The common cold in children: Clinical features and diagnosis
- Diane E Pappas, MD, JD
Diane E Pappas, MD, JD
- Professor of Pediatrics
- University of Virginia School of Medicine
The common cold is an acute, self-limiting viral infection of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low-grade fever, headache, and malaise. It can be caused by members of several families of viruses; the most common are the more than 100 serotypes of rhinoviruses.
The epidemiology, clinical features, complications, and diagnosis of the common cold in children will be discussed here. The treatment and prevention of the common cold in children and the common cold in adults are discussed separately. (See "The common cold in children: Management and prevention" and "The common cold in adults: Diagnosis and clinical features" and "The common cold in adults: Treatment and prevention".)
Viral causes — The symptoms of the common cold can be caused by a variety of viruses (table 1). Rhinoviruses, which include more than 100 serotypes, cause up to 50 percent of colds in children and adults . (See "Epidemiology, clinical manifestations, and pathogenesis of rhinovirus infections".)
Many of the other viruses that cause colds also cause other characteristic clinical syndromes in children :
●Coronaviruses – Pneumonia and croup (see "Coronaviruses", section on 'Respiratory')
Subscribers log in hereLiterature review current through: Nov 2017. | This topic last updated: Aug 17, 2017.References
- Heikkinen T, Järvinen A. The common cold. Lancet 2003; 361:51.
- Pappas DE, Hendley JO. The common cold and decongestant therapy. Pediatr Rev 2011; 32:47.
- Boivin G, Abed Y, Pelletier G, et al. Virological features and clinical manifestations associated with human metapneumovirus: a new paramyxovirus responsible for acute respiratory-tract infections in all age groups. J Infect Dis 2002; 186:1330.
- Esper F, Boucher D, Weibel C, et al. Human metapneumovirus infection in the United States: clinical manifestations associated with a newly emerging respiratory infection in children. Pediatrics 2003; 111:1407.
- Kirkpatrick GL. The common cold. Prim Care 1996; 23:657.
- Monto AS. The seasonality of rhinovirus infections and its implications for clinical recognition. Clin Ther 2002; 24:1987.
- Sung RY, Murray HG, Chan RC, et al. Seasonal patterns of respiratory syncytial virus infection in Hong Kong: a preliminary report. J Infect Dis 1987; 156:527.
- Hendley JO. Epidemiology, pathogenesis, and treatment of the common cold. Semin Pediatr Infect Dis 1998; 9:50.
- Hendley JO, Gwaltney JM Jr. Mechanisms of transmission of rhinovirus infections. Epidemiol Rev 1988; 10:243.
- Gwaltney JM Jr, Moskalski PB, Hendley JO. Hand-to-hand transmission of rhinovirus colds. Ann Intern Med 1978; 88:463.
- Gwaltney JM Jr, Hendley JO. Rhinovirus transmission: one if by air, two if by hand. Am J Epidemiol 1978; 107:357.
- Hendley JO, Wenzel RP, Gwaltney JM Jr. Transmission of rhinovirus colds by self-inoculation. N Engl J Med 1973; 288:1361.
- Gwaltney JM Jr, Hendley JO. Transmission of experimental rhinovirus infection by contaminated surfaces. Am J Epidemiol 1982; 116:828.
- Winther B, McCue K, Ashe K, et al. Environmental contamination with rhinovirus and transfer to fingers of healthy individuals by daily life activity. J Med Virol 2007; 79:1606.
- Winther B, McCue K, Ashe K, et al. Rhinovirus contamination of surfaces in homes of adults with natural colds: transfer of virus to fingertips during normal daily activities. J Med Virol 2011; 83:906.
- Pappas DE, Hendley JO, Schwartz RH. Respiratory viral RNA on toys in pediatric office waiting rooms. Pediatr Infect Dis J 2010; 29:102.
- Hendley JO, Gwaltney JM Jr. Viral titers in nasal lining fluid compared to viral titers in nasal washes during experimental rhinovirus infection. J Clin Virol 2004; 30:326.
- Douglas RG Jr, Cate TR, Gerone PJ, Couch RB. Quantitative rhinovirus shedding patterns in volunteers. Am Rev Respir Dis 1966; 94:159.
- Hendley JO. The host response, not the virus, causes the symptoms of the common cold. Clin Infect Dis 1998; 26:847.
- Bardin PG, Johnston SL, Sanderson G, et al. Detection of rhinovirus infection of the nasal mucosa by oligonucleotide in situ hybridization. Am J Respir Cell Mol Biol 1994; 10:207.
- Arruda E, Boyle TR, Winther B, et al. Localization of human rhinovirus replication in the upper respiratory tract by in situ hybridization. J Infect Dis 1995; 171:1329.
- Turner RB, Weingand KW, Yeh CH, Leedy DW. Association between interleukin-8 concentration in nasal secretions and severity of symptoms of experimental rhinovirus colds. Clin Infect Dis 1998; 26:840.
- Noah TL, Becker S. Respiratory syncytial virus-induced cytokine production by a human bronchial epithelial cell line. Am J Physiol 1993; 265:L472.
