Colds

Is this your child's symptom?

• Runny nose and sore throat caused by a virus
• You think your child has a cold. Reason: Other family members, friends or classmates have same symptoms.
• Also called an Upper Respiratory Infection (URI)

Symptoms of a Cold

• Runny or stuffy nose
• The nasal discharge starts clear but changes to gray. It can also be yellow or green.
• Most children have a fever at the start.
• A sore throat can be the first sign
• At times, the child may also have a cough and hoarse voice. Sometimes, watery eyes and swollen lymph nodes in the neck also occur.

Cause of Colds

• Colds are caused by many respiratory viruses. Healthy children get about 6 colds a year.
• Influenza virus causes a bad cold with more fever and muscle aches.
• Colds are not serious. With a cold, about 5 and 10% of children develop another health problem. Most often, this is an ear or sinus infection. These are caused by a bacteria.

Colds: Normal Viral Symptoms

• Colds can cause a runny nose, sore throat, hoarse voice, a cough or croup. They can also cause stuffiness of the nose, sinus or ear. Red watery eyes can also occur. Colds are the most common reason for calls to the doctor. This is because of all the symptoms that occur with colds.
• Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money. It can help you to avoid some needless trips to the doctor. The cold symptoms listed below are normal. These children don't need to be seen:
  • Fever up to 3 days (unless it goes above 104° F or 40° C)
  • Sore throat up to 5 days (with other cold symptoms)
  • Nasal discharge and congestion up to 2 weeks
  • Coughs up to 3 weeks

Colds: Symptoms of Secondary Bacterial Infections (other health problems)

Using this guide, you can decide if your child has developed another health problem. This happens in about 5 to 10% of children who have a cold. Many will have an ear infection or sinus infection. Look for these symptoms:

• Earache or ear discharge
• Sinus pain not relieved by nasal washes
• Lots of pus in the eyes (Eyelids stuck together after naps)
• Trouble breathing or rapid breathing (could have pneumonia)
• Fever lasts over 3 days
• Fever that goes away for 24 hours and then returns
• Sore throat lasts over 5 days (may have Strep throat)
• Nasal discharge lasts over 2 weeks
• Cough lasts over 3 weeks

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

• Struggling for each breath or shortness of breath
• Tight breathing so that your child can barely speak or cry
• Ribs are pulling in with each breath (called retractions)
• Breathing has become noisy (such as wheezes)
• Breathing is much faster than normal
• Lips or face turn a blue color

When to Call for Colds

Call 911 Now

• Severe trouble breathing (struggling for each breath, can barely speak or cry)
• You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

• Trouble breathing, but not severe. Exception: gone after cleaning out the nose.
• Wheezing (high-pitched purring or whistling sound when breathing out)
• Breathing is much faster than normal
• Trouble swallowing and new onset drooling
• High-risk child (such as cystic fibrosis or other chronic lung disease)
• Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
• Fever over 104° F (40° C)
• Fever in baby less than 12 weeks old. Caution: do NOT give your baby any fever medicine before being seen.
• Your child looks or acts very sick
• You think your child needs to be seen, and the problem is urgent

Contact Doctor Within 24 Hours

• Age less than 6 months old
• Earache or ear drainage
• Yellow or green pus from eyes
• Sinus pain (not just congestion) around cheekbone or eyes
• Fever lasts more than 3 days
• Fever returns after being gone more than 24 hours
• You think your child needs to be seen, but the problem is not urgent

Contact Doctor During Office Hours

• Blocked nose wakes up from sleep
• Yellow scabs around the nasal openings. Use an antibiotic ointment.
• Sore throat lasts more than 5 days
• Sinus congestion and fullness lasts more than 14 days
• Nasal discharge lasts more than 2 weeks
• You have other questions or concerns

