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Pediatric - Colds


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Does this describe your child's symptoms?

  • Viral infection of the nose and throat


  • Runny or congested nose
  • The nasal discharge may be clear, cloudy, yellow or green
  • Usually associated with fever
  • A sore throat often is the first symptom
  • Sometimes associated with a cough, hoarseness, watery eyes, and swollen lymph nodes in the neck


  • Colds are caused by viruses. Healthy children average 6 colds a year. Influenza usually feels like a bad cold with more fever and muscle aches.
  • Colds are not serious. Between 5 and 10% of children develop a bacterial complication (ear or sinus infection).

Colds: Normal Viral Symptoms

  • Colds cause nasal discharge, nasal congestion, sinus congestion, ear congestion, sore throats, hoarseness, coughs, croup, and red, watery eyes. When you combine all these symptoms, colds are the most common reason for calls to the doctor.
  • Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money and help you avoid some unnecessary trips to the doctor. You can be reassured the following are normal cold symptoms and children with these symptoms don't need to be seen:
    • Fever up to 3 days
    • Sore throat up to 5 days (with other cold symptoms)
    • Nasal discharge and congestion up to 2 weeks
    • Coughs up to 3 weeks

Colds: Symptoms of Secondary Bacterial Infections

  • Using this guideline, you can select out the 5 to 10% of children who have ear infections or sinus infections. Many are identified with specific symptoms and patterns. Some are suspected because symptoms last too long:
    • Earache or ear discharge
    • Sinus pain not relieved by nasal washes
    • Fever present over 3 days
    • Fever that goes away for 24 hours and then returns
    • Sore throat present over 5 days
    • Nasal discharge present over 2 weeks
    • Cough present over 3 weeks

Return to School

  • Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.

If not, see these topics

When to Call Your Doctor

Call 911 Now (your child may need an ambulance) If
  • Severe difficulty breathing (struggling for each breath, unable to speak or cry because of difficulty breathing, making grunting noises with each breath)
Call Your Doctor Now (night or day) If
  • Your child looks or acts very sick
  • Not alert when awake
  • Difficulty breathing not relieved by cleaning out the nose
  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine
  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think your child needs to be seen
  • Earache or cloudy discharge from ear canal
  • Yellow or green eye discharge
  • Sinus pain around cheekbone or eyes (not just congestion)
  • Fever present for more than 3 days
  • Fever returns after going away for 24 hours
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
  • Blocked nose interferes with sleep after using nasal washes several times
  • Yellow scabs around the nasal openings (Apply OTC antibiotic ointment)
  • Sore throat present over 5 days
  • Nasal discharge present over 14 days
Parent Care at Home If
  • Mild cold with no complications and you don't think your child needs to be seen

  1. For a Runny Nose With Profuse Discharge: Blow or Suction the Nose
    • The nasal mucus and discharge is washing viruses and bacteria out of the nose and sinuses.
    • Blowing the nose is all that's needed. For younger children use nasal suction.
    • Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).
  2. For a Blocked Nose: Use Nasal Washes
    • Use warm water OR saline nose drops to loosen up the dried mucus followed by child blowing or parent suctioning. Instill 2-3 drops in each nostril. (Caution: if under 1 year old, use 1 drop at a time) Do 1 side at a time. Repeat nosedrops until clear. Do nasal washes at least 4 times a day or whenever your child can't breathe through the nose.
    • Saline nosedrops - add ½ teaspoon of table salt to 1 cup (8 oz.) of warm water.
    • Importance: A young infant can't nurse or drink from a bottle unless the nose is open.
    • Note: Most stuffy noses are blocked by dried/sticky mucus and suction alone or blowing the nose cannot remove it.
    • Use a wet cotton swab to remove mucus that's very sticky.
  3. Humidifier: If the air in your home is dry, use a humidifier.
  4. Medicines for Colds:
    • Cold medicines are not recommended at any age. (Reason: they are not helpful. They can't remove dried mucus from the nose. Nasal washes can.)
    • Antihistamines are not helpful, unless your child also has nasal allergies.
    • Decongestants: OTC oral decongestants (Pseudoephedrine or Phenylephrine) are not recommended. Although they may reduce nasal congestion in some children, they also can have side effects.
    • Age Limit: Before 4 years, never use any cough or cold medicines. (Reason: unsafe and not approved by FDA) (Avoid multi-ingredient products at any age.)
    • No Antibiotics: Antibiotics are not helpful, unless your child develops an ear or sinus infection.
  5. Treatment for Associated Symptoms of Colds:
    • Fever - Use acetaminophen (e.g., Tylenol) or ibuprofen for muscle aches, headaches, or fever above 102° F (39° C).
    • Sore Throat - Use warm chicken broth if over 1 year old and hard candy if over 6 years old.
    • Cough - Use cough drops for children over 6 years old, and honey (2 to 5 ml) for younger children over 1 year old.
    • Red Eyes - Rinse eyelids frequently with wet cotton balls.
  6. Contagiousness: Your child can return to day care or school after the fever is gone and your child feels well enough to participate in normal activities. For practical purposes, the spread of colds cannot be prevented.
  7. Expected Course: Fever 2-3 days, nasal discharge 7-14 days, cough 2-3 weeks.
  8. Call Your Doctor If:
    • Earache suspected
    • Fever lasts over 3 days
    • Any fever occurs if under 12 weeks old
    • Nasal discharge lasts over 14 days
    • Cough lasts over 3 weeks
    • Your child becomes worse

And remember, contact your doctor if your child develops any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

Author and Senior Reviewer: Barton D. Schmitt, M.D.

Last Reviewed: 1/19/2009

Last Revised: 12/19/2008

Content Set: Pediatric HouseCalls Online

Copyright 1994-2009 Barton D. Schmitt, M.D.

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