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Colds and Coughs

November 13, 2023

Cold and cough season has clearly arrived! Unfortunately kids get a lot of colds, on average 8 a year. Colds can cause sore throats, congestion, sneezing, coughs and fever (usually 5 days or less.)  Since each cold can last 7-10 days, and most colds are during October thru April, it may seem as if your child is sick the entire winter.  This isn’t forever, as their immune systems develop memory of these germs and can fight them off more easily as they age. But the early years can be a beast!

A cough is an important defense mechanism that meant to clear the airways. Acute coughs are most often caused by an upper respiratory tract virus.

Dry coughs are usually viral, caused by inflammation of the lower airway, sometimes causing hoarseness or, in younger children, stridor (a high pitched sound on breathing in.) This is called croup, and can be caused by many different cold viruses.

The best treatment for croup is breathing in either cold outdoor air, warm, steamy mist (or a mix!)  A dose of ibuprofen also helps inflamed airways, and fever that may also be present. Croup is almost always worse at night and better in the am, and may last a day or two before it comes a typical snotty cold. If your child is struggling to breathe or has persistent stridor please call us.

Dry coughs are often followed by wet/loose coughs as the respiratory tract secretes mucous to fight invaders (cold germs, pollens, other airway irritants.)

Mucous, whether from the lower respiratory tract or the nose/sinuses is usually clear in the beginning of an illness then changes color (white/yellow/green) as white cells rush in to help fight illness.

We do not worry about colored mucous unless your child has:

• Been sick for 10-14 days with worsening symptoms
• Ear or chest pain
• Difficulty breathing/wheezing
• Conjunctivitis (reddening of the eyes along with a persistent, thick colored discharge).  Red eyes with a watery discharge early in illness are typically caused by a virus, and not treated with antibiotic drops.

Treatment of cough and congestion:
Remember that coughing isn’t all bad.  It helps clear mucus from your airway.  

Teach children to cough into their elbows.  Coughing with the mouth closed also helps avoid the walls of the lower throat from rubbing together and causing more irritation.

• Water/fluids– water, juice, warm chicken soup or tea helps loosen congestion and prevent dehydration.  Avoid caffeine, excess sugary beverages.

• Saline nasal drops/sprays– OTC saline nasal sprays help relieve thick congestion and stuffiness.    For infants, lay baby on its back and give a good squirt of saline up each nostril- it is safe for them to swallow or inhale the liquid.  You can gently suction out excess mucous with a snot-sucker (avoid frequent suctioning as it can irritate the nose.) Saline sprays can also be used in older children as often as necessary.  

• OTC Astepro is a topical decongestant spray that can be safely used twice a day in older kids with heavy congestion or stuffiness- if too drying, add nasal saline and some Vaseline to the lower third of the nostrils to avoid irritation/bleeding.

• DO NOT USE over the counter nasal decongestants such as afrin or neo-synephrine more than 2-3 days, as they can cause rebound congestion when stopped. 
• Honey- safe to use for coughs and sore throats in children older than one.  2 teaspoons (10 milliliters) of honey has been found to be as effective as OTC cough medicine in a study of children with URIs. Best given straight up, honey coats and soothes an irritated oropharynx. Thinner agave syrups like Zarbees are not effective and should not be given to infants.

• Pectin cough pops– safe to use in children at least 3 years of age who don’t choke easily.  Pectin coats the throat, and helps soreness and cough.

• Humidification– cold viruses thrive in dry conditions, and dry air also dries mucous membranes causing a stuffy nose and sore throat. Cool mist humidifiers help add moisture to the air- place it close to your child’s bed so they are effectively breathing in the mist. Be sure to clean it weekly (or more often) following the manufacturer’s instructions.

• Sitting in a steamy bathroom for a several times a day is a great way to loosen secretions and soothe irritated throats (run hot water until the mirrors are foggy then play in the room, not the hot shower, for 10-15 mins.) Avoid warm mist humidifiers as they can cause steam burns if  touched.

• The Boogie Micro-Mist Saline Inhaler (https://www.boogiewipes.com/product/boogie-micro-mist-saline-inhaler/) can be used in all ages to humidify both the upper and lower respiratory tract. If you have a nebulizer, saline nebs can also help humidify airways (do not use if a child is wheezing, unless directed by the pediatrician.)

• Ibuprofen/Acetaminophen- fine to use for aches, pain, fever as needed (for children 2+ month unless otherwise directed). Dosages by weight are on our website.

• Benadryl– a first-generation (sedating) antihistamine that may provide minor relief of congestion, sneezing and watery eyes, can be used in children 2+ months unless otherwise directed. Newer antihistamines like zyrtec and allegra are good for allergy, but not for colds.  Can use with acetaminophen or ibuprofen. Dosing by weight  for all three are available on our website.

• Delsym/Robitussin DM–  a long acting cough medication (dextromethorphan) that can be used for irritative coughs not relieved by non medicated measures in children over age 4.  This only suppresses the cough reflex, and does not decongest.  Can use with Benadryl, acetaminophen and/or ibuprofen.Delsym dosing:
  · Children 12 and older- 10 ml (2 teaspoons) every 12 hours
  · Children 6- 11 years- 5 ml (1 teaspoon) every 12 hours
  · Children 4-6 years- 2.5 ml (1/2 teaspoon) every 12 hours

• Expectorants (guanfacine)- meant to thin mucous, but not particularly effective.What NOT to use for coughs and colds:

• Avoid raising the head of a crib unless directed- babies move, and may end up in a dangerous position.

• Antibiotics– these attack bacteria, but do not work against viruses.  We will not prescribe antibiotics without evaluating your child, and only use them for treatment of likely bacterial ear infections, bacterial sinusitis and bacterial pneumonia.  Overuse of antibiotics can lead to antibiotic-resistant bacteria.

• Over the counter mixed ingredient cold and cough medications in children younger than 4- the FDA has recommended against the use of such medications due to serious and significant side effects and lack of efficacy in young children. 

• Homeopathic remedies– have no evidence or safety data for any cold symptoms.

• Zinc– most high quality studies show no benefit to the use of zinc, and the mineral can cause significant side effects such as bad taste, nausea, and even permanent loss of the sense of smell in zinc-containing nasal cold remedies