Is Your Child Feeling Sick? When is a Cold Not a Cold?

By Dr. Patricia Avila | Pediatrician

It’s that time of year again! The cooler weather is among us, nights are getting longer, and families are even busier than usual as the holidays approach. It’s also the time of year when children start coming down with symptoms of colds or other respiratory illnesses. While most of these symptoms will turn out to be simple colds and resolve on their own, there are some related illnesses that can be more serious.

The Common Cold: Also Known as an Upper Respiratory Infection

The common cold is caused by several different viruses and is the most common of all the respiratory illnesses. On average, children under the age of two will have three to five colds per year. Children who are in daycare or school-aged children are likely to get sick even more often, because they are exposed to lots of other children on a daily basis. Fortunately, most of these illnesses are just colds and will go away on their own. 

Symptoms of the Common Cold

• Low fever (101-102 degrees F).
• Runny nose, nasal congestion, and/or sneezing
• Sore throat
• Cough
• Lack of appetite
• Fussiness

Symptoms can last up o 14 days but most children feel better within 7-10 days.

When to Worry with the Common Cold

While the majority of children will not need to be see a medical provider for the common cold, you should seek immediate assistance if your child:

• Is an infant under 3 months old
• Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
• Nails or lips turn blue
• Symptoms last longer than 10-14 days
• Is dehydrated or not drinking or urinating well
• Is too sleepy or very fussy and not consolable
• Has ear pain
• Has any other symptoms or continues to get worse

Treatment for the Common Cold

• Antibiotics do not treat the common cold since it is caused by a virus
• Increased fluids
• Use of pain/fever medication such as acetaminophen or ibuprofen
• Nasal saline with suctioning for congestion
• Honey for cough in a child OLDER than 1 year (NEVER give honey to a child under the age of 1)
• Use of a humidifier may provide relief

The Flu: Also Called Influenza

The flu is also caused by respiratory viruses called influenza and can present very similar symptoms to the common cold.  However, children with the flu feel much worse and are sicker than with the flu than the common cold.  The flu can have very serious complications including need for hospitalization and sometimes death.   

Symptoms of the Flu

• Rapid onset of high fever (above 101 degrees F)
• Chills
• Headache or other body aches
• Runny nose, nasal congestion
• Chest pain and cough
• Sore throat
• Poor appetite
• Feeling tired and weak

Most children will get better after two weeks. Fevers from the flu can last up to seven days. 

When to Worry with the Flu

Flu symptoms can lead to serious complications that require immediate medical treatment. You should seek assistance if your child:

• Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
• Nails or lips turn blue
• Is dehydrated or not drinking or urinating well
• Is too sleepy or very fussy and not consolable
• Has ear pain
• Has any other symptoms or continues to get worse

Young children, infants, and children with high-risk medical conditions who are having flu symptoms should see their pediatrician as soon as possible. High-risk medical conditions may include:

• Heart defects
• Chronic lung issues
• Asthma
• Weakened immune system
• Diabetes
• Cancer

Treatment for the Flu

• Increased fluids
• Use of pain/fever medication such as acetaminophen or ibuprofen.
• Nasal saline with suctioning for congestion.
• Honey for cough in a child OLDER than 1 year (NEVER given honey to children under the age of 1)
• Use of humidifier may provide relief

Outside of supportive care, there is an antiviral medication called Tamiflu which may be prescribed if the flu is diagnosed within the first 1-2 days of onset.

Bronchiolitis

Bronchiolitis is another respiratory illness that is common during the winter months.  There are several viruses that can cause this illness, but RSV, also known as Respiratory Syncytial Virus, is the most common.  RSV is an infection that will affect almost all children under the age of 2 at least once. It usually starts as a cold and within 3-5 days of the onset of the illness is followed by lower respiratory symptoms. For some children the illness can be severe, especially in younger infants, preemies, and those with heart or lung defects.   

Symptoms of Bronchiolitis

• Cold symptoms with fever, runny nose, nasal congestion, and cough
• Fussiness
• Poor appetite
• Wheezing
• Difficulty breathing

When to Worry with Bronchiolitis

Bronchiolitis symptoms can lead to serious complications that require immediate medical treatment. You should seek assistance if your child:

• Has trouble breathing or fast breathing – using their muscles in between their ribs to breathe or the openings of the nose get larger with every breath
• Nails or lips turn blue
• Is dehydrated or not drinking or urinating well.
• Child is too sleepy or very fussy and not consolable
• Has ear pain
• Has any other symptoms or continues to get worse

Treatment for Bronchiolitis

• Increased fluids
• Use of pain/fever medication such as acetaminophen or ibuprofen.
• Nasal saline with suctioning for congestion.
• Honey for cough in a child OLDER than 1 year (NEVER given honey to children under the age of 1)
• Use of humidifier may provide relief

For infants who are high risk there is an injection that is given monthly during the winter months called Synagis that can decrease the risk of severe RSV infection. 

Croup

Croup is another respiratory illness that is common during the fall and winter months and is usually seen in infants and children under 5. Croup is caused by several different viruses including the flu virus and some cold viruses.  The illness is characterized by swelling of the upper airways including the voice box (larynx) and the windpipe (trachea). Symptoms from croup are usually worse at the beginning of the illness. 

Symptoms of Croup

• Fever which can be low grade or high
• Cold symptoms with runny nose and nasal congestion
• Hoarseness of voice
• “Barky” or “seal like” cough
• Noisy breathing called stridor, a high-pitched, turbulent sound when a child inhales or exhales

When to Worry with Croup

The swelling of the airway can sometimes be severe and need immediate medical attention. You should seek assistance if your child:

• Has trouble breathing – struggles to catch their breath
• Has noisy breathing that is getting louder and child/infant appears to struggle to breathe
• Cannot talk because of difficulty breathing
• Nails or lips turn blue
• Is drooling and not able to swallow saliva
• Is dehydrated or not drinking or not urinating well
• Is too sleepy or very fussy and not consolable

Treatment for Croup

Steroids can decrease the swelling and can be given by mouth, injection, or in a breathing treatment. If given early steroids can help decrease the need for hospitalization and improve breathing.  For severe cases, a breathing treatment with epinephrine may be administered, but this requires careful observation in the emergency department or hospital setting.

Use of cold moist air can help improve mild symptoms as well and can be used at home with a cool mist humidifier.

Tips to Keep Your Child Healthy and Well

• For all respiratory infections, the best form of prevention is to avoid exposing infants or young children to large crowds or people who are sick.
• Breastfeeding infants as long as possible (at least 6-12 months) is also an important way to help prevent and fight infections because breastmilk provides antibodies. 
• Practicing and teaching children good hand hygiene is key.
• Use soap and water and scrub for at least 20 seconds (sing the ABCs, Baby Shark, or another fun tune).  Another option is the use of an alcohol-based hand sanitizer if hands are not visibly soiled. 
• Teach children to cover their coughs and sneezes properly by using a tissue or coughing in their arm rather their hands. 
• Keep children home from daycare or school when they are sick to avoid spreading the illness. 
• Eating a healthy balanced diet high in fruits and vegetables can help boost the immune system and decrease the chances of getting sick.   

If you have questions about these or other common childhood illnesses, talk to your NOAH provider. If at any time you’re not sure what to do, you can also call our Nurse Triage for immediate advice.