Colds and Kids

Why does my child get so many colds?

The common cold (also known as an upper respiratory infection) is caused by a virus. Trouble is, there are at least 200 different known viruses, with new ones occasionally appearing. Children develop immunity to the viruses one cold at a time. Remember all the colds you've had over your lifetime? Your child has to get every one -- and more -- to be immune to all cold viruses.

Expect the average toddler to have six to 12 viral infections a year. School-age children have fewer infections, and the number drops to about three a year for teens. Since each infection often takes more than a week to completely run its course, it may seem like children are constantly sick, especially during the colder months when more viruses are circulating.

How do I know if what my child has is just a cold?

The common cold is a group of symptoms that includes runny nose, fever, sore throat, and cough. Your child may also have red eyes and swollen lymph nodes on either side of his neck. If he has those symptoms, he very likely has the common cold, which results in more sicktime for the average American than all other illnesses combined.

When should I call the pediatrician?

Call if your child's symptoms go beyond that of the common cold. If your child's fever (over 100 degrees F) lasts for more than three days, for example, you may be dealing with a superinfection (a bacterial infection on top of a virus).

That complication, which results when cold viruses lower the body's defenses and allow bacteria to gain a foothold, needs antibiotics. If your child also has ear pain, difficulty breathing, a stiff neck and wheezing, or a sore throat with a high fever, he may have a bacterial infection and need antibiotics.

You should suspect an additional infection if your child's cold symptoms change. Call your doctor if you observe any of the following:

• Complaints of ear pain, which may signal an ear infection
• A thick yellow or green nasal discharge for more than 10 days with headaches and pressure over the forehead and under the eyes, which may be a sinus infection
• A worsening cough accompanied by fever and difficulty breathing, which could be signs of pneumonia
• A sore throat that comes on abruptly with a high fever and tender, swollen lymph nodes in the neck, which may mean your child has strep throat
• A stiff neck or wheezing

All of the above illnesses may involve bacteria and require antibiotic treatment.

How can I protect my child against colds?

Frequent hand-washing is one of your best weapons against the common cold. Cold viruses are spread by body secretions that penetrate the protective mucous membranes of the eyes, nose, and throat. The hardy viruses can survive for a few hours on hands, tissues, countertops, and toys. In addition to encouraging your child to wash his hands often, teach him to cover his mouth and nose when he coughs or sneezes, and to dispose of tissues in the trash to avoid spreading germs. (Instead of covering his mouth with his hands when a tissue isn't available, teach him to cough into the angle of his elbow.) If he's around people with colds, explain that he shouldn't touch his eyes and nose because he might get germs and become sick.

How do I treat my child's cold when he gets one?

Since there's no way to speed up the healing process, the best you can do is manage the symptoms. Offer your child plenty of water and soup: His body is working harder to fight off the infection, and fevers increase fluid requirements. Warm liquids, like chicken soup and vegetable broth, soothe the throat and temporarily unclog congested nasal passages.

What should I do if my child's nose is stopped up?

Nasal congestion is the most aggravating symptom of the common cold; you can expect toddlers and preschoolers to waken at night because of it. Teach your child to sniff up the mucus and swallow it as well as to blow into a tissue. A humidifier or a cool-mist vaporizer can prevent nasal passages from drying out, which makes the mucus more difficult to remove. You can also put warm water or salt water drops (1/4 teaspoon of salt dissolved in 8 ounces of water) in your child's nose and then suck the liquid and softened mucus out with a nasal bulb syringe, which you can find in a drugstore.

Why doesn't my doctor prescribe antibiotics for a cold?

Antibiotics are only effective against bacteria; they do nothing for the viruses that cause the common cold. Also, overusing antibiotics leads to widespread resistant bacteria, which circulate freely among children, especially in daycare.

Keep in mind that yellow or green nasal discharge is not a call for antibiotics unless it lasts for more than 10 days or there are other signs of sinus infection.

Should I use over-the-counter medicines?

IAccording to testimony from the American Academy of Pediatrics, over-the-counter (OTC) cough and cold medicines "do not produce any discernable health benefits" in children under 6.

While the U.S. Food and Drug Administration is still in the process of reviewing information about the safety of the medicines for children aged 2 through 11, the Consumer Healthcare Products Association, a trade group for drug manufacturers, announced recently that drug companies will voluntarily modify the labels of OTC cough and cold medicines to say "do not use" in children ages 4 and under.

