Viral Upper Respiratory Infections/Colds/Cough
As a child encounters large numbers of other children (daycare, church nursery, mother’s day out,older siblings, etc.) carrying viruses to which they are not yet immune ,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.Decreasing clear discharge may persist for another 3-4 days, commonly resulting in a 2 week illness from start to finish!. Some patients may have a sore throat and/or laryngitis with changes in vocal quality. 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! The viruses that cause colds number in the hundreds and some strains do not cause the patient to become immune to that virus. This means that , while children will experience a smaller # of colds/year as they get older, even adults may have 4-5 colds/year!
These viruses are primarily transmiited by self-inoculation (touching one's nose/eyes/mouth) with hands contaminated after contact with other individuals carrying the virus or contaminated surfaces. Frequent handwashing and cleaning of environmental surfaces with virocidal products has been shown to decrease transmission, but is difficult to achieve consistantly with young children. Virocidal hand gels/tissues are effective if used frequently but alcohol-based hand sanitizers are not effective against Rhinoviruses which are one of the biggest cause of colds in all age groups.
As the cause of these illnesses are viral infections for which there are currently no specific anti-viral medications, the only treatment that we have to offer is symptomatic. Fever is treated as noted above in the section on Management of Fever. Nasal congestion and post-nasal drip may be helped by having the child sleep in a semi-upright position on pillows for older children or in an infant carrier or car seat for younger ones; cleaning out the nose with the bulb syringe and OTC normal saline nose drops ( Ayr, Nasal, Ocean, Little Noses). 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 dextromethorphone, 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 HAVE BEEN BANNED BY THE FDA FOR CHILDREN < 2 YEARS OF AGE. THE ACADEMY OF PEDIATRICS STRONGLY RECOMMENDS AGAINST THE USE OF THESE PRODUCTS IN PATENTS < 6 YEARS OF AGE. SIDE EFFECTS FROM THESE MEDICATIONS RESULT IN THOUSANDS OF ER VISITS AND HUNDREDS OF DEATHS/YEAR!
THE ACADEMY OF PEDIATRICS STRONGLY RECOMMENDS AGAINST THE USE OF COUGH SUPPRESSANTS SUCH AS DEXTROMETHORPHONE (DELSYM) AND CODEINE FOR NIGHTTIME COUGH CONTROL IN CHILDREN. THESE PRODUCTS ARE OF QUESTIONABLE EFFICACY AND CAN CAUSE UNPREDICTABLE RESPIRATORY DEPRESSION LEADING TO DEATH WHEN GIVEN IN AMOUNTS THAT EXCEED RECOMMENDED DOSAGES.
ORAL OR NASAL SPRAY DECONGESTANTS ARE NO MORE EFFECTIVE THAN PLACEBO IN THE RELIEF OF COLD SYMPTOMS AND ARE CAPABLE OF CAUSING SERIOUS SIDE EFFECTS INCLUDING DEATH. THEY ARE NOT RECOMMENDED FOR CHILDREN UNDER 12 YEARS OF AGE.
Other products promoted for the relief of cold symptoms that are of unproven efficacy include: Guafenisin (Mucinex), Echinacea, Ipatropium Bromide Nasal Spray, Zinc and the use of vaporizers.
Remedies that may provide some relief of cold symptoms and that are considered safe include oral honey (in children older than 1 year of age), vapor rub applied to the chest (in children older than 2 years) and gentle nasal cleansing with OTC normal saline nose drops.
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 troublesome respiratory symptoms continuously beyond ten days.