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January 24, 2011

By Dr. Elizabeth Walenz with Methodist Physicians Clinic

It is winter, which means we are seeing plenty of sniffles and sneezes
in the office. Many parents want to know how to tell when a cold is more
than a common cold, and when to worry.
This is the time of year when kids will bring home coughs and sniffles,
especially if your child is in daycare or school. These coughs and
sniffles often spread throughout the family, although different members
of the families may experience different symptions.
Babies may develop a low grade fever at the beginning of the illness
that should dissipate over the course of 2 to 3 days. They will often
develop nasal congestion and, sometimes, a cough. This nasal congestion
may cause difficulty feeding. I advise parents to keep saline nasal
drops on hand, and place 1 to 2 drops in each nostril prior to feeding.
After placing the drops in each nostril, count to 5, then use a nasal
bulb suction to remove any thicker mucus. The saline will help to break
up the thick mucus so baby can breathe more freely. If your baby still
has difficulty nursing or feeding, try 1 to 2 feedings with Pedialyte to
help to keep him hydrated.
Use the saline/bulb suction prior to sleep at night as well, and keep
the room moist at night to keep the mucus running. A cool mist
humidifier placed away from the baby’s crib will help to keep the room
humid. Babies should not have pillows in the crib; however, parents may
roll up a towel and place it under the head of the mattress to elevate
the child’s head while sleeping. No cough or cold medications are
recommended for children under the age of 4.
If your child has a persistent fever for more than 3 days, or a fever
that reaches 103 to 104 F, she should be evaluated by a physician. Also
call your pediatrician if a cold is lingering for longer than 4 to 5
days without improvement because colds often precede ear infections.
This also is the season for RSV (respiratory syncitial virus), so be on
the lookout for wheezing or noisy breathing. Parents can certainly
catch RSV, but it will usually manifest as the common cold in adults.
When babies and young children contract RSV, they often present with
fevers, tight repetitive cough or wheezing and noisy breathing. This
wheezing is usually heard or felt by parents when holding the child.
The child can almost seem to be working to push the air out of the
lungs. From the physiologic perspective, this is exactly what is
occurring. Younger children with RSV produce quite a bit of mucus that
can clog their airways and make it difficult to get air in, as well as
to push it out. A child with a worsening cough, difficulty feeding,
noisy breathing or appearing to be working to breathe should be seen by
a doctor.
As healthy children age, they often grow past the point of wheezing;
however, they can still catch the common cold. If a child has a
productive cough or congested nose, I often recommend fluids and rest.
Parents may offer Tylenol or Motrin for any fevers or discomfort. Saline
nasal spray can be used in the event of thick congestion ,as well as to
teach children to blow their noses as well. If a child is coughing quite
a bit at night and is over the age of 1, I recommend a teaspoon of
honey. Honey has been shown in some studies to help to coat the throat
and to help to suppress the cough reflex. The common cold will last 7
to 10 days. If the cold lasts longer than 10 days without improvement,
take your child to his or her primary care physician.
The best advice for this season is prevention. Encourage good
hand-washing habits, as well as keeping fingers out of ears and noses.
Liquid or chewable multivitamins can help to provide children over age 3
with beneficial Vitamin C. A well balanced diet, plenty of fluids and
rest also should help to keep your little ones healthy.

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