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Patient information: The common cold in children (Beyond the Basics)

COMMON COLD OVERVIEW

The common cold is the most common illness in the United States. Infants and children are affected more often and experience more prolonged symptoms than adults. The common cold accounts for approximately 22 million missed days of school and 20 million absences from work, including time away from work caring for ill children.

This topic review discusses the causes, symptoms, and treatment of the common cold in children. The common cold in adults is discussed separately. (See "Patient information: The common cold in adults (Beyond the Basics)".)

COMMON COLD CAUSES

The common cold is a group of symptoms caused by a number of different viruses. There are more than 100 different varieties of rhinovirus, the type of virus responsible for the greatest number of colds. Other viruses that cause colds include enteroviruses (echovirus and coxsackieviruses) and coronavirus. Because there are so many viruses that cause the symptoms of the common cold, people may have multiple colds each year and dozens over a lifetime.

Children under six years average six to eight colds per year (up to one per month, September through April), with symptoms lasting an average of 14 days. This means that a child could be ill with intermittent cold symptoms for nearly half of the days in this time period, without cause for concern. Young children in daycare appear to suffer from more colds than children cared for at home. However, when day-care children enter primary school, they catch fewer colds, presumably because they are already immune to a larger number.

Seasonal patterns — The common cold may occur at any time of year, although most colds occur during the fall and winter months, regardless of the geographic location. Colds are not caused by cold climates or being exposed to cold air.

Transmission — Colds are transmitted from person-to-person, either by direct contact or by contact with the virus in the environment. Colds are most contagious during the first two to four days.

Direct contact — People with colds typically carry the cold virus on their hands, where it is capable of infecting another person for at least two hours. If a child with a cold touches another child or adult, who then touches their eye, nose, or mouth, the virus can later infect that person.

Infection from particles on surfaces — Some cold viruses can live on surfaces (such as countertops, door handles, or toys) for up to one day.

Inhaling viral particles — Droplets containing viral particles can be exhaled into the air by breathing or coughing. Rhinoviruses are not usually transmitted as a result of contact with infected droplets, although influenza virus and coronavirus can be transmitted via small droplets. Cold viruses are not usually spread through saliva.

COMMON COLD SYMPTOMS

The signs and symptoms of a cold usually begin one to two days after exposure. In children, nasal congestion is the most prominent symptom. Children can also have clear, yellow, or green-colored nasal discharge; fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness. The table describes how to take a child's temperature (table 1). (See "Patient information: Fever in children (Beyond the Basics)".)

Other symptoms may include sore throat, cough, irritability, difficulty sleeping, and decreased appetite. The lining of the nose may become red and swollen, and the lymph nodes (glands) in the neck may become slightly enlarged.

The symptoms of a cold are usually worst during the first 10 days. However, some children continue to have a runny nose, congestion, and a cough beyond 10 days. In addition, it is not unusual for a child to develop a second cold as the symptoms of the first cold are resolving; this can make it seem as if the child has a single cold that lasts for weeks or even months, especially during the fall and winter. This is not a cause for concern, unless the child has any of the more serious symptoms, discussed below. (See 'When to seek help' below.)

Symptoms of allergies (allergic rhinitis) are slightly different than those of a cold, and may include bothersome itching of the nose and eyes.

COMMON COLD COMPLICATIONS

Most children who have colds do not develop complications. However, parents should be aware of the signs and symptoms of potential complications.

Ear infection — Between 5 and 19 percent of children with a cold develop a bacterial or viral ear infection. If a child develops a fever (temperature higher than 100.4ºF or 38ºC) after the first three days of cold symptoms, an ear infection may be to blame. (See "Patient information: Ear infections (otitis media) in children (Beyond the Basics)".)

Asthma — Colds can cause wheezing in children who have not wheezed before, or worsening of asthma in children who have a history of this condition.

Sinusitis — Children who have nasal congestion that does not improve over the course of 10 days may have a bacterial sinus infection.

Pneumonia — Children who develop a fever after the first three days of cold symptoms may have bacterial pneumonia, especially if the child also has a cough and is breathing rapidly.

