As the tree leaves succumb to fall and temperatures drop, the dreaded common cold season begins. Sneezing, rhinorrhea (runny nose), coughing, sore throat, general malaise (feeling ill), low grade fever are some of the symptoms of the common cold. It’s an acute viral, self-limited illness. It requires no antibiotics and the treatment of care is supportive. I thought it would be a good idea to remind about some of the recommendations that may help to get back on feet quickly and remain healthy.
Common cold (also known as viral infection), is usually caused by various respiratory viruses. It is an acute illness, whose symptoms usually peak on 2nd or 3rd day of illness and gradually improve over time. In general, in infants and young children, the symptoms may last over 10-14 days. In older children and adolescents, symptoms usually resolve within a week or less.
Since antibiotics do not alter the course of the common cold and do not prevent secondary complications, many parents turn to over the counter medications (OTC). A number of OTC products are marketed for symptomatic relief of the common cold in children. These include antihistamines, decongestants, antitussives, expectorants, mucolytics, antipyretics, and combinations of these medications. Many studies have shown that over the counter medications have not been proven to work better than a placebo and may have serious side effects. Over the counter medications have been associated with fatal overdose in children younger than 2 years of age. The AAP recommends against the use of OTC cough and cold medication in children younger than four years. If parents choose to use OTC medications in children, it is recommended that child should be older than 6 years of age and only single-ingredient medication with proper instructions to avoid potential toxicity.
In my office, I usually advise my parents against OTC medication regardless of age. I begin by reminding my patients the importance of maintaining adequate hydration. Hydration alone helps to thin secretions and thus provides some alleviation of symptoms. Depending on the age of a child I recommend warm liquids that help soothe respiratory mucosa and thin secretion (most likely from inhalation of steam). Along with Infant/Children Acetaminophen and Ibuprofen, every household should have nasal saline drops. Its safety profile makes it a perfect remedy for a neonate or elderly and everyone in between. It can be purchased at any pharmacy or made at home by using the following recipe: add ¼ teaspoon salt to 8 ounces of warm water. Stir to dissolve the salt, and store the solution for up to one week in a clean container with a cover. Use medicine dropper to administer about 3-4 drops. I recommend the families with infants and small children to use nasal-oral aspirator. It produces less irritation of mucosa than a regular bulb syringes from the hospitals. I recommend use of aromatic vapors for external rub, with agents such as methanol, camphor, eucalyptus oil, unless they have conditions that may have relative contraindication (e.g. asthma- aroma may predispose kids to wheeze). Parents are instructed to apply to the chest or on patient’s cloth never under the nose, since the rub may cause burning or irritation.
For fever, you may give your child acetaminophen or ibuprofen, depending on patient’s age. Make sure to have correct formulation and age and weight appropriate dose. If your child is not affected by a fever during the day, you may withhold giving antipyretic till evening/bedtime.
Cough is a physiological response to airway irritation and functions to clear secretions from the respiratory tract. Therefore, suppression of cough may result in retention of secretions and potentially cause complications (e.g. airway obstruction, pneumonia). In kids older than 1 year, honey may have modest beneficial effect especially on nocturnal cough. In older kids, who are not at risk of aspiration, AAP suggest cough lozenges or hard candy to be used to soothe irritated throat.
If your child’s symptoms do not improve in timely manner or symptoms worsen, he/she should be seen by medical provider.
Thanks, as always!
- Uptodate, The common cold in children: Treatment and prevention
- Pappas DE, Hendley JO. The common cold and decongestant therapy. Pediatr Rev 2011; 32:47.
- Dart RC, Paul IM, Bond GR, et al. Pediatric fatalities associated with over the counter (nonprescription) cough and cold medications. Ann Emerg Med 2009; 53:411.