Unfortunately, at some time or another, every baby and child is going to catch a cold. Colds are caused by several different viruses and are usually spread person-to-person from the infected nose or throat.  Rhinoviruses (RVs) are the most common family of viruses to cause colds. There are many serotypes of Rhinovirus, hence you can catch it many times.

In addition to Rhinoviruses, other viruses such as Enteroviruses, Respiratory Syncytial Virus, human metapneumovirus, adenovirus, influenza, and parainfluenza viruses can all cause cold symptoms.  In addition to common cold symptoms, many of these viruses can also cause croup, and viral pneumonia. Cold viruses also play a significant role in the development of otitis media and the development of asthma flare ups.

Most everyone will come down with a cold from time to time.  Thankfully, most cases are mild and self-limited. Colds usually begin with a watery discharge from the nose accompanied by sneezing and watery eyes. The child can also develop fever, cough and a sore throat. Usually, the cough and sore throat are not particularly severe. The child may run fever for two to three days. As a cold progresses, the nasal drainage often becomes thicker and may turn yellow or green. This may be the final stage in the resolution of a cold and no additional treatment is needed if your child is otherwise doing well. The total duration of a cold may be as short as four to five days, or as long as 14 days or even longer. So far, there is no cure for the common cold. Since the infection is due to one of the many viruses identified above, antibiotics are not helpful. Treatment of a cold is aimed at relieving symptoms and keeping the body well hydrated and nourished so that it can fight off the infection.

Treatment:

  1. Rest. Stay in bed for a while. Sleep.
  2. Encourage plenty of fluids, especially clear liquids. This will keep the mucus thin and prevent dehydration.
  3. Encourage your child to eat nutritious foods.
  4. Acetaminophen (Tylenol) for fever and/or aches (see Dosing Guide) if these are particularly bothersome. Please see the section on fever for information on the benefits of fever in fighting off infections.
  5. Saline nose drops. These are particularly helpful for very small children who are unable to blow their noses. Saline nose drops (AYR, Salinex, Ocean, Simply Saline) are quite helpful when placed in the nose to loosen the mucus. You should put two or three drops in each nostril, wait a minute or so and then suction the nose with a nasal aspirator (bulb syringe) as often as needed. In using a nasal aspirator effectively, it is necessary to insert the tip of the nasal aspirator one-half inch into the nose and then aspirate. This is accomplished by using an aspirator with a small tip and inserting it straight into the nose. Saline nose drops can be made at home by adding one-half teaspoon of salt to four ounces of warm water. Allow the solution to cool before using and make it up fresh every day. Besides a nasal aspirator, there are several other methods of doing nasal suction. We will discuss two. One is the NoseFrida in which a small tube is placed into the nostril of the baby and the parent then provides oral suction to remove the mucus.  There are also battery operated nasal suction devices available.
  6. Vaporizer. Use a cool mist vaporizer to decrease the nasal congestion and make the mucus thinner so your child can cough this out. You should use this especially at night. Make sure to wash the water tank daily to prevent molds from forming in the tank. Although the steam of warm mist machines is actually a little better than cool mist machines, you should not use warm mist machines unless you can insure that your child will not be burned by them. Some safer warm mist machines have been brought to market which produce mist that is not of scalding temperature as the mist comes from the spout of the machine. These are fine to use. You should not make a habit of using vaporizers in Arkansas however. Vaporizers increase humidity in the home, making a welcoming environment for a black mold found in Arkansas called Stachybotrys. So, limit use of vaporizers to only a very few days.
  7. Taking a long hot shower can help loosen mucous and help children breath easier.
  8. Sometimes for children over the age of four years, nasal decongestants and cough/cold preparations can be helpful for comfort’s sake. Cough/cold preparations do not speed recovery of a cold.  They may slightly reduce a child’s runny nose and cough. See our dosing guide for more information on how to use these medications and continue reading below. Nasal decongestants and cough medication do nothing to speed recovery from a cold. They provide a small measure of symptomatic relief for a runny nose and or cough for children who are four years of age and older.

Children less than 4 years of age should no receive nasal decongestants and cough/cold preparations. For kids 4 years and older, if your child has a heart condition, especially an arrhythmia, do not give cough and cold preparations without our approval. Likewise children with chronic medical problems should not receive these medications without our advice.

You should call the office for an appointment with any of the following symptoms:

  1. If the nasal drainage persists after the usual 14 days of a cold and seems to become thicker and yellow, creamy, or greenish in color. This may indicate that your child has a secondary bacterial infection of the sinuses called sinusitis.
  2. If the cough becomes particularly severe and is associated with a high fever above 102 degrees Fahrenheit. This may indicate that your child is developing pneumonia and or influenza.
  3. If your child seems to “keep a cold” year around, your child may be allergic and should have an office visit to evaluate this. Please see the section on allergies in this handbook if your child seems to keep a cold all the time.
  4. If your child’s temperature persists over 101 degrees Fahrenheit for more than three days.
  5. If your child’s sore throat is particularly severe or if bad breath is present. This may indicate strep throat.
  6. If your child develops ear pain. This can mean your child has a middle ear infection.
  7. If your child develops significant breathing difficulty or wheezing (see the RSV bronchiolitis section of this handbook).

Do not start any leftover antibiotic prescriptions, as these drugs do not cure the common cold and can cause more harm than good (see section on antibiotics).

Note on cough and cold medication safety for Children:  In 2008, the FDA strongly recommended against giving over-the-counter cough and cold medicines to children who were under 2 years of age. Pediatricians had long prescribed these medications to infants and children for cold symptom relief. This action by the FDA abruptly changed our pattern of practice to our position written in item #8 above on the treatment of cough and colds. The FDA took their position on this matter because only adult studies for this class of medications had been done and there were reports of rare deaths in children under the age of two years which were thought to be due to these cold type medications. In response to this recommendation, the makers of children’s cold and cough medications have voluntarily re-labeled their products stating on the labeling that these medications should not be given to children less than 4 years of age. Some labels go even further, withholding doses for even older children aged six to even twelve.

So, what can be given to a child under the age of 4 years for relief of cold symptoms, such as runny nose and cough? Well, nothing. Actually, nothing is needed. Children get over colds and coughs just as quickly without cold medicines as with them. Nothing cures a cold, but a little time. You can consider using honey for coughs or sore throat for kids, but only if they are older than one year of age. Zarbee’s is one such commercial honey cough medication. It may help soothe symptoms just a little. But, remember it does nothing to stop or relieve the cold.

Reviewed 3/16/17 by Dr. Byrum