Upper respiratory infections or “URIs” are the most common illnesses in childhood. They are also known as “colds.” They are caused by viruses which invade the nose membranes which leads to swelling and inflammation which produces a clear, watery drainage from the nose. The virus also irritates the throat and upper airway, producing a cough. The cough results from direct viral irritation as well as from nose drainage dripping down the back of the throat, triggering cough. Sometimes a fever is seen during the first 1-2 days of these illnesses as well. Because upper respiratory infections are caused by viruses, antibiotics do not improve the symptoms at all. URI’s are terribly frustrating for parents as children can average 6-10 “colds” per year and it can seem as if your child just got over one illness and is starting again with another. URI’s are highly contagious, both via the respiratory route [spread by cough or sneezing] and the contact route [touching]. It is important to maintain good hand washing technique and not allow children to share toys, cups, or pacifiers when one is ill.
All therapy directed at URIs is simply symptomatic — that is, to help your child feel better — because there is no specific medicine to fight the viruses that cause the common cold. The normal progression of a cold is an initial 2-4 days of clear runny nose [and perhaps fever] followed by a middle 2-3 days of thicker, colored drainage [usually worse after sleeping] and then ending with another 2-3 days of clear runny nose again. A normal, routine “cold” lasts 7-10 days with some combination of runny nose, cough, sore throat, hoarse voice and fever. An antibiotic will make absolutely no difference in the length of these symptoms.
- Give plenty of fluids (juices, water, Gatorade, or Pedialyte) because your child’s body requires more fluids while fighting this viral infection. However, limit the amount of milk in the first 2-3 days as it tends to be vomited and can thicken the nasal discharge.
- Cool mist humidifiers and vaporizers near where your child is sleeping can help them rest more comfortably and can help thin and break up some of the secretions.
- Antihistamines, decongestants and cough suppressants can help dry up some of the nasal secretions and calm down some of the cough and can be used routinely in children over 6 years of age. [Examples: generic PediaCare Cough and Cold or generic Triaminic Cold and Cough]. However, these need to be used carefully in the 2-6 year olds as there have been serious consequences of overuse and overdosing of these medications.
Infants Less than 12 Months/Special Instructions
- Instead of antihistamines and decongestants to keep the nose clear, it is preferable in the younger age group to suction out your infant’s nose with the large bulb syringe they received while in the newborn nursery. First place 2-3 drops of nasal saline into one nostril and suction it back out with secretions; allow a break for your infant to catch his/her breath, and then repeat the same in the other nostril. The nasal saline solution helps to shrink the swelling in the nose and decrease the amount of secretions. This can be most helpful before bottles and right before bedtime. In addition, you can elevate the head of your infant’s crib or allow to sleep in their carrier within the crib in order to decrease the drainage dripping down the back of their throat which can lead to coughing fits when they are lying flat.
- Infants also need plenty of fluids during illness but we do not recommend juice, Gatorade or plain water under 6 months of age. Instead, use Pedialyte to increase the amount of fluids in your infant’s diet. Always contact the physician if your infant is not drinking his/her breast milk or formula well or you are otherwise worried about your child becoming dehydrated.
Corinth Family Medicine & Pediatrics
Karri Dutton, MD