Advice for Common Cold in Children
Cough, runny nose, and congestion are the most common signs of upper respiratory viral infections also called “URI” or the common cold. If symptoms are not associated with prolonged fever or dehydration, this infection, although very frustrating is a benign condition that will resolve on its own. Typically, secretions can last up to 3-7 days and cough for up to 10-14 days.
Reasons to call the doctor are:
- If these symptoms are associated with a deep productive cough with fever for more than 5 days (signs of pneumonia)
- Associated with ear pain that doesn’t resolve in 2 days (ear infection)
- Dehydration or signs of increased work of breathing with wheezing
Upper respiratory infections can also cause wheezing (a chest whistle with expiration) which in infants is most commonly from an infection called bronchiolitis or stridor (a chest whistle while breathing in) which causes a syndrome known as croup.
The first 6 months of life:
This can be a very frustrating time to develop a URI because young infants are obligate nose breathers meaning they preferentially breathe through their nose. If the nose is filled up with secretions, it can make it difficult to feed and can make babies very fussy. As long symptoms are not associated with prolonged fever or dehydration, this although very frustrating is a benign condition that should resolve on its own.
Treatment involves normal saline and the bulb syringe to mechanically suck out all the nasal secretions (especially before feeds) and elevating the head of the bed. A humidifier by the bedside (both warm or cool work, we like the warm best but be careful about putting it too close to the bedside for risk of burns) and vicks vapo rub can be used safely as well. The only medication which is safe in this age range are neosynephrine infant decongestant drops (also called phenylephrine) 0.125% drops to each nose every 4 hours as needed for up the 5 days (the brand which makes these is called “Little Noses”).
My Child has a Fever, What Should I Do?
Fever is the body’s natural response to infection and is a sign of a healthy intact immune system doing its job to help fight off infection.
Fever in the first 3 months of age:
Fever in the first 3 months of life needs to be evaluated. In the first 6 weeks of life, we consider a fever of anything equal to or greater than 100.4 degrees. Temperature in this neonatal period should be done rectally (as this is the gold standard) and is one of the few times when the degree of fever changes our clinical management. Any temperature above 100.4 needs evaluation in the emergency room to rule out a serious bacterial infection. Temperature above 100.4 from 6 weeks of life until 3 months of age can safely be seen in the clinic if your baby is otherwise doing well.
Fever after 3 months of age:
There is a natural panic response that occurs with a fever. There is a common misconception that the higher the fever, the more dangerous the illness. The fever itself is not dangerous. If the fever is 104 or 100.4 degrees, this usually means the same thing- the body’s immune system is intact and generating a fever to kill off an infection (usually caused by a virus, less commonly a bacterial infection).
Most common viral infections involve upper respiratory infections with cough/runny nose/congestion and GI virus infections with vomiting and/or diarrhea. Some virus infections cause just fever with no other signs. With most virus infection, the fever lasts anywhere from 2-5 days long, vasolating up and down, with children appearing tired during spikes of fever then regaining energy and “perking up” like their usual self when the fever is down.
Fever can safely be treated with Tylenol and/or Motrin (if over 6 months) (see dosing chart). Everyone with fever will have a decreased appetite. Eating is not as important as drinking to prevent dehydration. Virus infections go away on their own and do not require any specific treatment.
Reasons for concern are for signs of bacterial infection:
- Fever lasting longer than 5 days,
- Lethargy (even when the fever is down)
- Fever associated with ear pain which does not get better after 2 days
- Abdominal pain
- Pain with urination
- Back pain
- Signs of dehydration (decreased urine output less than twice per day, inability to tolerate any fluids by mouth)