Overview: Common Colds in Children
What Is the Common Cold?
The common cold, or upper respiratory infection (URI), is a viral illness that affects the protective lining of the nose and throat. More than 200 viruses can cause an upper respiratory infection, and it is one of the most common illnesses among children as it is highly contagious. According to the American Academy of Pediatrics (AAP), most children have 8 to 10 colds by the time they’re two years old, and this number increases if they attend daycare. The yearly number of colds tends to decrease after the age of 6, with teenagers and adults having about two to four colds per year.
What Causes the Common Cold?
The common cold is caused by a virus. There are over 200 viruses that can lead to the common cold—however, most colds are caused by rhinoviruses (there are over 100 different rhinoviruses alone!). Other types of viruses responsible for this illness include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus (RSV).
Once one of these viruses enters the body (either by breathing in invisible droplets in the air or by touching contaminated objects which then enter the protective lining of the nose or throat), it causes the body’s immune system to react. The immune system tries to attack the foreign virus, causing some of the following reactions:
Increase in mucus production (causing a runny nose and cough)
Swelling inside of the nose (causing congestion)
Sneezing (from nose irritation)
How Is the Common Cold Spread?
The common cold is highly contagious, particularly during the first 2-4 days after the start of symptoms. It is spread through contact with someone who is infected, either through the air or through touch:
Air—When an infected person coughs or sneezes, virus particles (droplets) can travel up to 12 feet in the air and can stay suspended in the air for varying amounts of time. If your child breathes in this air, the virus can stick to their nasal membrane, infecting them.
Touch—If your child directly touches an infected person or a contaminated object then touches their eyes, nose, or mouth, the virus can enter the body. Children often touch their face as well as other people and objects (like shared toys), making viruses easy to spread in young kids.
What Are the Signs and Symptoms of the Common Cold?
Signs and Symptoms in Older Children:
Stuffy/runny nose—Drainage appears clear and thin at first, later turning to thick yellow/green
Sore/scratchy/tickly throat—May have difficulty swallowing
Sneezing
Low-grade fever—Typically 101℉-102℉ (38.3℃-38.9℃)
Loss of appetite
Cough
Headache
Muscle aches
Chills
Mild fatigue
Signs and Symptoms in Infants:
Difficulty sleeping
Fussiness
Nasal congestion
Fever
Vomiting/diarrhea (sometimes)
When Should I Call My Child’s Primary Care Provider (PCP)?
Infants 3 Months Old or Younger:
It is important to call the pediatrician at the first sign of illness in your child 3 months old or younger. It is often hard to tell when young babies are very sick, and colds in this age group can quickly progress to dangerous illnesses, like bronchiolitis, croup, or pneumonia.
Remember, any fever in a child under 3 months old is a concerning and requires immediate action:
Infants younger than 2 months old—Go to the emergency department immediately if your child younger than 2 months old has a rectal temperature of 100.4℉ (38℃) or higher.
Infants between 2 and 3 months old—Call your child’s primary care provider immediately if your child between 2 and 3 months old has a temperature of 100.4℉ (38℃) or higher (taken any way).
Infants and Children Older than 3 Months:
Older children typically do not have to be seen by a physician for the common cold if they are otherwise well. However, always call your child’s PCP if you are concerned, if you think your child may have more than a cold, if your child gets worse instead of better, is not completely better in one week, or has any of the following:
Nasal flaring—When the nostrils widen with each breath
Retractions—When the skin in the neck or between or below the ribs “sucks in” with each breath
Difficulty breathing or breathing fast
Blue lips or nails
Nasal mucus lasting longer than 10-14 days
Persistent cough lasting more than a week
Ear pain—Indicative of an ear infection
Temperature over 102℉ (38.9℃)
Unusually tired or cranky
Headache that gets worse
Facial or throat pain that gets worse
Chest or stomach pain
How Is the Common Cold Diagnosed?
The common cold is usually diagnosed based on symptoms. Your child’s PCP may perform a physical exam where your child will be assessed, including their throat, ears, and lymph nodes. Since the signs and symptoms of the common cold can present similarly to other conditions or secondary infections, other tests may be ordered—especially if symptoms get worse instead of better after 3 days or so. These tests include a nasal swab test (to rule out COVID-19, the flu, or another condition), a throat culture (to rule out strep throat), or chest X-rays (to rule out bronchitis, pneumonia, or other conditions).
How Is the Common Cold Treated?
There is no cure for the common cold—the virus must run its course. Most children recover from colds on their own within 7 to 10 days. The goal of treatment is supportive to help relieve symptoms and discomfort, not to fight the virus or make the cold go away any faster. Antibiotics do not work against viral infections; they are used to fight against infections caused by bacteria. Since the common cold is caused by a virus—not bacteria—your PCP will not prescribe an antibiotic for your child’s cold. However, sometimes children may develop complications or secondary infections during a cold from bacteria, like an ear infection or pneumonia. Symptoms of a secondary infection to look out for include ear pain or discharge, sinus pain, trouble/rapid breathing, or fever that lasts more than 3 days or that goes away for 24 hours and then returns. Your child’s PCP may order an antibiotic to treat one of these secondary infections if present.
