The common cold, which a doctor might refer to as an upper respiratory infection (URI), is a viral infection most common during the “cold season” from September to May, but can occur year-round.

The common cold is most often caused by the rhinovirus but can also be caused by the corona virus, respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, metapneumovirus and adenovirus.

Why Are They So Common?

The average preschool child will get 5-9 colds a year and 10% to 15% of children will get 12 colds a year. Most of these occur during the “cold season,” so it seems as if some children have a cold all winter long. For comparison, adults get an average of 2-3 colds a year.

Colds cause more than 25 million lost school days and 21 million lost work days and account for about 14 % of visits to doctors. Americans spend more than 1 billion dollars a year on cold medicines. (1990 figures).

Common Cold Symptoms

Symptoms of the common cold begin 1-2 days following infection and peak at 2 to 4 days. Most symptoms are gone by 7 days in adults but can last about 14 days in children.

Early symptoms include:

• Nasal congestion
• Runny nose
• Sore throat
• Low grade fever (101- 102º) (first 1-3 days)

Prolonged Symptoms can include:

• Cough
• Thick yellow/green nasal discharge
• Mild diarrhea and occasional vomiting

Cough usually peaks at about 4-5 days in 30% of children about the time the discharge from the nose changes from watery to thick and yellow or green. Fever is unusual in adults but in children it is common to have a low grade (101- 102º) fever during the first 1-3 days of the illness.

Fast Facts:

• A child becomes less contagious after the first 7 days but 10% to 20% of children are still shedding the virus after 2-3 weeks.
• Children in daycare tend to get ill about 40% more than those who don’t attend.
• The infection rate from one spouse to another is about 40%.
• The rhinovirus most commonly passes from person to person by direct contact such as hand to hand or from an infected person touching a doorknob or toy which another person then touches.
• The virus can survive for several hours on the hands and several days on objects.
• Common cold is less commonly passed by coughing into someone’s nose or eyes.

Curing the Common Cold

Many over the counter medications and home remedies can help with common cold symptoms, but the plain reality is that there is no cure for the common cold. Over the counter cough and cold medications are not recommended for children under four years old. Some health resources even discourage them for ages under six.

Various products, including Echinacea (derived from the cone flower) and vitamin C have been proven ineffective in alleviating the severity or duration of colds. The use of zinc as a lozenge or pill, nasal spray or a medicated swab inserted in the nose has produced conflicting results in the studies that have been done.

If you have any concerns about the safety of cold medicines ask your pediatrician. Symptomatic treatment of a cold in children can be problematic for three reasons:

1. The dose of the ingredients used in most cold medicines in children has not been established.
2. Studies have not shown much improvement in symptoms of children taking cold medicines.
3. There have been rare deaths in children taking cold medicines.

The ingredients used in children’s cold medicines were determined by the Food and Drug Administration (FDA) over 30 years ago to be “generally recognized as safe and effective,” and were approved for over-the-counter sales.

Medications For Treating the Common Cold

Decongestants

Decongestants are medicines that cause the blood vessels in the lining of the nose to constrict leading to shrinkage of the swollen air passage allowing one to breathe better.

Though decongestants can be helpful, they are also mild stimulants similar to caffeine that can cause jitteriness, insomnia, increase in heart rate and slight elevation in blood pressure.

Pseudoephedrine was the decongestant used in most cold medicines until 2006 when laws were passed restricting its use due to it being an ingredient in making methamphetamine.

As a result, most pharmacies today have replaced pseudoephedrine with an inferior medication called phenylephrine.

Antihistamines

Antihistamines are medications that are used primarily for allergy but some of the older antihistamines have a side effect of causing a runny nose to dry up.

They tend to make people drowsy and therefore tend to offset the stimulant effect of the decongestants.

The antihistamines most commonly used in cold medicines are diphenhydramine (Benadryl), chlorphenirmine, brompheniramine and promethazine (Phenergan). The non-sedating antihistamines like Zyrtec, Claritin and Allegra do not help the runny nose from a cold.

Cough Medicine

Dextromethorphan is the more common ingredient in cough medicine, and almost all over-the-counter cough medicines contain it. This is the “DM” behind Dimetapp DM, Triaminic DM, Robitussin DM etc.

Cough medicines can cause upset stomach, dizziness, drowsiness and respiratory depression. A recent study showed that honey helped relieve cough in children 2-18 years of age. Many pediatricians don’t recommend suppressing the cough in a child that has asthma, bronchiolitis or pneumonia because it is important that they cough up the mucous.

Expectorants

The only expectorant that is used any more is guaifenesin. Its purpose is to thin out the mucous. It works by irritating the stomach, which then causes a reflex increase in secretions of the airway.

The purpose of an expectorant is to make the mucous thin enough to cough up, as to rid the body of the bacteria. However, studies have shown that there is not much evidence that expectorants actually work as intended.

Salt Water Nose Drops

Nose drops are of very limited value but can be of help in the newborn with a stuffy nose.

The mistake most people make is not using enough. It is recommended to put about 10 drops in each nostril.

The other mistake most people make is trying to suction it out with a bulb syringe.Most of the time it will run into the throat and be swallowed. A bulb syringe can be used at times, but too frequent or too vigorous use can cause nose bleeds and swelling of the lining of the nose which will make the congestion worse.

Fever Medications

OTC medications like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) can be used for fever or pain. Consult with your pediatrician on use and dosage for infants and children.

