Sick kids: how to know when it's more than just a cold

The “common cold” or viral upper respiratory infection is the most common infection seen in infants and children (and adults for that matter). Many normal infants and toddlers will have 6-12 colds in a year! Older children may have 2-5 colds a year. While colds usually are not serious, they cause runny nose, congestion, and cough which can be very uncomfortable and annoying.



How do you know if it’s more serious than a cold? Let’s review key markers of a cold and learn when it’s time to call your doctor.

With a cold, nasal secretions are often thick and can be discolored (as compared with the clear, watery discharge of allergies). The child who has a cold may have a sore throat and a cough, and the child’s temperature is sometimes slightly raised but not always.

Tips to relieve common cold symptoms

If your child has a cold, make them as comfortable as possible and wait it out. A virus needs to run its course and it’s not unusual for a cold to last 2-3 weeks.

Many infants and children will have loud, noisy breathing with colds simply because their nose is congested and clogged with secretions. This type of noisy breathing can be easily relieved. Teach older children to blow their noses. Infants will need you to suction their noses with a bulb syringe. You can use saline (such as AYR or Pediamist) in spray or drop form to loosen nasal secretions for easier blowing and suctioning. Saline also makes the nose feel better by helping clear secretions and shrinking some of the swelling in the nose caused by the cold. You can also run a cool-mist humidifier in your children’s room to help them breathe easier through their noses while they sleep.

Cough is the part of a cold that is a little tougher to relieve. To some extent, cough is necessary to get secretions out of the lungs. Keeping the nose clear helps prevent post nasal drip back into the throat and will prevent some cough. Older children can drink warm liquids or suck on cough drops to ease the cough. For younger children, lollipops or suckers can be used. These are safer options as compared to cough drops, especially at night for any age child.

What to do when it’s more than a virus

Viral respiratory infections are often complicated by secondary bacterial infections. The most common are ear infections, sinus infections and pneumonia. Antibiotics are sometimes necessary to fight these bacterial complications, but remember, antibiotics will do nothing for the underlying cold since colds, croup and bronchiolitis are caused by viruses, not bacteria.
Signs of secondary bacterial infections are

• ear pain, or fever for more than three days.
• a cold or cough that is getting worse instead of better after 2-3 weeks.
• a fever for more than 24 hours in a child younger than 2 years or more than 3 days (72 hours) in a child 2 years of age or older.

Call for an appointment if these symptoms are occurring. These complications usually occur several days after the cold started, so even if we have seen your child already for this illness, we will need to re-examine to diagnose any of these secondary infections.

In some children, viruses will not only cause colds, but the more serious illnesses of croup and bronchiolitis. They may also cause worsening of asthma. Watch for these signs of respiratory distress and call our office if they are occurring:

• Grey or bluish skin color
• “Retractions” or pulling in around the muscles of the collarbone and ribs during breathing
• Nostrils flaring during breathing
• Noisy breathing (wheezing, stridor, grunting) even after you’ve cleared your child’s nose of mucous and dried secretions
• Increased rate of breathing – count how many breaths your child is taking in one minute while they are resting quietly. Abnormal would be > 60 for ages 0-12 months, > 40 for ages 1-5 years, >30 for ages 6-12 years, >20 for ages over 12 years. Fever may cause your child to temporarily breathe faster, but the rate should slow down once the fever is down.
• Poor drinking even when the nose has been cleared
• Overall lethargy and just “not acting right” even when the fever

How sick is sick enough to warrant a doctor visit?

So your child is sick - do you come to the walk-in clinic, make an appointment, or call the triage nurse for advice on how you can help your child at home? Read our article to help you decide the best course of action for your sick child.

Check out our app NP PEDS MD for further information and home care advice.