Illnesses & Symptoms
Cough and Colds
- Water, water, water
- Saline to the nose with suctioning for young children/infants
- Saline irrigation and nose blowing for those able
- Increase fluid intake
- Add water to the air with a vaporizer or humidifier (without added medications) during dry months. It is not needed if your AC is on!
- Children over 1 year of age can use honey for cough treatment. Have them try a teaspoon of honey in warm herbal (no caffeine) tea- best since the warm liquid also helps. If they don't like tea, try honey on toast or from a spoon.
- Antibiotics are not recommended for cough and colds unless there are signs of a bacterial infection.
What are the Symptoms?
Symptoms vary, but can include any of the following:
When the cough is wet sounding, often the vibration can be felt in the chest. This does not mean it has settled in the chest. If your throat is cleared, you can feel the vibrations in the chest. This is similar to noisy breathing from the throat with a cold. If it settles in the chest, most children will suck in their ribs/belly or breathe faster than normal (60 or more breaths/minute in infants, 50 breaths per minute in older children).
At the beginning of a cold, there is a clear nasal discharge, swelling of the nasal passageways, throat irritation, and sneezing. After about 2 days, the nasal discharge becomes thicker and discolored. Changes in color from yellow to green are typical in the course of a cold and do not signify a bacterial infection, sinus infection, or anything more serious. Antibiotics are not helpful against colds, even when the mucus is green or yellow.
- runny nose (any color discharge)
- scratchy/sore throat
- postnasal drip
- loss of appetite
- fever (usually less than 103°F.)
- body aches
- problems sleeping
- eye drainage (mucus or watery eyes, but the white of the eye is not red)
- hoarse voice
- many children will vomit from the mucus gagging them
- Bulb syringes are typically given in the nursery and are not very helpful
- Suction devices that make a seal with the nostril and allow sufficient air to provide suction are good. Suggestions include the Nosefrida or the Baby Nasal Cleaner. (Note: we suggest these due to positive patient feedback. We are not paid endorsers of these products.)
- Saline sprays can help shrink mucus membranes for those unable to do nasal washes
- For information on how to do a nasal wash, the Nasopure website has a lot of written information and video demonstrations for kids as young as 2 years to learn to wash their nose! (Note: We are not a paid sponsor of this product. We recommend it based on quality. And we love that the product is made in Kansas City and packages are assembled by disabled adults. Great company!)
Elevate the head
Elevate the head about 45 degrees for sleep:
- For infants you can elevate the head of the bed by placing something stable under the feet of the bed or something under the mattress. Never use something soft under your infant before 1 year of age. If your back-sleeping infant rotates to the side, you can make a "nest" by rolling a blanket and forming a "U". Place the "U" on the mattress and put the fitted sheet over it to decrease the risk of it unrolling. Put baby's bottom at the bottom of the "U" and the knees over it.
- Babies who roll and sleep on their stomachs are best laying on a flat surface due to movement during sleep.
- Children who sleep on pillows can use extra pillows to elevate their heads.
Kids with a history of wheezing or asthma
- Any cough or cold can trigger wheezing, so be sure to watch for difficulty breathing
- Use your child's albuterol or levalbuterol (Xopenex) every 4-6 hours as needed for wheeze
- Bring your child in to be seen if cough or wheezing doesn't improve after the albuterol or levalbuterol
- Use your Action Plan to increase preventative medicines if appropriate
- See our Asthma pages for more information
When should I bring my child in with a cold?
Urgent appointment needs: If your child is breathing more than 60 times in a minute, ribs are going in and out with breaths, or the belly is sucking in and out with each breath, your child needs to be seen in the office, at urgent care or an ER (preferably one that specializes in children or has a pediatric specialist), depending on time of day and your location. Another complication that kids must be seen for is dehydration. Dehydration may be present when the child is unable to take in enough fluids to make urine at least 4 times a day for infants, twice a day for older children.
Routine office visits: If your child has ear pain, trouble sleeping, or general fussiness but is otherwise breathing comfortably and well hydrated, he should be seen during regular office hours. If the cold is worsening after 10-14 days, bring your child in during regular office hours.
Can't decide what the cough sounds like?
Check out Dr. Stuppy's collection of cough videos on Quest for Health.
What if you suspect Influenza?
See our page on influenza.
Why does my child always have a cold?
- Kids get 8-15 colds/year and each cold lasts 7-21 days
- Kids typically have up to 140 days of cold symptoms a year (about 1/3 of the time!)
- They spread each virus for up to 3 weeks, starting even before symptoms start
- Kids may always be contagious!!!
What causes a cold?
There are over 100 viruses that can cause a cold. They are spread by contamination of the hands from nasal secretions. Sneezing, wiping the nose, blowing the nose, or any other action that gets nasal secretions on the hands, toys, doorknobs, or other objects is how most cold viruses are spread. Some viruses can survive on objects for several days. Interestingly, coughing and saliva do not contain much virus, and are not a major source of transmission. Still, cover your cough with your arm (not a hand that will touch everything) to prevent potential spread.