COMMON COLD TREATMENT

Symptomatic treatment — The treatment of an infant or child with a cold is different than treatment recommended for adults. Antihistamines, decongestants, cough medicines, and expectorants, alone and in combinations, are all marketed for the symptoms of a cold. However, there have been few clinical trials of these products in infants and children, and there are no studies that demonstrate any benefit in infants or children.

The United States Food and Drug Administration (FDA) advisory panel has recommended against the use of these medications in children younger than six [1]. We agree with this recommendation because these medications are not proven to be effective and have the potential to cause dangerous side effects. For children older than 6 years, cold medications may have fewer risks; however, there is still no proven benefit.

Parents may give acetaminophen (sample brand name: Tylenol) to treat a child (older than three months) who is uncomfortable because of fever during the first few days of a cold. Ibuprofen (sample brand names: Advil, Motrin) can be given to children older than six months. Aspirin should not be given to any child under age 18 years. There is no benefit of these medications if the child is comfortable. Parents should speak with their child's healthcare provider about when and how to treat fever. (See "Patient information: Fever in children (Beyond the Basics)".)

Humidified air may improve symptoms of nasal congestion and runny nose. For infants, parents can try saline nose drops to thin the mucus, followed by bulb suction to temporarily remove nasal secretions (table 2). An older child may try using a saline nose spray.

Honey may be helpful for nighttime cough in children older than 12 months.

Parents should encourage their child to drink an adequate amount of fluids; it is not necessary to drink extra fluids. Children often have a reduced appetite during a cold, and may eat less than usual. If an infant or child completely refuses to eat or drink for a prolonged period, the parent should contact their child's healthcare provider.

Antibiotics — Antibiotics are not effective in treating colds. They may be necessary if the cold is complicated by a bacterial infection, like an ear infection, pneumonia, or sinusitis. Parents who think their child has developed one of these infections should contact their child's healthcare provider.

Inappropriate use of antibiotics can lead to the development of antibiotic resistance, and can possibly lead to side effects, such as an allergic reaction.

Herbal and alternative treatments — A number of alternative products, including zinc, and herbal products such as echinacea, are advertised to treat or prevent the common cold. There is some evidence that prophylactic use of vitamin C may decrease the duration of the common cold in children and adults. With the exception of vitamin C, none of these treatments have been proven to be effective in clinical trials; their use is not recommended.

COMMON COLD PREVENTION

Simple hygiene measures can help to prevent infection with the viruses that cause colds. These measures include:

Hand washing is an essential and highly effective way to prevent the spread of infection. Hands should be wet with water and plain soap, and rubbed together for 15 to 30 seconds. It is not necessary to use antibacterial hand soap. Teach children to wash their hands before and after eating and after coughing or sneezing.

Alcohol-based hand rubs are a good alternative for disinfecting hands if a sink is not available. Hand rubs should be spread over the entire surface of hands, fingers, and wrists until dry, and may be used several times. These rubs can be used repeatedly without skin irritation or loss of effectiveness.

It may be difficult or impossible to completely avoid people who are ill, although parents should try to limit direct contact.

Most children with colds need not be excluded from day care or school. It is likely that they spread the virus before they developed cold symptoms.

Using a household cleaner that kills viruses, such as phenol/alcohol (sample brand name: Lysol), may help to reduce viral transmission.

WHEN TO SEEK HELP

If a child develops any of the following features, the parent should call their healthcare provider, regardless of the time of day or night.

Refusing to drink anything for a prolonged period

Behavior changes, including irritability or lethargy (decreased responsiveness); this usually requires immediate medical attention

Difficulty breathing, working hard to breathe, or breathing rapidly; this usually requires immediate medical attention

Parents should call the healthcare provider if the following symptoms develop, or if there are general concerns about the child:

Fever greater than 101ºF (38.4ºC) lasts more than three days. The table describes how to take a child's temperature (table 1).

Nasal congestion does not improve or worsens over the course of 14 days.

The eyes become red or develop yellow discharge.

There are signs or symptoms of an ear infection (pain, ear pulling, fussiness).