Warnings and Guidelines from the Food and Drug Administration (FDA)

• Do not use cough and cold products in children under 4 years of age UNLESS given specific directions to do so by a healthcare provider.
• Do not give children medicine that is packaged and made for adults. Use only products marked for use in babies, infants or children (sometimes called “pediatric” use).
• Cough and cold medicines come in many different strengths. If you are unsure about the right product for your child, ask a healthcare provider.
• If other medicines (over-the-counter or prescription) are being given to a child, the child’s healthcare provider should review and approve their combined use.
• Read all of the “Drug Facts” box information on the package label so that you know the active ingredients and the warnings.
• Follow the directions in the “Drug Facts” box. Do not give a child medicine more often or in greater amounts than is stated on the package.
• Too much medicine may lead to serious and life-threatening side effects, particularly in children aged 2 years and younger.
• For liquid products, parents should use the measuring device (dropper, dosing cup or dosing spoon) that is packaged with each different medicine formulation and that is marked to deliver the recommended dose. A kitchen teaspoon or tablespoon is not an appropriate measuring device for giving medicines to children. They can hold between 2 to 10 ml.
• If a measuring device is not included with the product, parents should purchase one at the pharmacy. Make sure that the dropper, dosing cup or dosing spoon has markings on it that match the dosing that is in the directions in the “Drug Facts” box on the package label, or is recommended by the child’s health care provider.
• If you DO NOT UNDERSTAND the instructions on the product, or how to use the dosing device (dropper, dosing cup or dosing spoon), DO NOT USE the medicine. Consult your healthcare provider if you have questions or are confused.
• Cough and cold medicines only treat the symptoms of the common cold such as runny nose, congestion, fever, aches, and irritability. They do not cure the common cold. Children get better with time.
• If a child’s condition worsens or does not improve, stop using the product and immediately take the child to a health care provider for evaluation.

Complications That Can Come From a Cold

Ear Infections

A recent study showed that 46% of infants had an ear infection in their first year.

Some children seem to have a tendency to get ear infections every time they catch a cold and some children never get them. Signs of ear infection are excessive crying, discharge from the ear or complaining of pain.

Sinus Infection

Sinus infection probably occurs, to some degree, in most people that catch a cold and will usually go away without an antibiotic.

A green or yellow discharge from the nose does not indicate a need for an antibiotic. Pain over the sinus area or cold symptoms that last more than 10-14 days would suggest a sinus infection that may need treatment.

Croup

Croup is caused by inflammation of the upper part of the airway (the larynx), which causes a cough that sounds like a seal barking, hoarse voice and stridor (trouble getting air in). It is most commonly caused by the parainfluenza virus. Call your pediatrician if your child has croup.

Bronchitis

Bronchitis can vary in severity from a mild chest cold to almost pneumonia and it can be viral or bacterial.

Viral bronchitis will go away by itself. Bacterial bronchitis may require treatment.

Bronchiolitis

Bronchiolitis is caused by inflammation deeper in the airways than bronchitis and causes wheezing as if the child is having an asthma attack.

It primarily affects children under 18 months of age and is most commonly caused by the respiratory syncytial virus (RSV) or metapneumovirus.

Pneumonia

Pneumonia is usually preceded by a cold that becomes bronchitis and then pneumonia but one can have pneumonia without a cold and without cough.

Pneumonia can be either viral or bacterial. Viral pneumonia will usually go away by itself.

Pneumonia may be present in any child who

• Has a cough and fever past the first 3 days of a cold
• Is breathing faster than normal ( over 60 breaths per minute up to 6 months, 40/min from 6-12 months and 30/min thereafter)
• Has chest pain

Note: a bad cough plus high (104-105º) fever can be considered pneumonia until proven otherwise.

The Flu

Influenza (Flu) is similar to a cold in that it can cause cough and congestion but people with flu have additional symptoms including:

• Fever to 103º to 105º that can last for more than 5 days
• Muscle aches
• Sore throat
• Red eyes

Yearly flu shots are recommended for most children over 6 months of age.

When to call the doctor

• Trouble breathing includingtrouble getting air in (stridor) or wheezing or retractions (sucking in beneath lower ribs), rapid breathing or a grunting sound.
• Fever over 102º during the first 3 days of the illness or any fever past the first 3 days.
• Ear pain
• Chest pain
• Coughing up yellow, green, brown or bloody mucous.
• Listlessness is just as worrisome as a high fever.
• A stiff neck (pain when the chin is touched to the chest), or bulging soft spot in infants can be a sign of meningitis. Worry if child has a severe headache that will not go away.
• Pus on the tonsils or enlarged, tender lymph nodes in the neck.
• Cough or congestion lasting more than two weeks

How To Reduce The Chance of Catching a Cold

1. Avoid crowds and people who are sick.
2. Avoid touching your nose and eyes with your hands.
3. Wash your hands after coming in contact with someone who is ill, such as wiping a child’s runny nose. To be effective you need to wash for 30 seconds.
4. Get enough rest and avoid overstressing your body.
5. Cover your mouth when you cough or sneeze, preferably with your elbow.
6. Don’t share toothpaste or toothbrushes. Don’t keep toothbrushes together where they can touch. Some studies have shown putting toothbrushes in the dishwasher can eliminate strep bacteria, so this may also be a good practice.
7. Clean shared telephone headsets, doorknobs and keyboards regularly with something like Lysol.