Colds, also known as upper respiratory infections (URI), are extremely common in children (and adults). As the saying goes, there is no cure for the common cold. Fortunately, they are not usually serious. Infants, however, are at higher risk of complications such as dehydration, wheezing, difficulty breathing, ear infections, and pneumonia, and have to be watched more carefully than older children. Colds will go away on their own in about 7-10 days; coughs may last up to 3 weeks.

Key Points

  • Colds are caused by viruses. There is no cure. Antibiotics do not treat viruses.
  • Cough and cold medicines do not work at this age and can be dangerous.
  • Fever may be present the first 1-5 days. Fever is harmless and helps fight the infection. Treat fever only if it makes your child cranky or uncomfortable.
  • The runny nose and congestion will last 7-10 days. A cough may last 1-3 weeks.

How to treat

  • Saline nose drops and suction are the treatment for congestion.
  • A cool mist humidifier may help.
  • Agave nectar for infants or honey for 12 months and up may help soothe the cough (Zarbees is the most common brand).
  • If your child is cranky or uncomfortable, wit or without a fever, use Tylenol or Motrin.

What to watch for

Most colds are harmless, but there are some that are more serious. Your child needs to be checked if any of the following develop:

  • Breathing: Ribs sucking in, nostrils flaring, wheezing, or a “barking” cough/hoarse voice.
  • Dehydration: No wet diaper in 8 hours.
  • Fever:
  • Any fever (>100.4°F rectal) if baby is under 3 months.
  • Fever lasts more than 5 days.
  • The “U-Turn”: Fever goes away for 24h but spikes again (can be a sign of a new infection).
  • Ear Pain: Tugging ears, new fussiness, or waking up screaming.
  • Duration & Progression: Congestion for more than 14 days, cough for more than 3 weeks, or worsening symptoms.
  • Behavior & Alertness:
  • Inconsolable: Crying that will not stop despite holding, rocking, or comfort measures within 20 minutes.
  • True Lethargy: not just tired but hard to wake up, “floppy” like a ragdoll, or they wake up but don’t notice you.
  • Pain: They cry more when you touch or move them (especially their legs or neck).

What causes colds?

Colds are infections of the nose, sinuses, throat and upper airways. They are caused by viruses, and there are over 200 cold viruses!
The typical healthy child will have about 6-8 colds a year, most of them in the winter. If the child is an infant or toddler in preschool or daycare, she may have many more.
Colds are very contagious and spread easily from person to person.

What are the symptoms?

Symptoms will vary depending on the child and the specific virus. They can include any or all of the following:

  • Runny nose and nasal congestion lasting 7-10 days, and cough lasting up to 2-3 weeks
  • Fever up to 102-103 °F or higher for the first 2-4 days (remember fever itself will not harm your child)
  • Decreased appetite, tiredness, fatigue, crankiness
  • Sometimes red weepy eyes, vomiting, hoarse voice, loose stools and vomiting
  • Some children will have a sore throat and act like it hurts when eating or drinking
  • Some children wheeze with colds, and some cold viruses cause wheezing

What should I expect?

  • The nose is usually clear and very runny at first, though sometimes starts as congestion.
  • The mucous will get thicker and the child will be more congested. In younger children, it may turn green or yellow. This is normal and a sign the cold is getting better.
  • The worst day of the cold is usually around the 4th day. Fever should be resolved by the 5th day and the child will start to feel better.
  • Most children with colds will not eat well but will usually drink enough to stay hydrated, and this is what matters most.
  • Many infants spit up more due to thick post-nasal drainage and coughing.
  • Congestion usually lasts 7-10 days but can last up to 14 days; cough typically starts after the first few days and can last up to 2-3 weeks.

How do I treat my child’s cold?

