• Definition
• Facts
• Home care
• When to call your doctor

Definition

• Runny or stuffy nose, sometimes with a fever, sore throat, cough, hoarse voice or swollen glands in the neck, and decreased appetite.

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Facts

• Colds are caused by viruses, and antibiotics do not cure viruses.


• Transmission is by hand-to-hand contact, sneezing and coughing. Viruses can persist on surfaces of objects for many hours. The virus is shed from the nasal discharge.


• People are contagious a day or two before the onset of symptoms. As the cold progresses, contagiousness gradually decreases. Shedding of the virus from nasal discharge may last as long as two to three weeks. The incubation time (from exposure to the virus to the start of symptoms) is two to seven days.


• Colds are not caused by cold air, drafts or swimming.


• Colds usually decrease the appetite.


• Most newborns sound stuffy on and off. They have dried mucous in the nasal passages which can be cleared with salt-water drops and bulb syringing. Infants under about 4 months must breathe through their nose, and sucking can become difficult with a cold. Their nasal passages are small; therefore, a small amount of mucous can make a lot of noise. Don't worry about the sound, just the effort of breathing.


• Most children get about 12 colds per year. The frequency is higher if the child is in daycare, has siblings in school or is around a lot of other children. They cluster between October and March.


• Chronic congestion (duration of greater than one month) may represent allergies, sinusitis or a foreign body in the nose. A foreign body placed in the nose may cause a one-sided, foul smelling, thick runny nose.


• Colds last an average of 18 days. Fevers usually last three to four days. The cough is usually the last symptom to go away (sometimes up to four weeks).


• Nasal discharge can be clear, white, yellow or green. It is often more colored in the mornings or after a nap. Typically at the end of the cold, the discharge is more green due to the presence of white blood cells helping the body recover from a cold. The color alone does not mean an infection that requires antibiotics.


• Milk does not need to be eliminated with colds, unless milk allergy is suspected.

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Home care

Runny nose with lots of discharge. For young infants, use a bulb syringe to clear the secretions. It is especially helpful before a baby nurses or takes a bottle. Use a humidifier at night. Cool mist humidifiers are safer than steam. Elevate the head of the crib or bed. This is best done in cribs or bassinets by placing a pillow underneath the mattress. Never place infants on pillows. Keep the room temperature down below 65° F in the winter. Dress the child warmly.

Stuffy nose with little discharge. Warm nose drops with a solution of salt water (use 1 teaspoon of salt in a cup of warm water) or purchased saline drops can be placed in each nostril. This will often help to break up the mucous and the child can then be suctioned with the bulb syringe. For best results, block the opposite nostril when bulb suctioning. Older children can be told to blow the nose after the drops have been in for a minute. If you don't get results, discontinue the process as the irritation to the nasal linings from the suctioning may create mucous.

Allergies. Occasionally, a child may have allergies that are causing a stuffy or runny nose. Things that may make you think about allergies:

• Recent introduction of new formula or milk products


• Family history of allergies, asthma or eczema


• Runny nose more than four weeks, often associated with sneezing or itchy eyes


• Runny nose is seasonal


• Child does not seem ill


• Dark circles under the eyes, called "allergic shiners," or a crease on the nose from rubbing an itchy nose

If you have concerns about allergies, contact your doctor during office hours (Monday through Friday, 8 a.m. to 5 p.m.).

Complications of a cold. Ear infections, sinusitis and pneumonia may be complications of a cold. Not all green noses mean infections that need antibiotics. Sinusitis is a bacterial infection of the sinus cavities (small spaces in the bones of the face). Symptoms of sinusitis may include green or yellow mucous for two or more weeks, and nighttime or morning cough from a postnasal drip. Sometimes, they have a fever, foul breath, fussiness, headaches and decreased energy. Infants under one year of age do not have well-developed sinuses and are not as prone to getting sinusitis. Treatment involves antibiotics. Think about the bacterial complications of a cold when the fever lasts longer than four days or when the fever comes on at the end of a cold.

Over-the-counter medications. Over-the-counter medications are generally not helpful (certainly in children). They do not shorten the course of the cold and they do not prevent ear infections. Some of these medications will cause a child to be either jittery and "hyper" or sleepy. They are recommended when the child is very miserable and having difficulty drinking or sleeping. Please discuss with your doctor during office hours about their philosophy and recommendations for these medications, because this may vary according to your doctor. Acetaminophen or ibuprofen used for fever may be given at the same time as over-the-counter cold medicine.

Diet. Milk does not need to be eliminated with a cough or cold, unless milk allergy is present. (It does not contribute to mucous production.) Fluids do need to be encouraged and solid foods are not important. Make sure the child is staying well hydrated. Appetites always decrease when there is a cold; it will improve as the cold improves.
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When to call your doctor

Immediately call for advice if:

• Breathing is difficult and does not improve with suctioning of the nose, especially in a young infant less than 4 months.


• Your child is dehydrated because of inability to feed or persistent vomiting.

Call during office hours (Monday through Friday, 8 a.m. to 5 p.m.) if:

• Nasal discharge is more than 21 days, especially if the child appears to be getting worse.


• Skin under the nose becomes scabbed/crusted.


• Yellow eye discharge with red eyes.


• Earache


• Fever for more than four days.


• Suspicion of foreign body in the nose.

Please remember that this advice is for educational purposes and should only be used as a guide.
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