By Frank Lin, M.D.

The common cold is the number one cause of doctor visits in the United States and results in an estimated 22 to 189 million lost school days per year. In the course of one year, the U.S. population contracts approximately 1 billion colds. It is normal for children to catch multiple colds each year, especially during the winter season. Children in daycare, as well as children in their first years of school, can get eight to 10 colds or more per year due to exposure to many viruses that are new to their immune systems. Fortunately, most colds resolve by themselves and do not lead to worse illnesses. As children grow older, they develop immunity to increasing numbers of cold viruses and get sick less often. Adults generally catch two to four colds per year.

What causes colds, and how are they treated?

Contrary to what you may have heard, not wearing extra clothing when it is cold and going outdoors with wet hair do not cause colds. Colds are caused by more than 100 different viruses that can infiltrate the upper respiratory tract, causing an infection and triggering a cascade of immune responses that lead to cold symptoms. There are multiple reasons why children catch more colds during the winter. First, cold-causing viruses survive better when the humidity is low, such as during the winter. Second, cold, dry air may stress the immune system and make the inside lining of the nostrils drier, thus lowering a child’s resistance to infection. Lastly, people tend to keep windows closed and stay indoors when it’s cold outside. This gives viruses a better chance to spread. In addition, smokers and children who are exposed to second-hand smoke catch colds easily. These colds tend to be more severe with longer-lasting symptoms. So please don’t smoke, and don’t expose your children to second-hand smoke.

Currently, there is no cure for the common cold. Antibiotics do not work against cold viruses and may lead to side effects such as upset stomach, diarrhea and the creation of bacteria that are resistant to multiple antibiotics. However, colds can sometimes lead to secondary bacterial infections such as middle ear infection, which may then be treated with antibiotics. Treatment of the common cold generally involves relieving the symptoms of the cold.

Cold or flu?

How can you tell if a child has a cold or the flu when these illnesses share so many of the same symptoms? In general, cold symptoms start out with relatively mild symptoms, develop gradually and cause less severe symptoms than the flu, including low-grade fever, fatigue, nasal congestion, scratchy throat, muscle aches and mild headache. Flu, on the other hand, starts suddenly and hits hard, with generally severe symptoms including high fever, early cough, severe fatigue, intense muscle ache, severe headache, eye pain and sore throat. Please see your health care provider early if you suspect the flu.

Signs and symptoms

Cold symptoms can vary greatly, but generally appear within several days of exposure and resolve within one to two weeks. Common initial symptoms include throat irritation, stuffy or runny nose and sneezing. Later symptoms can include sore throat, cough, headache, low-grade fever and fatigue. Nasal discharge can also change from clear to yellow or green and becomes thick. Coughing is generally harmless and can actually protect the lungs by expelling the excessive mucus. Children tend to sniff and swallow mucus down into the throat, which irritates the throat and causes coughing. This is also the reason why coughing increases when a person is trying to sleep (via post-nasal drip irritation). A coughing child may also complain of abdominal pain or nausea, which is often caused by swallowed mucus or muscle strain from coughing. Finally, a dry cough may linger for several weeks after resolution of other cold symptoms.

Contagiousness and prevention

People with colds are most contagious during the first several days after symptoms appear and may be contagious for up to several more weeks. Children are in close proximity with each other and can catch colds most easily. The cold viruses can be spread by person-to-person contact, by breathing in aerosolized viral particles and by touching a contaminated surface and then touching one’s own face. To decrease the spread of disease, follow the recommendations listed below.

• Keep clean: Wash hands frequently and thoroughly with soap for 15 seconds and avoid touching the faucet by turning the faucet with a paper towel. This is the most effective way to prevent the spread of disease. Keeping toys, household surfaces and doorknobs clean also helps. Consider changing your toothbrush after your cold or flu symptoms resolve.
  
• Stay clear: Since viral particles can travel across the room through coughing or sneezing, your child should stay away from anyone who has these symptoms. Keep your children away from second-hand smoke, which makes them more likely to get sick.
  
• Cover up: Encourage kids with colds to cover their sneezes or coughs with tissue or their sleeves. Using hands to cover a cough may actually increase the spread of disease through person-to-person contact.
  
• Don’t share: Avoid sharing towels, utensils and drinks with others. You never know who is contagious and is about to start having symptoms.

Treatment guidelines and precautions

There is no cure for the common cold; it just has to run its course. Getting plenty of rest, avoiding vigorous activity and drinking plenty of fluids can all help children feel better without medications. Zinc and vitamin C supplements have not conclusively proven to be effective for colds. For parents who are considering giving their children over-the-counter (OTC) cold remedies, please read the statements below carefully.

