Coughs, Colds & Sinus Infections

You waken at three in the morning to the sound of your coughing eight-year-old child. You stumble down the hallway to his room to check on him and you hear his chest rattling. He is unable to breath through his stuffy nose and he feels like he has a fever. Another coughing fit hits him and he vomits some green mucus. What should you do? His fever worries you. Should you call your doctor or take him to the ER?

Your one-year-old has had a green runny nose and a cough for two weeks, but he seems happy and playful, has no fever, and has been sleeping relatively well. Should you take him to the doctor? Could this be an ear infection or sinus infection?

Your three-year-old has had a fever for the past three days, along with a runny nose and cough. It's Sunday, and your doctor isn't available. Should you take him to the ER, or perhaps the clinic down the street?

Here is a guide to helping you understand coughs and colds. Does green nose mean a sinus infection? Is a fever cause for worry? How do you tell if your child has bronchitis? Should you take him in to the doctor, or wait a few days? These and many other questions will be answered as we discuss how to get your child through the common cold, how to treat his symptoms, and how to decide when to see the doctor. For a full discussion on bronchitits, click here.

Coughs and colds are seldom a reason to go to the ER or page your doctor in the middle of the night. There are guidelines at the end of this discussion that instruct you when to go to the ER or page your doctor.

1. Viruses cause colds and coughs. Virtually all colds start off as a common cold virus. Whether or not your child has a fever, green nose, junky cough, or is throwing up mucus, the first several days of any cough and cold is usually due to a cold virus, not a bacteria.

2. Viruses are not treatable with antibiotics. Antibiotics will only treat the bacterial complications of colds and cough, such as pneumonia, sinus infection, and ear infection. They won't help the basic cough and runny nose associated with a cold virus.

3. The common cold virus can cause green nasal secretions and a junky sounding cough. Decades ago it was commonly felt that a green nose, productive cough or a rattling chest meant there was a bacterial infection. This belief led to a severe over-use of antibiotics, which in turn has allowed the bacteria that cause ear infections, sinus infections and pneumonia to become tougher and more resistant to antibiotics. Now we know that green or junky does not necessarily mean a bacterial infection. Viruses can also cause this.

4. My child has a productive, junky sounding cough. "Isn't this bronchitis and needs antibiotics?" Yes, a junky, productive cough is bronchitis, but no, he may not need antibiotics yet. In children, bronchitis is usually from a cold virus, not bacteria. The junky cough is usually from mucus dripping down from the nose and settling into the chest. We will discuss later when bronchitis needs an antibiotic.

5. Children often vomit mucus after coughing spells. This does not necessarily mean there is something more serious going on. Lots of thick mucus will often trigger vomiting. This is usually just part of a bad cold.

6. The common cold can take two courses:

• First scenario. Your child starts off with a clear runny nose for a few days, and then she begins coughing slightly. Over the next few days the nose turns from clear, to white, to yellow, then to green. She can't breathe through her nose. The cough worsens and starts to wake her up at night. About 5 to 7 days into the illness her cough begins to sound junky, you hear some rattling in her chest, and she gets a fever. She may complain of sore throat, headache and stomach ache at this time. The fever lasts for 3 to 5 days yet is seldom higher than 102º. The fever then goes away, but the green nose and junky cough continue. Between 5-7 days the nose starts to seem less thick and green, but the junky cough continues. Over the next week, the nose clears up more, the cough improves slightly, but she still has episodes of junky cough off and on. After about three weeks into the illness the cough quiets down and eventually goes away by four weeks.

   

• Second scenario. Out of nowhere your child is hit with a high fever, bad cough, headache, sore throat, and runny or stuffy nose. She may have some vomiting or diarrhea, and her sleeping and eating patterns will be poor. The fever, cough, green nose, night waking and poor appetite continue for 3 to 5 days, then the fever stops. The coughing and green nose continues. Slowly, over a period of 2 weeks the nose begins to clear, the coughing lessens, the appetite returns, and she begins to sleep better at night. After 3 or 4 weeks total, the cough is gone and everything is back to normal.

   

• While these scenarios sound worse and may last longer than many colds, they are well within the boundaries of what can be expected during the course of the common cold virus. By understanding what should be expected from the common cold, you can decide more accurately when to take your child to the doctor, and when to stay home and ride it out. It may be tough to ride it out through the above worst-case cold scenarios. However, if your child is generally acting well when the fever is down, does not have fever lasting more than 5 days (5 complete 24-hour periods), does not have respiratory distress (such as shortness of breath, moderate to severe wheezing, rapid breathing, or chest pains), and overall seems to be okay, then you don't always need to see a doctor. We will discuss later what signs to watch for that warrant a trip to the doctor.

