What are colds? Colds mean different things to different people. What we will be discussing are illnesses characterized by any or all of the following: runny nose, cough, congestion, aches and pains, headache and fever.
What causes colds? Viruses cause colds! (Going without a hat does not cause a cold despite what your mother says.) The common cold-causing viruses are: rhinovirus, respiratory syncytial virus (RSV), influenza, parainfluenza, adenovirus, enterovirus, coronavirus, and echovirus. There are literally hundreds of different possible serotypes (strains or varieties) of these viruses that can infect your family. Rhinovirus alone has over 100 different serotypes. When you catch one type of cold virus in a season, you won’t catch it again but you could catch the hundreds of other types of cold viruses.
Viruses cause colds in people whose immune protection is reduced. Children are subject to so many colds because their bodies have not yet experienced a wide variety of viruses and they still need to build their protection against standard community illnesses. Preschoolers (and daycare participants) average 6-10 colds per year, each lasting 10-14 days. School age children improve to about 5 per year. Immune systems are also compromised by lack of sleep, poor nutrition, and stress. This is why teenagers and young parents seem to catch so many colds.
Exposure to smoke causes a 60% increase in colds, and participation in a large daycare has been blamed for a 70% increase. When a child is in day care and in a household of smokers, the likelihood of catching a cold is almost 20 times as great.
The cost of colds? The cost of colds in this country is immense. One must factor-in days missed from work, doctor visits (many of which are unnecessary), missed school and activities, and medicines. Also, as a result of colds, ear and sinus infections may develop. Americans spend large amounts of money (over 1 billion dollars) on medicines alone. Unfortunately many of those medicines include antibiotics (which cannot cure a cold), and cold medicines, which have many side effects without much benefit. This leads to additional costs: burdening our bodies with unhelpful chemicals, drug side effects and toxicities, allergic reactions, and antibiotic-resistant bacteria.
How do I get a cold? Cold viruses are spread a variety of ways. The virus needs to find a way into your nose, eyes, or mouth. If you think of how often people touch their faces, it is obvious how viruses get where they need to go! An infected person rubs their nose, or coughs or sneezes onto a hand, the hand touches a person or a shared surface, someone else’s hand picks up the virus, scratches their nose or eye, and the virus has found a new home!
What happens after I get exposed to a cold virus? Symptoms usually develop within 24 hours after the virus has managed to penetrate your body’s defenses. (Remember, if your immune system already has the ability to fight this particular strain, and is not otherwise stressed, you will not necessarily develop symptoms when infected.) The blood vessels in the nasal passages dilate and your white blood cells rush to the area to fight the invader. This causes swelling and mucous production throughout the nasal mucosa (the lining of the nose and sinuses). This results in the clear, white, and yellow nasal drainage commonly associated with a cold. The white blood cells produce an enzyme that can turn the mucous green. This is normal! There is a common belief that green mucous means bacterial infection, but it is actually also a normal part of a viral infection.
If the virus also infects the conjunctiva (lining in the eyes) children will get viral conjunctivitis (“pink-eye”). This happens very easily since those hands go from a runny nose to rub tired eyes. Again, in response to the invasion, there will be increased blood flow to the area. Viral shedding (spread of the virus) is at its peak 2-4 days after the person was infected (1-3 days after symptoms start).
What are the symptoms of a cold? Before the runny nose, children will often have other complaints for 1-2 days. These can include headache, fever, general tiredness, a scratchy throat, and achy muscles. Many of these improve as the respiratory symptoms take over. Upper respiratory symptoms include nasal congestion, a runny nose (rhinorrhea), sneezing, sore throat, and cough. There may also be complaints of headache and sinus discomfort. This is normal; the lining of the sinus cavities also becomes inflamed and produces fluid during a viral infection. All of these symptoms are a direct result of the virus, and therefore cannot be treated with antibiotics.
As we discussed, the actions of the white blood cells fighting the infection will cause the mucous to change colors, even green. The normal progression is clear to white to yellow to green, and back through the spectrum. If your child has a mild infection, you will not see all of these symptoms and stages.
Ear discomfort may occur during a cold. The eustachian tubes drain the middle ear into the back of the throat. These tubes are also lined with the same tissue that swells during a cold. Therefore, ears do not drain as well. This does not automatically mean your child will get an ear infection, most actually do very well and the ears return to normal without intervention. However, because these tubes are not at optimal function, the ears may intermittently block causing some pressure and discomfort. Persistent ear pain, possibly with a new fever, may indicate an ear infection, especially if it is a week or more into the cold. However, because ear pain does not automatically mean there is an infection, we advise against starting antibiotics without an exam.
Other symptoms people experience with colds are: loss of appetite, hoarseness, tummy aches from swallowing mucous, and increased need for sleep.
How do I know if it's not a cold?
There are other factors that will cause some of the symptoms of colds.
- Allergies are the primary culprit. Allergic rhinitis (runny nose) is characterized by clear nasal drainage, often with a seasonal pattern, and no progression to thicker drainage or systemic illness. Allergies tend to respond to antihistamines such as Benadryl far better than colds do.
