Cold, Flu, or Something More? What Parents Need to Know.

You wake up suddenly in the middle of the night. Did you hear something? You wait, ears straining to catch the slightest sound. There it is again; someone is crying. Your mom’s instinct kicks in and tells you something is wrong. Heart racing, you follow the sound to your child’s room, pull him into your arms and comfort him. As you hold him you notice he feels hot and his face is flushed. His nose is running, and he starts coughing. Worry grips you; does he need to go to the doctor?

During cold and flu season infants and children are affected more often and for longer periods of time than are adults. 

Common Cold

The common cold, or an upper respiratory infection, is the most common illness during the fall and winter months. It is a viral infection affecting the upper airway passages. More than 200 viruses are responsible for the common cold. Rhinovirus is the most common, and there are more than 100 varieties of rhinovirus. With so many viruses around it’s a wonder we aren’t sick for the entire length of the season.

The common cold is the leading cause of increased visits to healthcare providers and missed days of work and school. Young children will have as many as 8 to 10 colds each year before their second birthday. Once a child starts kindergarten, he can have up to 12 colds a year. This results in 22 million missed days of school and 20 million absences from work, including days missed to care for sick children.

Children who attend daycare, or who have older siblings who go to school, have a higher risk of catching a cold. Luckily, with each cold contracted the body makes immunity to that virus, so as a child gets older, the number of colds they have per year decreases. 

Symptoms of the Common Cold:

• Begin 2 to 3 days after exposure.
• Nasal congestion
• Nasal discharge which can be clear, yellow, or green
• Fever (higher than 100.4 degrees) is common during the first 3 days.
• Mild Cough
• Trouble sleeping
• Irritability
• Decreased appetite
• Sore throat caused by increased mucous and drainage 
• Headache (mild)
• Body aches 
• Chills
• Extreme tiredness (fatigue)

Cold symptoms typically clear up within a week but can last as long as 14 days. Symptoms are worse during the first 10 days. It is not unusual for a child to catch a new cold as the symptoms of the first are resolving, making it appear as if they have had one long cold lasting weeks or even months. 

Complications of the Common Cold:

• Ear infections
• Wheezing in children who have never wheezed before or worsening wheezing in children with lung conditions such as asthma. 
• Sinus infection
• Pneumonia

How to Care for Your Child at Home:

Cold symptoms are typically mild and can be managed at home. Give over-the-counter infant or children’s fever reducers as needed. If your child is under 3 months of age consult your pediatrician for any signs of illness, and before giving any medication. You can use infant acetaminophen (Infant Tylenol) for children 3 to 6 months. Use infant or children’s ibuprofen only in children older than 6 months. Consult your pediatrician if you are unsure which medication to use, or the correct dose for your child. In children, medications are based on weight so make sure you know how much your child weighs.

Never give Aspirin to any child under the age of 19 years. Aspirin may cause a life-threatening condition affecting the brain and liver called Reye’s Syndrome.

DO NOT use over-the-counter cold medications. Research has shown them to be ineffective in children under 6 years old. Further, they have potentially dangerous side effects including fatal overdoses in children younger than 2 years old. Honey is safe to use in children 12 months of age and older and has been proven useful in soothing sore throats and coughs.

Make sure your child is drinking plenty of fluids to keep them hydrated. Hydration also helps reduce fever and thin mucous. For infants offer Pedialyte if they are refusing to breastfeed or take formula. For older children offer water, juice, sports drinks, or broth. Warm drinks help loosen and thin nasal mucous. If they have a sore throat, you can try ice cream, sherbet, frozen fruit pops, or popsicles. Continue to offer small frequent meals, they may not feel like eating, and that is okay if they are continuing to drink. Once the cold symptoms are gone, their appetite will return. 

Using a cool-mist humidifier to moisten the air can soothe dry nasal passages and sore throats. Nasal saline drops (for infants) or sprays (for older children) help thin and loosen mucous. In infants and young children, you can use a nasal suction device in combination with saline drops and sprays to temporarily clear the congestion. 

Seasonal Flu (Influenza)

The Flu is a highly contagious viral infection affecting the air passages of the lungs. The Flu is the most severe and common of the winter viruses with the highest infection rates being among children, approximately 20 to 30 percent of all cases. An estimated 20,000 children under the age of 5 years are hospitalized each year. Influenza is divided into 3 subtypes: Type A, Type B, and Type C. Type A and B are the most serious while Type C only causes minor symptoms. 

The flu passes easily from person to person and is contagious beginning 24 hours before symptoms start through day 7 of the illness. Influenza can live for short periods on objects like toys, doorknobs, electronics, and countertops. Children contract the flu by close contact with an infected person, sharing utensils and drinks, touching contaminated items then touching their faces. 

Most healthy children recover within a week however, those who are very young, who have chronic illnesses or worsening symptoms may require medical attention or even hospitalization.

Symptoms of The Flu:

• The same symptoms as the Common Cold, see above, with the following differences.
• Sudden onset of high fever, which may be as high as 103 F (39.4 C) to 105 F (40.5 C)
• Cough becoming severe (cough is usually dry)
• Clear or runny/stuffy nose
• Severe muscle and joint pain
• Nausea
• Vomiting
• Diarrhea

Treatment of The Flu:

Generally, the treatment for the flu is the same as that for the common cold. However, factors such as the age and general health of your child along with the severity of his illness need to be considered. Children considered to be high risk for complications are those under the age of 5 years, have a chronic medical condition (chronic heart, lung, kidney, liver, blood, metabolic, or neurodevelopmental diseases), or have an immunosuppressive disease/treatment (HIV, malignancy, chemotherapy, or steroids). Children at high risk should be seen by a medical provider promptly.

When to Call the Doctor:

Any child with worsening symptoms should be seen by a medical provider. No matter if you think your child has the Common Cold or The Flu, the following symptoms require immediate medical attention:

• Severe breathing problems and/or persistent cough
• Chest pain
• Fever that does not respond to fluids, rest, and fever-reducing medication
• Refusing to eat or drink
• Headache that does not go away
• Stiff neck
• Extreme fatigue
• Confusion
• Weak legs and/or feet
• Back pain
• Severe muscle pain
• Red urine

COVID-19 in Kids

COVID-19 is caused by SARS-CoV-2, a respiratory virus causing a wide range of symptoms. Not everyone with COVID-19 will have all the symptoms. Some of those infected do not show any symptoms, while others may exhibit mild to severe symptoms. 

Symptoms of COVID-19:

• Same as Flu with the following differences:
• Shortness of breath or difficulty breathing
• New loss of taste or smell
• New severe headache
• Abdominal pain
• Rash

Treatment:

Treatment for COVID-19 is the same as treatment for the flu and the common cold. If your child has a chronic illness or has worsening symptoms seek medical attention right away.

Complications:

• Multisystem Inflammatory Syndrome in Children (MIS-C)
• Long COVID

Prevention:

• Immunizations
• Avoid anyone you know is sick. 
• Keep a sick child at home.
• Cover coughs and sneezes
• Handwashing with soap and water for 20 seconds or use an alcohol-based hand sanitizer before and after eating or touching your face.

Your child will be exposed to many viral illnesses over the course of the fall and winter. It is important to know the signs of illness and to be alert for symptoms requiring medical attention. Antibiotics do not treat or shorten the course of viral illnesses. However, if your child gets a secondary infection, like an ear infection, sinus infection, or pneumonia, your healthcare provider will likely prescribe one.