There is no cure for the common cold. Antibiotics will not treat viral infections and can cause harm. Cough and cold medicines do not work in infants and toddlers and may be harmful. Do not use them in children less than 4 years old. There are things you can do to help your child feel better until his body fights off the infection:
Treatment for a runny nose: wiping, and suctioning with a soft rubber suction bulb.
If the skin around the nose becomes raw and irritated, Vaseline can be put on the skin.
Treatment for a congested, stuffed up nose:

  • Nose drops and suction. Use nose drops of warm tap water, homemade saline (½ tsp table salt in 8 oz warm water) or saline drops from the drug store. Place 1 drop in each nostril and after 1 minute remove mucous with soft rubber suction bulb. Children may cry, cough, or sneeze in this process. Repeat until nose sounds clear. This process will need to be repeated 4 or more times a day.
  • Cool-mist humidifiers may also help at night with congestion.
  • You may need to clear an infant’s nose with saline and suction before each feeding and before putting the child down to sleep.
  • Fever (temperature 100.4º F or higher) should only be treated if it makes your child uncomfortable or fussy.
  • Do not treat fever in infants less than 3 months old without seeing a doctor first.
  • Babies 3-6 months old may use acetaminophen (Tylenol®) for feeling bad or crankiness.
  • Children older than 6 months old may use acetaminophen or ibuprofen (Motrin®/ Advil®).
  • Do not alternate fever/pain medicines choose one and give according to instructions.
  • Children 12 months and up can try 1/2 to 1 teaspoon (2.5 mL to 5 mL) of honey for cough. Zarbee’s is a honey-based cough remedy for toddlers.
  • Zarbee’s also makes an agave nectar-based cough remedy for babies less than 12 months old.
  • Vicks VapoRub sometimes helps with congestion or cough. Put it on the chest, not the nose or the feet.

When can my child return to daycare?

Your child can return to school when there has been no fever in 24 hours and your child is drinking well and feels well enough.

When should I seek further care?

You should call 911 or seek immediate care if your child:

  • Has breathing difficulty or labored breathing, has chest retractions (skin pulling around ribs when breathing), grunts when breathing, has blue or dark purple color to lips, or stops breathing for more than 10 seconds.
  • Is lethargic and/or barely responds to you or is very weak.

Seek care if your child:

  • Does not smile or play some at least a few minutes every four hours.
  • Starts to wheeze or has worsening wheezing, or develops a barking cough.
  • Is not drinking enough fluid (not having urine/wet diapers at least every 6-8 hours).
  • Is inconsolable and cannot be calmed down at least a few minutes every hour.
  • Looks or acts a lot sicker or the way your child looks or feels concerns you.
  • Is less than 3 months old and has a fever (a rectal temperature greater than 100.4 °F).

Call us for an appointment today or tomorrow if your child:

  • Has a fever that lasts longer than 3 days or has a fever that goes away for 24 hours or more and then returns
  • Has signs of an ear infection (is cranky or fussy, especially at night, is pulling at the ears, and usually has fever).
  • Has congestion that lasts more than 10-12 days or that worsens after the 10th day.
  • Has severe cough or a cough that lasts longer than 14-21 days or that worsens after the 14th day.

Resources

Choosing Wisely: Antibiotics for Respiratory Illness in Children

Common Cold (CDC)

Common Colds: Protect Yourself and Others (CDC)

Cold Versus Flu (CDC)

FDA: Colds in Infants and Young Children

FDA: Use Caution When Giving Cough & Cold Products to Children

Common Cold in Babies (Mayo Clinic)

Children and Colds (AAP HealthyChildren.org)

Caring for Your Child’s Cold or Flu (AAP HealthyChildren.org)

Colds in Children (Caring for Kids Canadian Pediatric Society)

Coughs & Colds in Children (Patient Info Great Britain)

References

Thompson, M., Vodicka, T.A., Blair, P.S., Buckley, D.I., Heneghan, C., Hay, A.D., 2013. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 347, f7027. doi:10.1136/bmj.f7027

De Sutter, A.I.M., van Driel, M.L., Kumar, A.A., Lesslar, O., Skrt, A., 2012. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev 2, CD004976. doi:10.1002/14651858.CD004976.pub3

Smith, S.M., Schroeder, K., Fahey, T., 2014. Over-the-counter (OTC) medications for acute cough in children and adults in community settings. Cochrane Database Syst Rev 11, CD001831. doi:10.1002/14651858.CD001831.pub5

Committee on Drugs, American Academy of Pediatrics, 1997. Use of Codeine- and Dextromethorphan-Containing Cough Remedies in Children. Pediatrics 99, 918–920. doi:10.1542/peds.99.6.918