When your child is sick with a cold, the best thing you can do is to make them comfortable. If your child is uncomfortable, over-the-counter pain relievers and fever-reducers such as acetaminophen and ibuprofen may be given. Do not give ibuprofen if your child is under 6 months old or if your child is dehydrated. Call your doctor if you do not know the recommended dose or if your child is younger than 2 years old. Do not give your child aspirin or other salicylates as it has been linked to a serious, potentially life-threatening disease called Reye syndrome that affects the liver and brain. Make sure to store all medications out of reach of children.
The AAP recommends that over-the-counter (OTC) cough and cold medicines not be given to infants and children under 4 years of age because of the risk of dangerous side effects, such as slowed breathing, irregular heartbeats, hallucinations, and irritability. Studies have also shown that many cough and cold medications do not work in children younger than 6 years old. It is also important to remember that many of these OTC products contain acetaminophen (Tylenol or generic form)—therefore, you must be careful not to give along with acetaminophen (Tylenol or generic form) or your child could get a double dose, or overdose. If overdose or suspected overdose occurs, call your local Poison Control by dialing 1-800-222-1222, or dial 911.
Other Ways to Help Keep Your Child Comfortable:
Ensure they get proper rest
Encourage plenty of fluids such as breastmilk or formula for infants and water, electrolyte drinks (like Pedialyte, Enfalyte, or store brands), soup broth, popsicles, or flavored gelatin for older children
Avoid drinks with caffeine (like soda or tea) as these can worsen dehydration by increasing urination
Cool mist humidifiers to moisten air and help clear nasal passages—Use distilled water; Place near your child but keep out of their reach; Clean humidifier often according to the manufacturer to prevent mold or mineral buildup
Saline (saltwater) drops to clear stuffy nose and congestion—Use 1 to 2 drops in each nostril; For infants, use bulb syringe to remove mucus and extra saline
Honey to help ease cough—Do not give honey to infants under 12 months old as it can contain bacteria that causes infant botulism; If given at bedtime, always brush your child’s teeth after to prevent tooth decay; Consider the following amounts of honey according to age:
1 to 5 years old—1/2 teaspoon
6 to 11 years old—1 teaspoon
12 years old or older—2 teaspoons
Cough drops or throat lozenges to ease cough and sore throat—Not to be given to children under 6 years old as they are a choking hazard; Do not exceed the number of cough drops listed in the instructions
Hot showers to create a steam-filled bathroom where your child can sit to relieve stuffiness
Petroleum jelly—Applied to area under the nose to soothe rawness
How Can the Common Cold Be Prevented?
The best way to prevent a cold is to keep your child away from a person with a cold—particularly infants under 3 months old as a virus that causes a mild illness in an older child or adult could cause a serious illness in an infant. Encourage proper handwashing techniques both with soap and water and with hand sanitizer (containing at least 60% alcohol), and teach your child not to touch their nose, mouth, or eyes until their hands are properly washed. Additionally, children can be taught how to cough or sneeze into a tissue or their elbow (not their hands) and to not share towels, drinking glasses, or eating utensils. Toys and common play areas should be cleaned and sanitized regularly. Children should also avoid secondhand smoke, as this can increase your child’s risk of getting sick.
Your child should stay home from school or daycare until feeling better and fever-free for 24 hours without the aid of over-the-counter fever-reducing medications.
When Is “Cold Season?”
While children can get an upper respiratory infection any time of year, they are most common during the fall and winter (starting late-August or early-September through March or April). That is because viruses thrive in low humidity—dry air can cause nasal passages to be dry as well, making them easier for viruses to invade. Also, during these colder months, schools are in session and children tend to be indoors and close to each other—all of which increase their risk of exposure to viruses.
What Are Some Common Cold Myths?
Not wearing a jacket when it’s chilly, sleeping in a draft, and going outside with your hair wet (to name a few) do not cause colds. Colds are caused by viruses, not by cold weather.
Key Points to Remember:
The common cold is a highly contagious viral illness that has no cure. The common cold in otherwise healthy children typically improves in 7-10 days, but sometimes it can result in secondary bacterial infections and complications that require treatment. Treatment with over-the-counter pain relievers and fever-reducers may be used for comfort measures, however, you should contact your child’s primary care provider at the first sign of illness in infants less than 3 months old. Proper hydration and plenty of rest are key. There are several techniques to help relieve congestion and cough including the use of cool mist humidifiers, hot, steamy showers, and honey (not to be used for children under 12 months old). While most colds in children will resolve on their own with no intervention, it is important to always call your child’s pediatrician for advice if your child seems off, they seem to be getting worse, or you are unsure what to do. Remember, you know your child best—always trust your gut!