- Noah TL, Henderson FW, Wortman IA, et al. Nasal cytokine production in viral acute upper respiratory infection of childhood. J Infect Dis 1995; 171:584.
- Naclerio RM, Proud D, Lichtenstein LM, et al. Kinins are generated during experimental rhinovirus colds. J Infect Dis 1988; 157:133.
- Winther B, Brofeldt S, Christensen B, Mygind N. Light and scanning electron microscopy of nasal biopsy material from patients with naturally acquired common colds. Acta Otolaryngol 1984; 97:309.
- Winther B, Farr B, Turner RB, et al. Histopathologic examination and enumeration of polymorphonuclear leukocytes in the nasal mucosa during experimental rhinovirus colds. Acta Otolaryngol Suppl 1984; 413:19.
- Winther B, Brofeldt S, Grønborg H, et al. Study of bacteria in the nasal cavity and nasopharynx during naturally acquired common colds. Acta Otolaryngol 1984; 98:315.
- Naclerio RM, Proud D, Kagey-Sobotka A, et al. Is histamine responsible for the symptoms of rhinovirus colds? A look at the inflammatory mediators following infection. Pediatr Infect Dis J 1988; 7:218.
- Proud D, Reynolds CJ, Lacapra S, et al. Nasal provocation with bradykinin induces symptoms of rhinitis and a sore throat. Am Rev Respir Dis 1988; 137:613.
- Winther B, Gwaltney JM, Hendley JO. Respiratory virus infection of monolayer cultures of human nasal epithelial cells. Am Rev Respir Dis 1990; 141:839.
- Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013; 347:f7027.
- Pappas DE, Hendley JO, Hayden FG, Winther B. Symptom profile of common colds in school-aged children. Pediatr Infect Dis J 2008; 27:8.
- Wald ER, Dashefsky B, Byers C, et al. Frequency and severity of infections in day care. J Pediatr 1988; 112:540.
- Ball TM, Holberg CJ, Aldous MB, et al. Influence of attendance at day care on the common cold from birth through 13 years of age. Arch Pediatr Adolesc Med 2002; 156:121.
- Aronson MD, Weiss ST, Ben RL, Komaroff AL. Association between cigarette smoking and acute respiratory tract illness in young adults. JAMA 1982; 248:181.
- Kelly LF. Pediatric cough and cold preparations. Pediatr Rev 2004; 25:115.
- Shields MD, Bush A, Everard ML, et al. BTS guidelines: Recommendations for the assessment and management of cough in children. Thorax 2008; 63 Suppl 3:iii1.
- Winther B, Hayden FG, Arruda E, et al. Viral respiratory infection in schoolchildren: effects on middle ear pressure. Pediatrics 2002; 109:826.
- Elkhatieb A, Hipskind G, Woerner D, Hayden FG. Middle ear abnormalities during natural rhinovirus colds in adults. J Infect Dis 1993; 168:618.
- Randall JE, Hendley JO. A decongestant-antihistamine mixture in the prevention of otitis media in children with colds. Pediatrics 1979; 63:483.
- Gwaltney JM Jr, Phillips CD, Miller RD, Riker DK. Computed tomographic study of the common cold. N Engl J Med 1994; 330:25.
- Manning SC, Biavati MJ, Phillips DL. Correlation of clinical sinusitis signs and symptoms to imaging findings in pediatric patients. Int J Pediatr Otorhinolaryngol 1996; 37:65.
- Gwaltney JM Jr, Hendley JO, Phillips CD, et al. Nose blowing propels nasal fluid into the paranasal sinuses. Clin Infect Dis 2000; 30:387.
- Winther B, Alper CM, Mandel EM, et al. Temporal relationships between colds, upper respiratory viruses detected by polymerase chain reaction, and otitis media in young children followed through a typical cold season. Pediatrics 2007; 119:1069.
- Revai K, Dobbs LA, Nair S, et al. Incidence of acute otitis media and sinusitis complicating upper respiratory tract infection: the effect of age. Pediatrics 2007; 119:e1408.
- Armengol CE, Hendley JO, Winther B. Occurrence of acute otitis media during colds in children younger than four years. Pediatr Infect Dis J 2011; 30:518.
- Hendley JO. Clinical practice. Otitis media. N Engl J Med 2002; 347:1169.
- Butler CC, Hood K, Kinnersley P, et al. Predicting the clinical course of suspected acute viral upper respiratory tract infection in children. Fam Pract 2005; 22:92.
- Hay AD, Fahey T, Peters TJ, Wilson A. Predicting complications from acute cough in pre-school children in primary care: a prospective cohort study. Br J Gen Pract 2004; 54:9.
- Viral causes
- Subsequent immunity
- Seasonal patterns
- Period of infectivity
- Incubation period
- CLINICAL FEATURES
- Frequency and duration
- Symptoms and signs
- - Overview
- - Fever
- - Nasal manifestations
- - Cough
- - Other symptoms and signs
- Middle ear abnormalities
- Radiographic features
- Acute otitis media
- Asthma exacerbation
- Lower respiratory tract disease
- Other complications
- DIFFERENTIAL DIAGNOSIS
- INFORMATION FOR PATIENTS