- Constant thick colored discharge from only one nostril should make one suspicious of a foreign body lodged in it.
- “Pink-eye” can be viral or bacterial. Viral conjunctivitis is very common with colds and may consist of redness and tearing of the eye. After sleep the eye(s) may be very crusty, but after they are cleared most of the drainage is watery. Viral infections clear without medication. Bacterial eye infections tend to produce thick creamy discharge throughout the day, parents are often trying to wipe the eye(s) every ½ hour! Only a bacterial infection will respond to antibiotic eye drops.
- Sinus and ear infections may develop as a result of a cold. The good news is they are the exception rather than the rule. Persistent ear pain, new fever without a new cold, and great difficulty sleeping due to pain are signs of an ear infection. Remember little ones often have trouble sleeping because of congestion and fever also. Sinus infections are suspected when someone remains full of thick congestion without improvement, or worsening, after 10-14 days. Often these children have headache, fatigue, and persistent cough, too. If your child seems to fit these criteria, give us a call.
- Children are notorious for getting a new cold before they are fully recovered from the last one. This is annoying, but not dangerous. As they are improving, these children start with a new clear runny nose and possibly fever. We can help you differentiate between a new cold and a complication of the existing one.
How is a cold treated? There is no medicine to cure a common cold. Society however seems driven to “fix” a cold with numerous medicines, chemicals, and treatments. It is not uncommon for a parent to try a cold preparation for 2 days, change to another and another because of poor results, and by then the cold is improving anyway and the family is sure that the third medicine was the cause of the improvement.
Let’s review the types of products you will find in the drug store:
- Decongestants: the most popular of which is phenylephrine. Some decongestants seem helpful in adults and teens, but that does not automatically mean they will have the same results in smaller children. A 2008 study showed no benefit to using phenylephrine compared to placebo (sugar pills). Side effects include heart palpitations, increased heart rate, sleeplessness, irritability, high blood pressure, and vomiting. The risk of irritability and side effects are much higher in children under 1 year.
- Antihistamines: Examples of this class of medication include Diphenhydramine (BenadrylTM) , Brompheniramine (DimetaneTM) and Chlorpheniramine (ChlortrimetonTM). These are often combined with decongestants in cold preparations. Again, the studies do not indicate these are useful in children. Side effects include: sedation, excitability, upset stomach, increased heart rate, and dry mouth.
- Cough suppressants: The two medicines that most people think of here are Dextromethorphan (the DM in many cough medicines) and codeine. Studies in adults show equivalent results between DM and codeine, studies in children show response similar to placebo for both, meaning that there is no evidence that cough suppressants truly suppress the cough. Common side effects of codeine include nausea, vomiting, constipation, dizziness, and heart palpitations. Codeine overdose can cause respiratory depression.
- Expectorants: These agents supposedly thin secretions. In theory this would make it easier to cough, or blow, them out. Again, studies are not supportive of these claims. Expectorants (esp. Guaifenesin) are combined with DM cough suppressants. If both of these ingredients were as effective as they claim, you would be left with thin runny secretions that you could not cough up.
- Nasal sprays: Some are helpful, some harmful. Saline (salt water) nasal spray or nose drops can be very helpful for washing out nasal passages, breaking up thick mucous, and flushing sinuses. You can make your own with ¼ - ½ tsp salt to 1c. warm water, or you can buy the mixture at the drug store (with the other cold remedies or use contact lens solution). This can be used as frequently as desired, and there are no side effects or dangers. Beware of decongestant nasal sprays such as Neosynephrine. The medication in these sprays temporarily constricts the blood vessels in the nasal passages. If used too much, your nasal passages will become “addicted” to the spray, and if it is not used you will experience rebound congestion worse that the cold. Weaning noses off of this is an unpleasant task. Additionally, the nasal passages may feel “burned” by the spray. It is best to avoid medicated nasal sprays completely, particularly in infants.
- Neti Pots: These are sinus washes and actually have been shown to be helpful in older children. The child has to be able to pour saline down their nose for this to be effective. Neti pots are available in health food stores and on line.
- Analgesics&antipyretics (for fevers): In children we use acetaminophen (TylenolTM) and ibuprofen (MotrinTM & AdvilTM). It is important to remember that fevers serve a purpose. Fevers help the body fight infection and often, the higher the fever, the more efficient the body is in fighting the illness. However, we generally treat fever > 101°F because it makes children so uncomfortable. If children have a low fever and are drinking well, it is not necessary to medicate their fever. These medications will only reduce the fever for 4-8 hours, and then it will come back. They do not “cure” a fever. These medications are also helpful for body aches, headaches, and ear pain. It is always advisable to be judicious in your use of medication, but if the kids are really uncomfortable, it is worthwhile to use these according to directions to improve their symptoms.
