Chances are a child's first illness will be the common cold. This is especially true if the youngster has an older sibling or is exposed to other children at day care or a babysitter. Since more than 100 different viruses can cause colds, kids are going to do a lot of sniffling and sneezing. In my experience, preschool children average six to eight colds per year.
Any parent who has recently tried to call a child's physician or sat in a doctor's waiting room knows the cold season is here. Why colds are more common during the late fall and winter months is a mystery. It is simply not true that drafts, wetness, chilling or weather change cause colds. On the other hand, lowered resistance, which may result from continued exposure to other sick children, allergies and second-hand cigarette smoke, can make a child more susceptible to a cold.
Contrary to popular belief, cold viruses flourish even in warm climates, so children living in Florida have just as many runny noses as their cousins up north. Perhaps it has something to do with the beginning of school and children spending more time indoors with each other.
The cold virus attacks the membranes lining the nose, throat, larynx (vocal cords) and trachea (windpipe). The symptoms arrive slowly after an incubation period of one to four days and include sneezing, nasal discharge and blockage, tearing eyes, cough, scratchy throat, muscle aches and listlessness. In babies, colds may be signaled by fever, poor appetite and crankiness.
Occasionally, swelling and inflammation prevent the respiratory tissues from draining. When this happens, the bacteria that are normally present in the nose and throat flourish and can cause a more serious infection. For example, when the tube that connects the ears and nose becomes clogged, a middle ear infection (otitis media) may result. Symptoms include increasing fretfulness on the third or fourth day of a cold, coupled with an inability to sleep except when being held upright.
Parents should also be aware of their child's breathing during a cold, especially in infants younger than a year old. Wheezing or labored breathing may mean a serious lower-respiratory tract infection called bronchiolitis, which requires medical attention. A nasal discharge that becomes odorous and distinctively yellowish or greenish could mean a bacterial infection in the nose or sinuses.
There is no cure for the common cold. Antibiotics will not help, since a cold is a viral infection. I was taught that untreated, a cold lasts seven days; treated, a cold lingers a week. But that does not mean that parents are helpless in easing a child's pain and discomfort. The three most important things parents can use to combat a child's cold are (1) acetaminophen to relieve fever and aching; (2) bed rest; and (3) plenty of fluids. Other helpful suggestions include:
Cold-mist vaporizers or humidifiers will thin out mucus and heal irritated respiratory membranes. If the child's nose is very stuffy, parents might try feeding their child in a fairly steamed-up bathroom.
Plain saline nose drops, which are available at the drugstore, also will help clear stuffy noses and encourage sneezing, especially in babies. While a cold is no more a threat to an infant than an older child, a unique problem for infants is that they cannot breathe through their mouths and suck at the same time. Parents should try to unstuff that little nose and keep it as runny as possible. Don't use medicated nose drops or sprays without first calling the child's physician.
Use chicken soup. Not only is the broth nutritious, but the steam will also cut through the mucus and help clear the child's nasal passages.
Prop the head of the child's bed to encourage the runny nose to drain freely.
Nonprescription medicines can lessen the effects of symptoms such as cough and congestion. Be sure to call your child's physician for instructions before giving any over-the-counter medications. Since coughing is the body's protective mechanism for removing mucus, there may be hazards in using cough suppressants too much. Antihistamines are of little value for children's colds and may even make things worse by drying secretions too much. Avoid preparations that contain a mixture of three or four different ingredients _ these only increase the chances of side effects and the "shotgun" approach usually doesn't work anyway.
For sore throats, giving ice chips and mild salt water gargles will clear out mucus and make the child more comfortable.
Fevers are fairly common in children with colds. A high fever does not necessarily indicate a more serious infection, and some physicians think that a low-grade fever should not be reduced since it helps fight infection. It is important, however, to call a doctor at the first sign of fever in an infant. A baby under 3 months does not have a fully developed immune system, and any fever can mean a serious infection. In addition, a newborn can be very sick even without a fever.
At some point, parents are bound to find themselves taking care of a child with a cold. And no matter how common the cold is, it's still no fun for either the child or the parents. Children miss school; parents miss work; families miss vacations; and frequently the parents catch their children's colds.
Therefore, when a cold hits, parents and children need all the "tender loving care" they can get. While most colds are minor, this common ailment sometimes opens the door to more serious bacterial infections that require prompt medical attention. If parental instincts tell you all is not well, call your child's physician, just to be sure.
This column is meant to draw attention to the issues discussed and should not be relied upon as medical advice. It is not intended to replace the advice of your child's physician. Dr. Bruce A. Epstein has practiced pediatrics in St. Petersburg since 1973. He is a member of the American Academy of Pediatrics. He is married and has three grown children and a granddaughter.