Clinical Reference Systems: Pediatric Advisor 10.0
Colds (Upper Respiratory Infections, or URIs)
- runny or stuffy nose
- usually a fever and sore throat
- sometimes a cough, hoarseness, red eyes, and swollen
lymph nodes in the neck.
- Vasomotor rhinitis: Many children and adults have a
profusely runny nose in the wintertime when they are
breathing cold air. The nose usually stops running
within 15 minutes after a child comes indoors. It
requires no treatment beyond a handkerchief and has
nothing to do with infection.
- Chemical rhinitis: Chemical rhinitis is a dry stuffy
nose that results from using vasoconstrictor nosedrops
too often and too long (longer than 1 week). It will be
better a day or two after you stop using the nosedrops.
A cold or upper respiratory infection is a viral infection
of the nose and throat. The cold viruses are spread from
one person to another by hand contact, coughing, and
sneezing. Colds are not caused by cold air or drafts.
Because there are up to 200 viruses that cause colds, most
healthy children get at least six colds a year.
Usually the fever lasts less than 3 days, and all nose and
throat symptoms are gone in a week. A cough may last 2 to
Watch for signs of secondary bacterial infections such as
earaches, yellow drainage from the eyes, sinus pressure or
pain (often indicating a sinus infection), or difficulty
breathing (often a sign of pneumonia).
If you have a young infant, make sure that the baby does not
get dehydrated. A blocked nose can interfere so much with
the ability to suck that dehydration can occur.
Not much can be done to affect how long a cold lasts.
However, we can relieve many of the symptoms. Keep in mind
that the treatment for a runny nose is quite different from
the treatment for a stuffy nose.
- Treatment for a runny nose with a lot of discharge.
The best treatment is clearing the nose for a day or
two. Sniffing and swallowing the secretions is probably
better than blowing because blowing the nose can force
the infection into the ears or sinuses. For younger
babies, use a soft rubber suction bulb to remove the
Put petroleum jelly around the nostrils to protect them
Nasal discharge is the nose's way of getting rid of
viruses. Antihistamines are not helpful unless your
child has a nasal allergy.
- Treatment for a dry or stuffy nose with only a little
discharge or dried yellow-green mucus.
Most stuffy noses are blocked by dry mucus. Blowing the
nose or suction alone cannot remove most dry secretions.
Using nosedrops and then suctioning or blowing out the
fluid in the nose can help. This is called a nasal wash.
Nosedrops of warm tap water or saline are better than any
medicine you can buy for loosening up mucus. If you
prefer normal saline nosedrops, mix 1/2 teaspoon of table
salt in 8 ounces of water. Make up a fresh solution
every few days and keep it in a clean bottle. Use a
clean eyedropper to put drops into the nose. Water can
also be dripped in using a wet cotton ball.
- For the younger child who cannot blow his nose:
Place three drops of warm water or saline in each
nostril. After 1 minute use a soft rubber suction
bulb to suck out the loosened mucus gently. To
remove secretions from the back of the nose, you will
need to seal off both nasal openings completely with
the tip of the suction bulb on one side and your
finger closing the other side. If you cause a
nosebleed, you are putting the tip of the suction
bulb in too far. You can get a suction bulb at the
drugstore for about $2. Try to buy a short, stubby
one with a clear-plastic mucus trap.
- For the older child who can blow his nose:
Use three drops in each nostril while your child is
lying on his back on a bed with his head hanging over
the side. Wait 1 minute for the water to soften and
loosen the dried mucus. Then have your child blow
his nose. This can be repeated several times for
complete clearing of the nasal passages.
- Mistakes in using warm-water or saline nosedrops:
The main errors are not putting enough water in the
nose, not waiting long enough for secretions to
loosen up before suctioning or blowing the nose, and
not repeating the procedure until the breathing is
easy. The front of the nose can look open while the
back of the nose is all gummed up with dried mucus.
Make sure that the nose is suctioned or blown after
the warm-water nosedrops are put in.
- Use the nasal wash at least 4 times a day or
whenever your child can't breath through the nose.
- The importance of clearing the nose of a young infant.
A child can't breathe through the mouth and suck on
something at the same time. If your child is breast-
feeding or bottle-feeding, you must clear his nose out
so he can breathe while he's sucking. It is also
important to clear your infant's nose before you put him
down to sleep.
- Treatment for associated symptoms of colds.
- Fever: Use acetaminophen or ibuprofen for aches or
mild fever (over 102ƒF, or 38.9ƒC).
- Sore throat: Use hard candies for children over 4
years old and warm chicken broth for children over 1
- Cough: Use cough drops for children over 4 years old
and 1/2 teaspoon corn syrup for younger children. Use
a humidifier to make the air in the room less dry.
- Red eyes: Rinse frequently with wet cotton balls.
- Poor appetite: Encourage drinking fluids by letting
the child choose what to drink.
- Prevention of colds.
A cold is caused by direct contact with someone who
already has a cold. Over the years we are all exposed
to many colds and develop some immunity to them.
Complications from colds are more common in children
during the first year of life. Try to avoid undue
exposure of young babies to other children or adults
with colds, day care nurseries, and church nurseries.
A humidifier prevents dry mucous membranes, which may be
more susceptible to infections.
Vitamin C, unfortunately, has not been shown to prevent
or shorten colds. Large doses of vitamin C (for
example, 2 grams) cause diarrhea.
- Common mistakes in treating colds.
Most over-the-counter cold remedies or tablets are
worthless. Nothing can make a cold last a shorter time.
If the nose is really running, consider using a pure
antihistamine (for example, chlorpheniramine products)
if your child also has allergies. Especially avoid
drugs that have several ingredients because there is a
greater chance of side effects from these drugs. Avoid
oral decongestants if they make your child jittery or
keep him from sleeping at night. Use acetaminophen for
a cold only if your child also has a fever, sore throat,
or muscle aches.
Do not give leftover antibiotics for uncomplicated colds
because they have no effect on viruses and may be
CALL YOUR CHILD'S PHYSICIAN IMMEDIATELY IF:
- Breathing becomes difficult AND no better after you clear
- Your child starts acting very sick.
CALL YOUR CHILD'S PHYSICIAN DURING OFFICE HOURS IF:
- The fever lasts more than 3 days.
- The runny nose lasts more than 10 days.
- The eyes develop a yellow discharge.
- You can't unblock the nose enough for your infant to
drink adequate fluids.
- You think your child may have an earache or sinus pain.
- Your child's throat becomes quite sore (get a throat
- You have other questions or concerns.