It's 3 a.m. and your 8-month-old baby is coughing. As you change her diaper, you notice she is very warm and has a temperature of 102 degrees. Her nose is running with clear mucus and she is crying miserably. This is a familiar story for just about every parent, especially between November and April the cold season.
"Colds" are respiratory infections caused by a variety of viruses, especially rhinovirus, adenoviruses, Para influenza virus and respiratory syncytial virus. These viruses infect all of us many times in our lives. Most the time we get over them without complications, although we may have seven to 10 days of illness and varying degrees of misery.
It is estimated that infants and toddlers get about six colds each year, or about one each month during the winter season -- and some children get even more than six. Sometimes a child appears to have a cold that lasts a month or two, but this is probably a second cold that occurs before the first cold has completely resolved.
Children in day care, children who have older brothers and sisters, and those whose parents smoke seem to have more colds than other children. A baby who is breast-fed usually develops only a mild cold, even when his mother may have a fairly severe one, because maternal antibodies against the cold virus are believed to enter the breast milk and reduce the illness in the baby. Recent studies suggest that frequent colds in young children who attend day care build up the children's immune systems and may make them less likely to have asthma and other respiratory conditions later in childhood.
Babies and toddlers often develop fevers, in the 100 to 103 degree range or higher, at the start of colds; older children and adults usually do not develop fevers with "typical" colds. For a young child, the fever lasts two to three days, and the child may be irritable and may not want to eat much until the fever subsides. The child's nose may run with clear mucus, followed by yellow or green mucus for a few days, and a cough commonly develops within just a few days. By about the ninth or 10th day of illness, the child is usually recovering well -- the cough diminishes, the runny nose dries up, and the child returns to normal activities and eating.
Home treatment of colds usually involves allowing the child to rest and get plenty of sleep, giving your child acetaminophen (Tylenol and other brands) or ibuprofen (Advil, Motrin and other brands), and providing her with plenty of liquids and food, if she is interested in eating. When medicating, remember that aspirin has not been recommended for children at all since the 1980s because of concerns about Reye's syndrome.
Infants often do well with extra breast-feedings, or with formula diluted a bit with water. Your doctor may recommend a commercial rehydrating solution made especially for infants. Older infants and toddlers will enjoy beverages such as fruit juices and commercial drinks. Offer frequent small meals with some of your child's favorite foods, but don't be surprised if he's not interested.
It's important to keep the nose clear so that your young one can breathe more easily. You can teach your toddler how to blow his nose at about 12 to 15 months of age. For babies, remove mucus from the nose with a bulb syringe and saline (salt water solution), available from your pharmacy. An "ear syringe" creates more suction than a "nose syringe" and is what is often recommended. Lay your baby on her back and turn her head up toward the ceiling. Put one or two drops of saline in each nostril, wait a few seconds, squeeze the bulb syringe closed with one hand, place the closed syringe into the nostril as far as it will go, and then relax your hand. The suction from the syringe filling with air will remove mucus from the nose passages. Be sure to clean the syringe after every use.
What is not recommend are over-the-counter medicated nose drops or cold medications of any type for infants under the age of 12 months. Keeping the baby more upright, cleaning out his nose, keeping the fever down and giving fluids are usually all that is needed to help an infant get over a cold. In the past, many doctors recommended humidifiers or vaporizers for colds. This equipment can be useful if your house is very dry, but you must use distilled water and keep the equipment extremely clean in order to avoid spraying molds, harmful minerals and other hazards into the air.
For children older than 1, your doctor may suggest a cold preparation containing pseudoephedrine, or an antihistamine such as brompheniramine or chlorpheniramine to reduce congestion and nasal discharge. Be sure to follow the directions on the label; overuse of pseudoephedrine and other decongestants can result in even worse congestion. And please do not give your child a medication containing phenylpropanolamine (PPA), which has been associated with stroke in some people.
Most cough medications or lozenges are not very helpful, but they can soothe the throat in some situations. Remember that viruses -- not bacteria -- cause colds, so antibiotics are not useful in the vast majority of respiratory illnesses. Bacterial complications, such as ear infections or pneumonia, do respond well to antibiotics. Your doctor will let you know whether your child will benefit from an antibiotic.