Self Care at Home

• Mild cold with no other problems

Care Advice for a Cold

1. What You Should Know About Colds:
   • It's normal for healthy children to get at least 6 colds a year. This is because there are so many viruses that cause colds. With each new cold, your child's body builds up immunity to that virus.
   • Most parents know when their child has a cold. Sometimes, they have it too or other children in school have it. Most often, you don't need to call or see your child's doctor. You do need to call your child's doctor if your child develops a complication. Examples are an earache or if the symptoms last too long.
   • The normal cold lasts about 2 weeks. There are no drugs to make it go away sooner.
   • But, there are good ways to help many of the symptoms. With most colds, the starting symptom is a runny nose. This is followed in 3 or 4 days by a stuffy nose. The treatment for each symptom is different.
   • Here is some care advice that should help.
2. For a Runny Nose with Lots of Discharge: Blow or Suction the Nose
   • The nasal mucus and discharge is washing germs out of the nose and sinuses.
   • Blowing the nose is all that's needed. Teach your child how to blow the nose at age 2 or 3.
   • For younger children, gently suction the nose with a suction bulb.
   • Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness.
3. Nasal Saline to Open a Blocked Nose:
   • Use saline (salt water) nose spray to loosen up the dried mucus. If you don't have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
   • Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop.
   • Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
   • Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear.
   • How Often. Do nasal saline rinses when your child can't breathe through the nose.
   • Limit. If under 1 year old, no more than 4 times per day or before every feeding.
   • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
   • Reason for nose drops: suction or blowing alone can't remove dried or sticky mucus. Also, babies can't nurse or drink from a bottle unless the nose is open.
   • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
   • For young children, can also use a wet cotton swab to remove sticky mucus.
4. Fluids - Offer More:
   • Try to get your child to drink lots of fluids.
   • Goal: keep your child well hydrated.
   • It also will thin out the mucus discharge from the nose.
   • It also loosens up any phlegm in the lungs. Then it's easier to cough up.
5. Humidifier:
   • If the air in your home is dry, use a humidifier.
   • Reason: dry air makes nasal mucus thicker.
6. Medicines for Colds:
   • Cold Medicines. Don't give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can't remove dried mucus from the nose. Nasal saline works best.
   • Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough.
   • No Antibiotics. Antibiotics are not helpful for colds. Antibiotics may be used if your child gets an ear or sinus infection.
7. Other Symptoms of Colds - Treatment:
   • Pain or Fever. Use acetaminophen (such as Tylenol) to treat muscle aches, sore throat or headaches. Another choice is an ibuprofen product (such as Advil). You can also use these medicines for fever above 102° F (39° C).
   • Sore Throat. If over 6 years of age, your child can also suck on hard candy. For children over 1 year old, sip warm chicken broth. Some children prefer cold foods, such as popsicles or ice cream.
   • Cough. For children over 1 year old, give honey ½ to 1 teaspoon (2 to 5 mL). Caution: do not use honey until 1 year old. If over 6 years of age, you can also use cough drops. Avoid cough drops before 6 years. Reason: risk of choking.
   • Red Eyes. Rinse eyelids often with wet cotton balls.
8. Return to School:
   • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities.
   • For practical purposes, the spread of colds can't be prevented.
9. What to Expect:
   • Fever can last 2-3 days
   • Nasal drainage can last 7-14 days
   • Cough can last 2-3 weeks
10. Call Your Doctor If:
    • Trouble breathing occurs
    • Earache occurs
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • Any fever if under 12 weeks old
    • Nasal discharge lasts more than 14 days
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse
11. Extra Advice - Air Travel with Colds:
    • It's safe to fly when your child has a cold.
    • He could get some mild ear congestion or even a brief earache while flying. Most often, that can be prevented. (See # 12).
    • Flying will not cause an ear infection.
12. Extra Advice - Prevent Ear Congestion During Air Travel:
    • Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing.
    • Keep your child awake during takeoff and descent.
    • Swallow during descent using fluids or a pacifier.
    • Children over age 4 can chew gum during descent.
    • Yawning during descent also can open the middle ear.
    • Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out.

And remember, contact your doctor if your child develops any of the 'Call Your Doctor' symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 10/11/2023

Last Revised: 12/30/2022

Copyright 2000-2023. Schmitt Pediatric Guidelines LLC.