The Common Viral Cold (Upper Respiratory Infection)    

 General Information:

Colds are caused by viruses and infect the nose and the throat.  They are spread through close contact with saliva and mucus through hand contact, sneezing, coughing, etc. and so they will spread easily in households, daycares and schools.  Poor hand washing and interactions with people with colds can increase the chance of catching a cold, but cold air or teething will not.  Since there are so many cold viruses, it is not unusual for children to get 6-12 colds a year (which means 1 cold a month is not unusual) with toddlers with siblings or in daycare tending to be at the higher end of this range. 

Symptoms:

The common symptoms of a viral illness are coughing and congestion (runny or stuffy nose).  Viruses can also cause fevers (even in the 102-103 range) and sore throats (usually from post-nasal dripping of mucus).  Sometimes children can throw up mucus after coughing spells - since they are not very good at coughing up mucus this is not actually such an unexpected way to clear mucus.  They might also have less appetite as they do feel sick and probably have some mucus in their stomach that has dripped down from their throat.  The symptoms of a viral cold can last longer than some parents would like - a fever may last up to 5 days and cough and congestion can last 7-10 days.  

   Treatment:

   Antibiotics (NOT HELPFUL):

Since colds are caused by viruses, antibiotics are not helpful (these treat bacterial infections).  Giving antibiotics when they are not needed is not a good idea - besides being a waste of money they can also:

• have side effects (i.e. cause upset stomach)

• can kill good bacteria that live in our body so that bad organisms take over (i.e. yeast infections)

•  increase the chance that when your child and other children in the community have bacterial infections, that the antibiotics we have will not work (i.e. the bacteria will have become resistant from being exposed to them)

   Supportive Measures:

Since there is no cure for viral colds, the general strategy is to wait for them to run their course and keep the child comfortable, rested and well hydrated in the mean time.  This means:

1. aggressively encouraging fluid intake - watching energy level and amount of urination is a good way to tell how well hydrated a child is (if you don't drink, you don't urinate!)

2. treating fever with fever reducers (see medication calculator) to keep the child comfortable and decrease the amount of fluids that are burned off by extra heat (see #1)

3. helping with congestion and cough when able as follows:

   • cool mist humidifier - by putting cool mist into the air it can loosen phlegm and sooth inflammation in the nose and throat.  It generally works the way steaming up the bathroom can "loosen your head" (which can also work).  In order for it to work best, however, the humidity should make it to the areas where it is needed so a rule of thumb could be to put the humidifier close enough that the child's hair gets slightly moist.  Since it may have to be close to the child, cool mist is recommended instead of warm mist so that if it spills, it does not cause burns

   • bulb syringe and nasal saline (i.e. Little Noses) - a few drops of warm nasal saline can be put in the nostrils and, after 1 minute, can be removed with the bulb syringe with mucus.  Using the bulb syringe too often can cause more inflammation of the nose so it is best to focus on clearing the nose before sleep (and before eating in babies)

   • decongestant medicines - these may be helpful in certain situations but are generally of limited value, especially in infants where there is less evidence that they can help.  If you have questions about dosing, please contact your doctor

   • cough suppressant medicines - again they may be helpful in certain situations but are also of limited value, especially in infants.  A cough is the body's natural protection to prevent mucus from settling into the lungs (people with muscle weakness who can't cough well develop pneumonia).  While over-the-counter cough suppressants may help a little without being too strong, prescription cough medicines may not be the best way to overcome a virus.  While it may help a child sleep for a night, it suppresses the "tickle" in the throat so that you don't feel the mucus dripping into your chest.  

   • Note: in a child with asthma or who may have asthma a dry cough (one that doesn't sound like there is phlegm) especially one that is worse at night is usually caused by the cold irritating the asthma.  If your child has asthma medicine prescribed for periodic use as needed (i.e. albuterol), this dry cough may respond better to asthma medicine than to over-the-counter cough medicines and you might consider using this to make them more comfortable.  For more information on asthma, click here to see our comprehensive guide to asthma.

   Complications:

Viral colds are the most common causes of bacterial ear infections, sinus infections and  lung infections.  Presumably, the drainage of fluid from places like the ear and sinuses can be blocked by congestion and when this fluid sits around it can become infected by bacteria.  If your child starts with a virus and then develops ear pain, sinus (forehead) headaches or breathing symptoms, it would be good for a doctor to examine your child to see if one of these secondary bacterial infections have occurred.  Also the fever from viral colds are more common in the beginning of the infection.  If a new fever develops later on in the cold, it may suggest one of these bacterial infections may have occurred. 

   When to call: 

You should call your doctor if you have any questions about your child's cold, but especially if:

• the child appears significantly ill or is not acting properly

• the child has a significant decrease in drinking and urinating

• the child is having any breathing difficulty (not just stuffy in the nose)

• an infant under 4 months old has a temperature > 100.5° F

• fevers do not respond to fever medicine even for a few hours

• fevers last longer than 4-5 days or come later on in the course of the infection

• cough and congestion are getting worse after 7-10 days or are not getting better after 2 weeks

• the child develops significant pain in the ears, throat, sinuses or chest