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Clinical Reference Systems: Pediatric Advisor 10.0
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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 3 weeks.

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.

  1. 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 secretions gently.

    Put petroleum jelly around the nostrils to protect them from irritation.

    Nasal discharge is the nose's way of getting rid of viruses. Antihistamines are not helpful unless your child has a nasal allergy.

  2. 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.

  3. 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.

  4. 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 year old.
    • 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.

  5. 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.

  6. 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 harmful.


  • Breathing becomes difficult AND no better after you clear the nose.
  • Your child starts acting very sick.


  • 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 culture).
  • You have other questions or concerns.

Written by B.D. Schmitt, M.D., author of "Your Child's Health," Bantam Books.
Copyright 1999 Clinical Reference Systems