Caring for your child’s cold

If you or your child has recently suffered a cold, you know how frustrating this annoying viral illness can be.  Though the symptoms are not typically miserable, they do not resolve quickly and medications that promise to help symptoms often do not and have undesirable side effects.  Also frustrating are the words you often hear from your health care provider, that the cold is a virus and will go away with time.  We all desperately want something to make our kids (and ourselves) feel better.  Below we discuss what remedies are worth trying and which are worth avoiding as we enter cold and flu season.

What is a cold?

A cold is also known as an upper respiratory infection and is caused by a virus.  Most colds resolve on their own with time and do not cause secondary infections or complications. 

Signs and Symptoms

Symptoms include runny nose, nasal congestion, cough, sore throat, decreased energy, low-grade fever, and headache. Unfortunately, it is normal for these symptoms to last up to 2 weeks.  While most symptoms are improved by 10-14 days, the cough portion may last another 2 weeks.  In young children and infants, the symptoms typically peak around day 2-3 and then very gradually begin to improve. 

Treatment Options:

Though many remedies are advertised for the common cold, most do not help, and some have adverse side effects. 

Treatments that have not been proven to help cold symptoms include: 

Antihistamines:  Though helpful for seasonal allergy symptoms, antihistamines, like Benadryl, are not effective in reducing symptoms of a cold.  They also have undesirable side effects, such as increased sleepiness.

Decongestants: Decongestants cause blood vessels in the nasal passages to constrict helping to relieve nasal congestion.  Though they can be used for those 12 and older, they do have side effects including elevation of blood pressure and heart rate.

Cough suppressants: Cough suppressants are not recommended for children because “they have potential harm with no proven benefit.”  Honey has been proven to offer as much benefit as the over the counter cough suppressant dextromethorphan (Robitussin), and does not have any side effects.

Expectorants:  Mucinex (guaifenesin) is an example of an expectorant medication.  Expectorants work to thin out secretions and increase mucus production. Though guaifenesin is a very safe medication with few side effects, there are no proven studies that it helps with the common cold.  Also, it is often combined with other medications in combination cold medication products and is not recommended in these forms. 

Nasal steroids:  Nasal steroids can be very helpful for seasonal allergies, but do not provide any relief for the common cold. 

Antibiotics: Antibiotics, used to treat bacterial infections, will offer no help for the common cold, as colds are caused by a virus.  Not only will they not alleviate symptoms more quickly, they will not prevent secondary complications, and they may have side effects. 

Vitamin C:  Unfortunately supplementing with Vitamin C has not been shown to lessen cold severity, though it may shorten cold duration by about 14%. 

Echinacea: Like Vitamin C, supplementing with Echinacea has not been shown to shorten the course of a cold or lessen the severity.  There is also a risk of rash in children taking this supplement.

Zinc lozenges: There is some research that zinc acetate decreases cold severity and duration; however, benefits are limited, and side effects can include nausea and poor taste.  It is important to avoid zinc gluconate (found in Zicam and other over the counter zinc-containing nose sprays) because the FDA reports that it may cause permanent anosmia (loss of smell).

Thankfully, there are a few things that may help your child’s cold symptoms.  Helpful remedies include:

Honey:

In those over 1 year of age, giving ½ to 1 teaspoon alone, or diluted in water or a warm beverage, as needed can help lessen cough.  Studies show that honey is as effective as the cough suppressant dextromethorphan (Robitussin), and does not have side effects. 

Saline nose spray:

Though it does not speed recovery, saline nose spray helps to remove nasal secretions and improve breathing through the nose.  It is inexpensive, has few side effects, and should cause no harm.  For older children and teens, if choosing to irrigate the nose with a Neti Pot, follow these instructions from the Centers for Disease Control and Prevention (CDC): https://www.cdc.gov/parasites/naegleria/sinus-rinsing.html

Hydration and ingestion of warm fluids:

You often hear this advice from grandparents, and they are right, that “maintaining adequate hydration may help to thin secretions and soothe the respiratory mucosa.”  “Warm liquids (eg, tea, chicken soup) may have a soothing effect on the respiratory mucosa, increase the flow of nasal mucus (possibly also mediated by the inhalation of steam), and loosen respiratory secretions, making them easier to remove.” 

Humidified air:

Though breathing humidified air is not well studied as a treatment for colds, there is no harm in adding moisture to the air which may loosen nasal secretions.  We recommend using a cool mist humidifier/vaporizer (a warm mist humidifier does not reduce symptoms as well and could result in burns).  Be sure to remember to clean humidifiers per the manufacturer's instructions.   

Fever reducer:

Since colds may be accompanied by low-grade temperatures, over the counter (OTC) fever reducers such as acetaminophen (Tylenol) or ibuprofen (Motrin or Advil) can be used.  Be sure to avoid those that are part of a combination cough/cold medication.

Hard candy or lozenges

Though there is no research that proves that hard candy or lozenges can help with cold symptoms, if the child is over 4, they should not be harmful and may soothe throat irritation.

Menthol rubs

Mentholated rubs for those 2 years and older can help soothe a cough at night so the child can sleep.   Be aware that they can be associated with skin and nasal irritation.  After use, be sure to keep out of reach of children as this medication can be harmful if ingested. 

Prevention

Since children with colds who do not have fever can attend school, colds pass very quickly from one child to the next.  The best way to avoid catching a cold is frequent handwashing and avoiding contact with one’s mouth, eyes, and nose after touching potentially contaminated surfaces (doorknobs, counter tops, Kleenex, etc).  Remind children to cough into their sleeves and to not share snacks, drinks, utensils, etc with others. 

Other useful information

When symptoms persist beyond the expected time period or worsen (causing high fever, trouble breathing, wheezing, or trouble swallowing), we recommend re-evaluation.  There are great trustworthy online resources for more information about managing cold symptoms.  These are few we recommend:

  1. https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/How-to-Manage-Colds-and-Flu.aspx
  2. https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Coughs-and-Colds-Medicines-or-Home-Remedies.aspx
  3. https://kidshealth.org/en/parents/flu-vs-cold.html?WT.ac=ctg
  4. https://www.healthychildren.org/english/tips-tools/symptom-checker/Pages/default.aspx

References

  1. Caring for your child’s colds or flu. Retrieved from: https://www.healthychildren.org/English/safety-prevention/at-home/medication-safety/Pages/How-to-Manage-Colds-and-Flu.aspx 
  2. Pappas, D.E. (2019). The common cold in children: Management and prevention.  Retrieved from UpToDate
  3. Sexton, D.J., McClain, M. T. (2019). The common cold in adults: Treatment and prevention Retrieved from UpToDate
  4. Klass, P. (2018). For a Child’s Cough, the Best Medicine Is No Medicine.  Retrieved from  https://www.nytimes.com/2018/11/05/well/family/for-a-childs-cough-the-best-medicine-is-no-medicine.html
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