• Do not give OTC cold products to children under age 2. Since January 2007, the Centers for Disease Control and Prevention (CDC) has warned parents not to give OTC cold medications to children under age 2 due to potentially dangerous side effects. The Food and Drug Administration (FDA) has concurred with these recommendations. There is still some question about giving OTC cold medications to children ages 2 to 5.
  
• Ask your health care provider if you should give OTC cold medicines to children ages 2 to 5. Although the FDA has not yet banned OTC cold medicines for this age group, the American Academy of Pediatrics recommends treating children under age 6 without OTC cold products because these products are not effective in children under age 6 and can have potentially serious side effects.
  
• The FDA also recommends that parents read package labels and instructions thoroughly and carefully; do not exceed the recommended dosage; avoid giving children medicine intended for adults; talk to their child’s physician if they are uncertain about what to give; inform their child’s physician about what medications (OTC and prescription) are currently being used, so new prescriptions can be given safely; and use only the measuring device packaged with the medicine to avoid errors in dosing.
  
• OTC cold medicines may be safer for older children and teenagers, but are usually not necessary since colds can generally be treated without OTC medications. For example, suppressing a wet-sounding cough with cough suppressing medications (dextromethorphan) can limit the body’s ability to clear the airway of mucus and cause dangerous side effects. Thinning of mucus can be done safely without any medications. Expectorants (guaifenesin) can thin the mucus, but may also cause drowsiness, nausea and vomiting. Drying up secretions with antihistamines (diphenhydramine) and opening up nasal passageways with decongestants (pseudoephedrine) may both cause serious side effects in young children.

Recommended treatments without using OTC cold remedies

• Give older children OTC pain relievers to reduce fever and ease the pain of sore throat, headache and body aches. Acetaminophen (Tylenol) is generally safe for children, but it must be given as directed. Ibuprofen (Advil, Motrin) should not be given to children under age 6 months and children who may be dehydrated. Aspirin should not be used by anyone younger than age 18 due to its association with a rare but potentially fatal illness called Reye’s syndrome.
  
• Encourage your child to drink plenty of fluids to help loosen the congestion and allow mucous to be cleared from the airways through nose-blowing and coughing. Extra fluids lost through fever and cold symptoms need to be replenished. Alcohol and caffeinated drinks may increase fluid loss through increased urination and should be avoided.
  
• Give your child chicken soup. It has been proven in research to help lessen cold symptoms by its warm vapors, its mucus-thinning amino acid called cystine and its ability to reduce the inflammation associated with cold symptoms by inhibiting movement of cells that cause inflammation. Researchers also found canned chicken soup to be as effective as soup prepared from scratch.
  
• Have your child rest at home, especially if he or she has fever or a bad cough. This also helps prevent spreading the disease to others.
  
• Use a humidifier to help to soothe the irritated nasal passageways and airways. Steam and hot showers also help.
  
• Use nasal suction bulbs (for babies), saline nose drops and nasal saline rinses (for older children) to help loosen thick mucus, decrease swelling and make it easier to breathe.
  
• Have your child gargle with salt water or suck on hard candy (when the child is old enough to avoid choking) to help ease a sore throat.
  
• Apply skin moisturizers under the nose and menthol rubs to soothe your child and aid better sleep.
  
• Avoid cigarette smoke to help prevent worsening of symptoms.

When to seek medical attention

Parents must be extra cautious when caring for infants with colds.

• If your child is under age 3 months and catches a cold, his or her health care provider should be called at the first sign of symptoms.
  
• Newborns with any fever (100.5 degrees or higher) must be evaluated immediately by a health care provider.

In any age group, “cold-like” symptoms may also develop into more severe illnesses, including Strep throat (and its complications), middle ear infection, croup, pneumonia, dehydration, meningitis and respiratory distress. Please seek medical attention if the child’s symptoms are severe or include any of the following:

• Fever over 103 degrees (39 C) with shaking chills
• Fever over 101 degrees (38 C) lasting more than 24 hours
  
• Newborns with fever (100.5 degrees or higher)
  
• Unusual fatigue or lethargy, especially with mental status changes (hard to awake, seems confused, irritable and inconsolable)
  
• Severe headache, especially with stiff neck
  
• Any shortness of breath, increased breathing effort, wheezing, or changes in skin color (bluish or pale)
  
• Dehydration: poor fluid intake, decreased urinary output with dark concentrated urine, or decreased number of wet diapers in younger children
  
• A rash develops -- especially with fever
  
• Earache (pulling at the ear by younger children) or ear drainage
  
• Severe or worsening sore throat
  
• Coughing up large amounts of thick mucous, blood-tinged sputum, or coughing for more than seven to 10 days
  
• Worsening of a chronic medical condition (such as asthma, diabetes or heart disease)

Dr. Frank Lin is a family medicine physician at PAMF’s Dublin Center.