SUMMARY

The common cold is a group of symptoms caused by a number of different viruses. Children under six years average six to eight colds per year (up to one per month, September through April), with symptoms lasting an average of 14 days. This means that a child could be ill with intermittent cold symptoms for nearly half of the days in this time period, without cause for concern.

Colds are most contagious during the first two to four days. People with colds typically carry the cold virus on their hands, where it is capable of infecting another person for at least two hours. Some cold viruses can live on surfaces (such as countertops, door handles, or toys) for as long as one day. Droplets containing viral particles can be exhaled into the air by breathing, coughing, or sneezing.

The signs and symptoms of a cold usually begin one to two days after exposure. In children, nasal congestion is the most prominent symptom. Children can also have clear, yellow, or green-colored nasal discharge. Fever (temperature higher than 100.4ºF or 38ºC) is common during the first three days of the illness. Other symptoms may include sore throat, cough, irritability, difficulty sleeping, and decreased appetite.

Most children who have colds do not develop complications. However, parents should be aware of the signs and symptoms of potential complications, including ear infections, asthma, sinusitis, and pneumonia.

There have been few clinical trials of cold medications (antihistamines, decongestants, cough medicines, and expectorants) in infants and children, and there are no studies that demonstrate any benefit in infants or children. We do not recommend their use in infants and children because of the lack of proven efficacy and the potential risk of dangerous side effects.

Parents may give acetaminophen (sample brand name: Tylenol) to children older than three months or ibuprofen (sample brand names: Advil, Motrin) to children older than six months to treat discomfort associated with fever. Humidified air can improve symptoms of nasal congestion and runny nose. Honey may be helpful for nighttime cough in children older than 12 months.

Parents should encourage their child to drink an adequate amount of fluids; it is not necessary to drink extra fluids.

Antibiotics are not effective in treating colds. They may be necessary if the cold is complicated by a bacterial infection, like an ear infection, pneumonia, or sinusitis. Parents who think their child has developed one of these infections should contact their child's healthcare provider. Inappropriate use of antibiotics can lead to the development of antibiotic resistance, and can possibly lead to side effects, such as an allergic reaction.

A number of alternative products, including zinc, vitamin C, and herbal products such as echinacea, are advertised to treat or prevent the common cold. None of these treatments has been proven to be effective in clinical trials; their use is not recommended.

Simple hygiene measures can help to prevent infection with the viruses that cause colds, including hand washing or use of an alcohol-based hand rub and limiting contact with others who are ill.

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Cough, runny nose, and the common cold (The Basics)
Patient information: Sore throat in children (The Basics)
Patient information: Sinusitis in adults (The Basics)
Patient information: Giving your child over-the-counter medicines (The Basics)
Patient information: Eustachian tube problems (The Basics)
Patient information: Pneumonia in children (The Basics)
Patient information: Swollen neck nodes in children (The Basics)
Patient information: Adenovirus infections (The Basics)
Patient information: Mycoplasma pneumonia in children (The Basics)
Patient information: Enterovirus D68 (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: The common cold in adults (Beyond the Basics)
Patient information: Fever in children (Beyond the Basics)
Patient information: Ear infections (otitis media) in children (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Acute bacterial rhinosinusitis in children: Clinical features and diagnosis
Acute bacterial rhinosinusitis in children: Microbiology and treatment
Approach to the child with recurrent infections
Allergic rhinitis: Clinical manifestations, epidemiology, and diagnosis
Epidemiology, clinical manifestations, and pathogenesis of rhinovirus infections
The common cold in adults: Treatment and prevention
The common cold in children: Clinical features and diagnosis
Zinc deficiency and supplementation in children and adolescents
The common cold in children: Treatment and prevention

The following organizations also provide reliable health information.

National Library of Medicine

     (www.nlm.nih.gov/medlineplus/healthtopics.html)

National Institute of Allergy and Infectious Diseases

     (www.niaid.nih.gov/)

Centers for Disease Control and Prevention (CDC)

     Phone: (404) 639-3534
     Toll-free: (800) 311-3435
     (www.cdc.gov)

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Literature review current through: Aug 2014. | This topic last updated: May 3, 2013.
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