Kids' colds: When to see the doctor

Today we welcome another regular contributor to the Healthy Kids blog: Stephen C. Aronoff, M.D., M.B.A., Waldo E. Nelson Chair, Department of Pediatrics, Temple University School of Medicine. Dr. Aronoff is a specialist in infectious diseases, and he gets started with one of the most common of all:  the cold. 

Who hasn’t had a child return from school early one afternoon with the complaint “I have a cold”?  We all know what’s coming: Three to five days of coughing, sneezing, runny nose, fever and missed school. We also know that within a week or so, everything will return to normal. It may come as a surprise, then, that colds (also called acute upper respiratory tract infections) are the leading cause of visits to pediatricians’ offices and emergency rooms across the country. The cost for all of these visits runs into billions of dollars nationally — all for a disease that has no specific treatment and that will be over in about a week. 

Colds raise two questions for parents of otherwise healthy children: “What can I do to make my child more comfortable” and “When should I seek medical care for my child?”  Here’s what you should know:

No. 1: What can I do to keep my child more comfortable? Colds are caused by a variety of viruses that invade the lining of the nose, throat and airways that lead to the lungs. This viral infection results in fever and increased mucous production throughout the respiratory tract. Fever causes no harm but it does make children uncomfortable. In most cases, the fever can be controlled with ibuprofen alone. Other drugs that fight fever, acetaminophen and aspirin, may have significant side effects in children. Aspirin should not be given to children younger than 18 years old. Acetaminophen is safe when used as directed, but may cause liver damage if doses are too large or too close together. You may have heard about a fever-reducing strategy that involves combining more than one medication – such as alternating acetaminophen with ibuprofen, for example. Don’t do it. This approach has been shown to be no more effective in controlling fever than ibuprofen alone.

Increased mucous production causes most of the symptoms associated with colds. Most of the medications used by adults to control these symptoms are not recommended for young children. Recent studies have shown that many of the decongestants and other cold medications represent a great temptation to children and many children each year are seen in the country’s emergency rooms following accidental ingestion or over dosage. Keeping your child well hydrated with Gatorade or Pedialyte will keep secretions loose so they can be cleared by coughing or sneezing. Mechanical removal of secretions with salt water nose drops and gentle use of an aspirator bulb will provide relief for most young children. 

What about antibiotics? Since the common cold is a viral infection, antibiotics – which take care of bacterial infections – won’t change a cold’s course. And antibiotics will not protection against complications. There is no role for antibiotics in uncomplicated colds.

No. 2: When should I seek medical care for my child? Bacterial infections that complicate colds in otherwise healthy children are the main reason caregivers seek medical attention for kids’ colds. Infections of the middle ear are the most common bacterial complication of colds. The increased secretions become trapped in the middle ear of young children. The accumulation of fluid alone can cause ear pain; in about two-thirds of cases, bacteria infect the trapped fluid and antibiotics are required. Bacterial infections of the sinuses are uncommon in children. Sinusitis should be suspected in children who complain of unremitting headache and high fever and in those who have persistent cold symptoms for more than seven days. Because untreated sinusitis may lead to serious complications, children with suspected sinusitis should receive antibiotics.

The bottom line?

  • Fever control and hydration are the mainstays of therapy for healthy children with colds. 
  • Ear pain, persistence of symptoms beyond seven days or severe headache and fever should be evaluated by your child’s healthcare professional.