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Viral Upper Respiratory Infections/Colds/Cough
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As a child encounters large numbers of other children (daycare, church nursery, mother’s day out, etc.) they will begin to have viral Upper Respiratory Infections- URI’s/colds with increasing frequency and variable severity. Eight to ten a year is not unusual. In the winter months it is common for the end of one cold to blend into the beginning of another making the distinction between colds and sinus infections very difficult at times. If the symptoms are prolonged with clear drainage and no fever, the diagnosis of allergic rhinitis must also be considered.
The illness often begins with fever that may occur intermittently over the first two to three days. There are variable degrees of nasal congestion and obstruction to breathing along with a cough due to post-nasal drip and nasal discharge. The nasal discharge is initially clear, often turns cloudy and purulent on the third to fifth day and usually clears and ceases by the tenth day. The patients are contagious for a day or two prior to the onset of fever and traditionally it is said until the patient is free is fever for 24 hours. In actuality these patients are often contagious for 10 to 14 days after the onset of fever. However, if children were excluded from school and daycare for this long a time after each illness the entire country would grind to a halt! As the cause of the illnesses are viral infections, the only treatment that we have to offer is symptomatic. Fever is treated as noted above. Nasal congestion and post-nasal drip may be helped by having the child sleep in a semi-upright position in an infant carrier or car seat; cleaning out the nose with the bulb syringe and normal saline nose drops (over the counter- Ayr, Nasal, Ocean); attempting to keep the nasal secretions as thin and loose as possible by humidifying the air with a cool mist humidifier and the occasional use of vasoconstrictive nose drops such as 1/8%-1/4% neosyneophrine (do not use more than two to three times daily and more than two to three days consecutively to avoid dependence). There is a myriad of OTC and prescription “Cold/Cough/Allergy” medications such as Dimetapp, Pediacare and Triaminic which are combinations of antihistamines and decongestants. When cough is mentioned on the label, it often means that the preparation also contains dextomethorphone, a non-narcotic cough suppressant. This whole category of medicine is of very questionable efficacy. While an occasional dose at bedtime or in the middle of the night may provide a little relief of nasal obstruction and cough, it is not true that their regular use three to four times/day will shorten an illness. It is also true that they may cause excessive drowsiness, moodiness and irritability. The reason there are so many varieties on sale at the pharmacy is that none of them work very well and human nature keeps us hoping that a newer brand will get us the sleep we want so much! THESE MEDICINES SHOULD NOT BE USED IN PATIENTS UNDER 2 YEARS OF AGE. For coughs that are very severe and disturbing, we do have prescription drugs with codeine that are helpful; as these are narcotics, they are prescribed on a case by case basis.
Signs and symptoms with a “cold” that would suggest the need for an office visit include: significant fever beyond 48 hours; severe irritability; poor fluid intake; severe cough consistently interfering with sleep and/or causing vomiting; elevated respiratory rate and persistence of respiratory symptoms continuously beyond ten days. |
Copyright 2007, Clinical Pediatric Associates
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