- Vitamins and herbs: This is a controversial area in which our primary goal should be “to do no harm”. No studies support the use of these remedies in children, but there are years of cultural use, anecdotal support, and for some there are adult studies to support adult use. Many herbal remedies are safe, some may be effective, but many are not safe-especially for children. Please be careful what you give your child. Remember, “do no harm” on your quest to help. DO NOT use ephedra or Ma Huang; they are herbal decongestants with significant risks to the heart.
- Vapor rubs, vapor baths: These are very common; many parents will remember their own parents rubbing VicksTM VapoRub on their chests. There are creamy versions now available, as well as a vapor bath additive. These products soothe many children, especially at bedtime. Not only do the menthol vapors seem to improve breathing, but also the warm feeling of the rubs and the soothing effect of a massage are beneficial. Children with more sensitive skin, and babies, may not tolerate these products directly on their skin. Try applying the cream to a onesie or undershirt, then place pajamas over the top. There is even an urban legend that it is helpful to use them on the soles of the feet.
- Lozenges are helpful to dry irritated throats. But you need not purchase medicated, brand name lozenges. There is some evidence that the menthol found in some of these lozenges, helps with nasal congestion.
What else can I do for my child?
- Humidifiers are long-standing cornerstones for cold treatment. Interestingly, there is not strong support in research for their use. However, they make sense. In the winter the air in the house is significantly dryer than the rest of the year. Children with colds tend to breath through their mouths, especially while sleeping. Breathing dry air can 1) cause a sore throat, 2) thicken and dry mucous, and 3) cause a cough (since we all have cough receptors -nerves that when irritated, cause us to cough- in our throat). Therefore, a clean well-functioning humidifier can do a lot to improve comfort. Many parents like hot water machines (vaporizers); these are fine as long as you deal with the significant safety risk involved. Any mobile child is likely to investigate that machine, and many have gotten burned by dumping hot water on themselves or putting their fingers in the wrong place. It is for this reason that we tend to recommend cool-mist humidifiers. In addition, a cool mist humidifier can be used in spring and fall for colds when the weather is warmer. All humidifiers should be cleaned with a 10% bleach solution weekly, and monitor filters for mold growth.
- Fluids are important for sick children. Fluids are lost during colds by fevers, mouth-breathing, and mucous production. Better hydration will lead to thinner mucous which is easier to manage. Many kids lose their appetites for solid foods, not to be regained until they are feeling significantly better. This is fine, but they should still be drinking some. Children under 1 year should still take breast milk or formula, but they may take in slightly less, or have smaller more frequent “meals”. Please call if you have concerns about your baby’s intake. Warm fluids seem very helpful in comforting kids, as well as helping to break up mucous. Children over 1 year may have honey (often placed in lemon tea) to help soothe their cough. Karo syrup has also been suggested as a cough syrup (just remember, it is also used to soften stool). And yes, chicken soup really does seem to help!
- Rest and sleep, as much as children want, are necessary for the body to repair itself. You do not have to enforce extra naptime, but let your kids know it is OK to take a nap, watch a movie, read a book, or have quiet time.
Putting it all together, what should I do? Our primary recommendations are: fluids, rest, vapors, humidifiers, and for babies-helping them to sleep more upright (in car seat, bouncy seat, or place a blanket roll under one end of the mattress).
What about medicines? For older kids with a lot of trouble sleeping, you may want to try something. It is important to remember, if it is not working then it won’t work, and stop using it. Try to limit use to times when it is most necessary-i.e. for sleep. Use medicines without a lot of extra ingredients, and keep in mind that very few are even sometimes helpful. You can try any of the antihistamines to help dry secretions and honey or lollipops to soothe the throat and reduce the cough. Remember, most coughs serve a purpose, they clear and protect the lungs, therefore, suppressing coughs should be avoided unless sleep is a real problem. Kids with a bad cough from post-nasal drip may sleep better more upright also.
How can I prevent a cold? So what is the best way to prevent the spread of colds? The best way to keep your family healthy - hand washing!!!!! As crazy as it sounds, it has been proven over and over, our best defense is frequent hand washing! But it is also important to realize that kids will get colds, and that they need to get colds! How else will they build their immune system? But we can work to minimize the frequency, severity, and duration of the illness.
Teach kids to cough into their elbow instead of their hand, that way they won’t automatically spread their germs with their hands. Also, enforce handwashing after using the bathroom, before meals, and any other time it can be worked into the schedule! Recent studies show that antiseptic hand lotion can be very helpful in preventing colds.
Kids (and adults) need a regular sleep schedule, exercise, and a nutritious diet in order to keep the immune system at full strength.
Daycare size correlates with illnesses also. Children in a small daycare environment (5 or less) will experience less colds and less resistant bugs than their counterparts in large daycare settings. For most children this is not a big problem, but for premature babies and children with other medical issues this may be a factor when choosing care arrangements.
Will antibiotics prevent an ear or sinus infection? No they won’t. The only results of unwarranted antibiotics are resistant bacteria, loose stools, stomach upset, and diaper rash.