion and runny nose are the result of inflammation and mucus caused by the virus. Nasal and upper airways secretions increase and become thicker. Sometimes they may turn yellow or yellow/green. This is usually colonization by normal bacteria and need not be treated unless it is present for more than two weeks and/or a fever is present.

Cough is usually caused by secretions draining down the back of the throat (post-nasal drip). Coughing for this reason will be worse at night and may even result in vomiting in infants or children with a sensitive gag reflex. A sore throat may develop as a result of the cold and post-nasal drip. All of these symptoms will be increased and prolonged in homes where the air is dry or someone smokes.

Fever is a normal part of infection with a cold virus. It may fluctuate up and down, and occasionally go above 102-103o F. This is a normal part of the illness. In fact, fever is one of the ways the body fights off the virus.

In most cases, the body will fight off the infection within 1 to 2 weeks. Sometimes a cold will appear to last longer. This is usually due to infection by a second virus. (There are hundreds of viruses which can cause a cold.) A second infection is easier to acquire when the body's immune system is busy trying to fight the first virus. Sometimes this cycle will repeat itself resulting in a child who "has a cold all winter".

A small percentage of children will develop a bacterial infection -- an ear infection, strep throat, or pneumonia -- when they have a cold. This is usually signaled by a change in symptoms such as an earache, irritability, shortness of breath, etc. Cold viruses have been with us for thousands of years and the phrase "YOU CAN'T CURE THE COMMON COLD" is still true. Traditional treatment with rest, fluids, humidity, and tender loving care is still the best medicine you can give.

Treatment of a cold is aimed at making the child comfortable. Medications will not cure the viral infection, they only treat the symptoms:
  • Rest, fluids, and acetaminophen (Tylenol, Panadol, and others) are still the cornerstones of treatment. Children will do this on their own. This is why they slow down and decrease their appetite for food when they have colds.
  • A humidifier (cool mist is preferred) will add moisture to the air, lubricate the breathing passages, and loosen up mucus secretions. This is especially important during the cold, dry air of winter. Medications added to the vaporizer are of no benefit.
  • Saline nose drops (Salinex, Ayr, Ocean, and others) are especially helpful for infants and younger children who have not yet learned to blow their noses. Saline nose drops are very safe and may be used every 2-4 hours if necessary (1-2 drops in each nostril for infants; 3-4 drops for older children). They may be prepared at home by dissolving 1/4 tsp. of table salt in 8 oz. (1 cup) of warm water. Gentle suction with a nasal bulb syringe may also be useful to clear any mucus loosened by the drops.
  • Cough and cold medications may relieve the symptoms somewhat, in fact , the American Academy of Pediatrics no longer recommends them due to lack of effectiveness. They can possibly be helpful when the symptoms are most severe. They are not intended to be used continuously during the course of the illness and may lose their effectiveness if used this way. They are notorious for side effects.
Expectorants ( e.g., Robitussin) are used to liquefy and loosen thick secretions in the airways. Water and humidity are the most effective expectorants. Sometimes it may actually increase mucus production thus increase the cough.

Cough suppressants (e.g., Dextromethorpan, Robitussin DM) decrease the cough reflex and are somewhat helpful in relieving a "nuisance cough". Not all coughs should be suppressed, though. Coughing is often the body's protective mechanism to keep infected secretions out of the lower airways and lungs. Sometimes DM acts like an antihistamine and thickens mucus, thus causing a more difficult and persistent cough.

Decongestants (e.g., Sudafed) oral liquids or nasal sprays are used to shrink swollen, congested nasal passages. After a few days of continuous use, most children develop an "immunity" to decongestants and they are no longer helpful. Since decongestants are "speed", your child may get hyped if given too much. One decongestant was removed because of an association with brain hemorrhage.

Antihistamines (e.g., Benadryl and Chlortrimetron) are for allergy symptoms. These prevent allergens from causing loose, runny secretions and post-nasal drip. They do not relieve congestion. If over-used, they may turn already thick secretions into "concrete". All antihistamines are associated with drowsiness.