Sometimes, pediatricians have to give unpopular advice. Recommendations that go against what any well-meaning parent is programmed to do. And in recent years, what we’re saying about the treatment of a common cold has fallen into that category.
No one wants to see an infant or young child suffer from the symptoms of a cold, or upper respiratory infection in medical speak. We’re prewired to want to give something—anything—by mouth, preferably, to make that little one feel better. Yet, out there is research concluding that most of what we have been giving isn’t really helpful and may be harmful. All is not lost, however, because there are measures that you can take to keep him comfortable. We’ll loop around to that later. But first, let’s talk a little about what colds are and why we get them.
Colds are caused by viruses, those tiny germs that, for the most part, go away on their own without the use of antibiotics. The virus that most often causes a cold is known as rhinovirus. However, any one of a number of other viruses can cause colds. Since knowing what virus it is usually isn’t helpful in treatment or in predicting what will happen, if it seems like a simple cold, we usually don’t put babies and young children through the hassle (to say nothing of the cost) of collecting a specimen for testing.
Myths abound as to why we get colds and how to avoid them. The virus is transmitted from person to person and can live on surfaces for short periods of time. The best way to avoid a cold is to not be around someone with one. That’s not always possible; someone in the immediate environment almost always has a cold. Good handwashing, covering sneezing and coughing noses and mouths, and disinfecting surfaces may help. However, wearing a hat or a warmer coat won’t protect a child against getting a cold!
We’ve all had ‘em, so you probably know the signs: a fever, usually on the low side, but occasionally high; runny nose, mild sore throat, and cough; not wanting to eat; sneezing; and, later on, stuffy nose and a looser cough. Most last seven to ten days, and then: probably another one! The average infant gets eight to ten colds the first year. Immunity toward upper respiratory infections doesn’t last long, which is why Mom doesn’t provide a lot of antibodies to cold viruses while pregnant. Thus, even young infants get colds.
Treating Colds: The Don’ts
We’ve long preached that antibiotics don’t kill cold viruses, and in recent years I’ve found that parents have gotten that message and request antibiotics for colds much less often. Since the drug industry hasn’t really been out there developing new antibiotics, particularly for outpatient use, we need to preserve the function of the ones we have. And although most kids tolerate antibiotics, they do have other downsides. As much as we want to feel like we’re giving our infants and children some treatment, if it’s a simple cold, the treatment shouldn’t be antibiotics.
A common myth that’s right up there with the “hat” one, above, is that “green means infection.” While a prolonged (more than a week or so) green runny nose in an older person, particularly when combined with high fever and/or headache, can mean a sinus infection, infants generally haven’t developed significant sinuses in which to get an infection. The green runny nose can be a part of a normal cold, usually after the clear runny nose. Providers do differ in when they will start to think about diagnosing a sinus infection, but an infant with a day or two of green runny nose and little or no fever probably doesn’t have one and shouldn’t need an antibiotic.
In more recent years, medicines designed to treat symptoms in infants and children have come under fire, and most—antihistamines, decongestants, and cough medicines—are now not recommended under age 4. They should be used with caution even over that age, and always as directed. They’ve not been found to be effective, and, particularly in infants and young children, have been associated with side effects which can be severe. Even a few deaths have been reported, some at recommended doses.
There is a choice for parents who want to give something to a toddler or preschooler with a cold: honey. Many over-the-counter preparations contain it rather than the more harmful stuff, and it’s been shown to be of benefit in relieving cough due to a cold. Big BUT here: it can’t be given to infants under a year of age because of the risk of infant botulism from honey.
Medicated ointments to be rubbed on chests are a special case. They’ve remained on the market despite questionable effectiveness. Over the age of two, if parents prefer to use them, there at the very least probably not harmful.
Treating Colds: The Do’s
This news is all a little depressing. Is there nothing we can do for our littlest sufferers? Fortunately, there are some (no pun intended) hacks. Giving lots of fluids will make your child feel better because they replace those lost by the fever. (That’s where chicken soup comes in.) You can also gently suction mucus out of the nose with a bulb; picking up some salt water (“saline”) nose drops will help this process. So will investing in a humidifier or vaporizer, which is generally not very expensive and will last for years. Finally, elevating the head of the bed will help your child breathe easier.
When Is It Not a Cold?
It’s never a bad idea to check with your child’s provider to make sure it is a cold, especially if she’s a young infant and it’s one of her first ones. Some more severe illnesses can share some features of colds. Among the many reasons to check in with the provider, some are:
- A temperature over 100.4 Fahrenheit (38 Celsius), particularly in a younger infant.
- Breathing that looks uncomfortable (it will probably sound noisy no matter what’s going on, but when in doubt, check with the provider).
- Poor feeding.
- A pale of bluish color.
- An earache or severe or prolonged sore throat.
- Your baby looks unusually ill. Most infants and children with regular colds will play at least some of the time.
- The symptoms don’t seem to be resolving. One to two weeks is a good time frame for them to get better.
- It’s often worth a call earlier rather than later during influenza (“flu”) season, particularly if a close contact has been diagnosed with flu. This is the exception to the “no meds for viruses” rule, as there is medication available for treatment.
Fortunately, kids do get better from colds, and the older they get, the less of them they get. Although we don’t, and probably will never, have a medicine that will speed things up, never underestimate the power of a little extra simple TLC in a child’s recovery!
Pappas DE, Hendley JO. The Common Cold and Decongestant Therapy. Pediatr Rev 2011 Feb; 32(2):47-54.