Cold Facts
Robert P. Lindeman, MD, PhD
Natick Pediatrics, PC

The common cold is a fact of life. There is no practical way to avoid getting a cold, unless you live in a plastic bubble. By the time your child is 2 years old, the chances of his catching at least one cold is virtually 100%.

The common cold is caused by any of a number of viruses that infect the nose, the sinuses, and the back of the throat. Colds are not caused by cold weather or by going outside without buttoning your top button or sitting in a drafty room!

How do you REALLY catch a cold?
Viruses are spread by contact. The most common way to catch a cold is by touching someone who has a cold and then touching your face. Cold viruses enter your body through your nose and your eyes, not your mouth, as is commonly believed. You can also catch a cold by touching a surface that has recently been touched by someone who has a cold. For example, if you have a new baby, you certainly don’t want anybody with a cold to touch her! But if the sick person touches a table in your house, then you touch the same spot on that table, then touch your baby… Now the sick person has "touched" your baby: Viruses are spread by contact! Occasionally cold viruses are spread by direct contact with droplets that are coughed or sneezed out of the mouth and nose of a person with a cold. This is the reason why we teach young children to cough or sneeze into the crook of their arm, or better, into a tissue. Coughing or sneezing into the hand is no good, since the sick person is almost certainly going to touch something with his hand sooner or later.

How do I know it’s a cold?
The symptoms of the common cold typically involve runny nose, watery eyes, sneezing, sore throat, and coughing. The baby/child may also appear tired or "run down". What is not commonly understood is that colds can cause fevers, even high fevers. Just because a child with a cold has a fever it does not necessarily mean that there is any explanation for the fever illness in addition to the common cold!

Babies with colds often bat at their ears. This does not necessarily mean that they need antibiotics! The middle ear is a sinus, like the sinuses in your face. When you get a cold, the lining of the sinuses (including the lining of the middle ear) often becomes swollen with fluid. In fact, many normal children with colds will collect fluid behind their eardrums. This does not mean that the child needs antibiotics!!! When the body’s immune system clears the virus away, the fluid will go away on its own.

How long should a cold last?
This is really two questions: How long is a child with a cold contagious and how long will the symptoms last? The answer is that a child with a cold is contagious from the day he develops symptoms until two to four days later. However, it may be two weeks before the mucus, the congestion, and the cough go away entirely. Unfortunately, the child may catch a second cold as soon as the first cold has cleared, and then again two weeks after that, depending on her contact with other sick children. This may give her parents the impression that the child is sick constantly all winter, or that there is something wrong with her immune system. In fact, she is merely unlucky. A child may catch 6-9 colds during the Fall and Winter months. If you perform the calculations, that makes 1-2 colds per month from October to March! Take into consideration the number of days the child may have symptoms (14), and we come up with 90 to 120 days of coughing, sneezing, and congestion per year!

Colds get "worse" before they get better
The natural course of a cold is such that mucus gets thicker, stickier, and darker with time. Green mucus is not a sign that the child has a bacterial infection and therefore needs antibiotics! In some children, particularly infants, the cough may sound junkier or harsher several days into the cold. Mucus is also a very effective appetite suppressant. A child who swallows any amount of mucus is not going to feel particularly hungry. On the other hand, the child’s thirst should remain fairly constant; A child with a cold may not eat as much, but he should drink the same amount (or more!). The fever should not last longer than 4 days, which coincides with the period of contagiousness.

Caring for a child with a cold
The most important treatments for a child with a cold are fluids and sleep. A baby or child with a cold needs plenty of fluids. It doesn’t matter what kind of fluids you give as long as the child drinks it! Breast milk, formula, diluted juice, Pedialyte are all good choices. Sleep and rest are important because a child needs to "direct her energy" toward fighting off the cold.

I use medications for children with colds only to improve fluid intake and sleep. I never use fever medications to bring down fever for its own sake, but rather to make the child feel better…so that they drink and sleep! Acetaminophen (Tylenol) and Ibuprofen (Advil/Motrin) at appropriate doses for the child’s weight are the best cold remedies that I know of. There are many herbal preparations that are useful as well, including Echinacea.

I never recommend decongestants (any medication containing pseudoephedrine) for children less than 2 years old. The reason is that decongestants tend to make small children jittery and sleepless, and may cause them to feel thirstier, two things we definitely want to avoid in children with colds! To be sure that you aren’t giving a medication with a decongestant in it, avoid products with the word "cold" in the name (e.g., "Tylenol Cold").

A humidifier in the child’s room will also help. I prefer "cool mist" humidifiers since they are safer and they tend not to grow as much mold as "hot mist" humidifiers. Finally, it might be helpful to keep the mattress on the child’s bassinet/crib angled up. This will help to reduce the post-nasal drip and cough.
If the infant/child cannot drink or sleep because of trouble breathing through the nose, you might make her more comfortable by using a rubber bulb syringe to clear out mucus. If the mucus is very hard or dry, a couple of drops of salt water (saline) will help loosen it up (you’ll need help to do this, it’s a two-person job!).

Preventing Colds
Keeping in mind that colds are inevitable in a child’s life, there are three ways you can significantly reduce the chances of catching and spreading the cold virus: 1) Good hand washing, 2) Good hand washing, and 3) Good hand washing. Viruses are spread by contact, and the part of the body that makes contact with most things in our world are our hands. The best way to wash hands is with soap and water. The type of soap and the temperature of the water do not matter at all: what matters is the length of time you spend at the tap. Good hand washing means thirty seconds. That may seem like an eternity when you’re busy, but it’s worth it! Anti-bacterial washes and soaps are acceptable alternatives, but I prefer old-fashioned soap and water. How often should a sick child or a person caring for a sick child, wash hands? As often as you think of it! Once per hour is not excessive.

Good hand washing is difficult; keeping sick children away from healthy children is very difficult. Keep in mind that a child with a cold is contagious for as long as four days after the beginning of symptoms. Certainly a child with a fever should stay home from day care or school. A child is no longer contagious 24 hours after his fever has gone.

When to call the doctor

• If the child develops trouble breathing, despite your best efforts to keep the nose clear
• In a child less than two months old, any fever over 100.4 degrees Fahrenheit
• If the child’s fever lasts longer than four days
• In an older child, severe headache, neck pain, or stiffness. In an infant, if the baby does not stop crying, even momentarily, for one hour
• If the child/infant cannot or will not drink fluids
• If the child becomes unusually sleepy
• If the child/baby has no wet diapers or toilet trips in 12 hours