The incubation period of most cold viruses is 1-7 days. We shed the virus mostly in the first 2-3 days of symptoms, but for up to 3 weeks. Children tend to shed the virus longer than adults. They do not wash hands as well or as often as adults. Therefore, they tend to spread more infection than adults. If you would like to see a video with great graphics on how viruses are spread, see NPR's Flu Attack! How a virus invades your body.
How long will the cough and cold last?
For information on how long cough and colds last, see How Long Will a Cough or Cold Last?
What does not cause a cold?
Weather changes, cold weather, being outside without a coat or hat, and drafts are all blamed falsely on causing colds. Colds are caused by viruses, and are common in the winter months, even in climates that remain warm in those months. Wearing warm clothing does not protect against colds. Hand washing is the best defense against catching a cold.
What are complications of upper respiratory infections or colds?
Colds can trigger asthma exacerbations and pneumonias. They can be a set up for an ear infection or non-infected fluid in the middle ear causing temporarily decreased hearing and fullness in the ear. Sinus infections may start with a cold virus. A sinus infection that requires antibiotics must be present at least 10 days.
More Treatment Options for the Common Cold
Wash with soap and water
The most important thing to do with a cold is to prevent its spread and wash hands after wiping a nose, sneezing, or touching objects likely to have virus on them. Treating symptoms is the mainstay of treating a cold.
Drink water or other fluids
Encourage plenty of fluids to keep the body hydrated (or it will suck moisture out of mucus, which then makes it more sticky and more likely to plug up airways/sinuses/ears.)
No decongestants are recommended in children.
We do not routinely recommend cough and cold medications for children, but they are discussed below.
- First generation antihistamines (diphenhydramine, hydroxyzine, chlorpheniramine, brompheniramine, and clemastine) can help dry mucus membranes, but make people drowsy. They should be used with caution in children with asthma because they thicken secretions and can make them harder to clear.
- Second generation antihistamines (terfenadine, astemizole, loratadine, and cetirizine) do not cause drowsiness, but do not help with common cold symptoms.
Decongestants (pseudoephedrine, phenylephrine, oxymetazoline) decrease nasal congestion by constricting the blood vessels in the nasal passageways.
- May cause tiredness or excitability, dizziness, fast or irregular heart rate, dry mouth, blurred vision, or urinary retention.
- If topical decongestants are used (i.e., medicated nose drops) they may cause a rebound congestion and should be avoided, especially in infants.
- The most beneficial decongestant, pseudoepedrine, was taken out of most cold remedies because it can be used to make methamphetamine.
- Decongestants thicken mucus. This can encourage ear infections.
Antitussives (cough suppressants)
- Studies in children do not show any benefit in cough suppression over placebo for any type (narcotic or non-narcotic) cough medication. They are not recommended in children.
- All cough suppressants should be used cautiously in children with asthma.
- Narcotic cough suppressants (prescription only) contain codeine or hydrocodone, which act on the brainstem to inhibit the cough. They have side effects of respiratory depression (which can lead to stopping of breathing), nausea, vomiting, constipation, dizziness, heart beat irregularities. The FDA and the American Academy of Pediatrics have strong warnings against codeine.
- Non-narcotic cough medications (both OTC and prescription) usually contain dextromethorphan. In adults it has been shown to suppress cough as effectively as (not better than) codeine, but studies in young children fail to show any benefit. It can cause respiratory depression (decreased breathing) in overdose. It is not recommended in any child.
- For more on cough medicines, see Quest for Health.
The most common expectorant is guaifenesin. Studies in adults show it may help loosen mucus to allow the body to cough it out better. It should not be given to children under 4 years of age. Do not use expectorants for chronic cough (such as asthma).
Fever Reducers/Pain Relievers
Acetaminophen and Ibuprophen are used to control fever and aches associated with illness. Some studies show that they suppress the adult host's immune response and prolong the duration of the virus.
There are no studies in children.
Nasal saline with xylitol may help reduce bacterial sinus and ear infections. This can be found online and some local retailers.
Antibiotics do not cure colds or most coughs
The color of nasal drainage does not indicate if it is a sinus infection. Mucus typically goes from clear to yellow to green and finally back to clear during a viral infection. Antibiotics are not used to treat the color of the mucus.
Menthol vapor products are never recommended for infants under 24 months of age.
If you use in older children, stop if they do not seem to improve.
For more on menthol, please see Menthol for sore throats, colds and coughs. Should we use it?
Zinc, Echinacea, Vitamin C
Studies in children are lacking. Overall, there is no evidence that they help. For more on Vitamin C, see this article from a Children's Mercy doctor.