Until these issues are resolved, the FDA recommends the following:

• Don't give children medications labeled only for adults.
• Check the "active ingredients" section of the DRUG FACTS label of the medicines you choose, and follow the dosing directions carefully.
• Use only measuring devices that come with the medicine or those specially made for measuring drugs.

If you want to try an OTC medication for older children, follow these rules of thumb:

• Choose a product with a single active ingredient tailored to your child's symptoms, and talk with your doctor or health care professional if you have any questions.
• Don't give a separate acetaminophen fever-reducer if you use an OTC product with more than one ingredient. (Many OTCs already have acetaminophen as an ingredient and the extra dose could be too much). And never give aspirin to a child under 20 with a fever; it has been associated with Reye's syndrome, a rare but potentially life-threatening condition.
• Buy OTC cough and cold medicines with child-resistant safety caps, when available.
• Feel free to buy less expensive in-house or generic brands of decongestants; they work just as well as name brands with similar ingredients. One widely used component in decongestants is pseudoephedrine, which can dry up the nose but can also cause excitement, a fast heart rate, and sometimes nightmares. Be sure to read all warnings on the label before using any decongestant.
• Use decongestant nasal sprays only for 3 to 5 days. After that, your child's nose will become accustomed to them, and you'll see a rebound effect of even more stuffiness.
• Consider using antihistamines only at night. Their main ingredient is usually diphenhydramine, chlorpheniramine, or brompheniramine, which help stop the nose from running and itching, but also cause sleepiness and irritability.
• Check the labels of all medications to get the correct dosage for your child. The label should tell you what dose is right for your child's weight.
• Stop giving the OTC medication if it isn't helpful or if you notice side effects.

What about natural treatments?

Never use Ma huang, also known as ephedra or ephedrine, a plant-derived decongestant, for a child. Its strength can vary widely, and the Food and Drug Administration has linked it (in adults) to 16,000 adverse reactions, including high blood pressure, irregular heartbeat, seizures, heart attack, and stroke.

In addition, Many herbalists recommend against using herbs to treat children. Herbs are not regulated as medications, so their potency and purity isn't controlled.

Some parents have asked about zinc lozenges thought to modify the strength and duration of cold symptoms in adults. The unpalatable lozenges, which must be sucked every few hours for the first days of a cold, haven't been studied in children, but they might be worth a try. Remember: Children under 4-years-old should not suck on lozenges because they're a choking hazard.

Unless you're vegetarian, you may want to stick with chicken soup, whose healing powers have actually been documented in a scientific study. If you'd like more ideas, The Holistic Pediatrician by Kathi J. Kemper is an excellent source of research-based information on natural remedies.

How can I boost my child's immune system?

Vitamin C may modify cold symptoms, although the high doses required can cause diarrhea. Long-term effects of megavitamin C are unknown, so stick to a multivitamin. Make sure your child is eating a healthy diet, resting enough, and (when he's not sick) getting plenty of exercise.

Further Resources

National Institute of Child Health & Human Development
http://www.nichd.nih.gov/default.htm

References

Pantell, Robert H. M.D., James F. Fries M.D., and Donald M. Vickery M.D. Taking Care of Your Child: A Parent's Illustrated Guide to Complete Medical Care, Eighth Edition. Da Capo Lifelong Books.

Taverner D et al. Nasal decongestants for the common cold. Cochrane Database of Systematic Reviews. Issue 3.

Herbal Remedies and Children: Do They Work? Pediatrics. Volume 112, http://pediatrics.aappublications.org/cgi/content/full/112/1/S1/240

Food and Drug Administration. Sales of Supplements Containing Ephedrine Alkaloids (Ephedra) Prohibited.

Consumer Healthcare Products Association. Press Release: Makers of OTC Cough and Cold Medicines Announce Voluntary Withdrawal of Oral Infant Medicines.

Public Citizen. Children Under 12 Should Not Be Given Cough, Cold Medications, Public Citizen Tells FDA. http://www.citizen.org/pressroom/print_release.cfm?ID=2529

WorstPills.org. Children 12 and under should not be given cough and cold meds.

Food and Drug Administration. Public Health Advisory: Nonprescription Cough and Cold Medicine Use in Children.

Food and Drug Administration. FDA Statement Following CHPA's Announcement on Nonprescription Over-the-Counter Cough and Cold Medicines in Children.