• Dr. Sears Suggests: When cold symptoms worsen after 5 days or do not improve after 10 days consider your child may have a sinus infection and should be examined by a doctor.

   

• The main point of these two scenarios is to help parents understand that antibiotics are not necessary for most common colds and coughs. I do recommend you see your doctor if your child has a fever over 103 degrees for 3 or more days. He may not need antibiotics yet for his green nose and junky cough, but your doctor will decide if antibiotics are necessary after examining your child to see if a bacterial infection is present.

• Steam cleaning. Give your child steam, steam, and more steam. For infants and young children, turn the bathroom into a steam room with the door closed and the shower on full hot. Sit in there for 10 or 15 minutes. For older children, use a facial steamer or pot of hot water (carefully!). The steam will help loosen the nose and chest congestion, and help your child cough it up or blow it out. Do this steam cleaning every morning and before bed, as well as during the day if possible.
• Clap the chest and back. While you sit in the bathroom steaming, clap on your child's chest and back (where the lungs are) firmly (harder than burping) with an open hand. This helps shake the mucus loose so your child can cough it up better.
• Sleep upright. If possible, allow your child to sleep in a slightly upright position. This allows for easier breathing during sleep.
• Nose hose. For older children, it is crucial to have them blow their nose several times during a steam cleaning, as well as frequently throughout the day. Getting out all the junk will help prevent this from turning into a bacterial infection. An alternative to steaming is to use nasal decongestant spray to loosen up the nasal congestion before blowing it out. For infants too young to blow their nose, you can suction them out using a blue rubber bulb syringe.
• Hot steam vaporizer. Use a hot steam vaporizer in the bedroom at night (not a cool mist humidifier). This warm, humid environment can help keep noses and chests clear at night. Be sure to air the room out well during the day because mold can start to grow in the room due to the warmth and humidity.

   

  Dr. Sears suggests: To prevent burns keep your hot mist vaporizer out of reach of infants.

   

• Eucalyptus and lavender oil. Add only one drop of each of these to a facial steamer, pot of hot water or some vaporizers. They can help clear up the congestion faster.
• Vapor rubs on the chest. Occasionally, these can cause wheezing because the vapors may be too strong for some children, but overall they will work well. It is safe to try, but do observe your child to make sure it doesn't cause wheezing.
• Drink twice as much liquid. This will help to thin secretions and prevent dehydration.

Warning: All four types of cough and cold medications are NO LONGER APPROVED for kids younger than 4 years of age.

All bottles of cold and cough meds that have dosing labels for kids under 2 have been taken off the shelves and are no longer available. Manufacturers have also just declared that these meds should not be used in children under 4 years of age as well. The reason for this is two-fold: First, there have been a number of infants and young children harmed by accidental overdoses of these meds when a parent mixed different meds together OR gave too high a dose, this is the reason that the FDA decided to step in and make them no longer available. Second, there has been very little research done on young kids to prove that cold and cough meds are safe and/or effective. Even though they seem to work well and rarely cause any problems when dosed properly, the FDA felt it was prudent to put a hold on their use until further safety and efficacy data become available, and we agree.

In addition, the FDA is considering removing cough and cold meds for kids as old as 12, due to the lack of safety and efficacy research in these age groups. The decision for older kids may not come until 2009.

What can parents do in the meantime when their young kids catch a cold or flu?
We suggest you try a natural alternative called SINUPRET. This plant-based pharmaceutical grade natural remedy has been used in Europe for decades as the number one doctor recommended natural remedy for sinus and respiratory support, and it is now available in the U.S. Not only does it promote healthy airflow and drainage of mucus in the sinus and respiratory tracts, it also supports the immune system. Sinupret comes as a liquid or capsules. For more information visit www.BionoricaUSA.com.

Many parents have stood in the cold medicine aisle at the drug store and stared for hours at the hundreds of different options. Choosing between cough suppressants, expectorants, antihistamines, and decongestants, or any possible combination of these, can be confusing. Here is a guideline for treating your child's symptoms.

• Only use medication when the symptoms are interfering with your child's daily life or keeping them, or you, awake at night. It's okay to let your child cough several times an hour during the day. It is better for her to cough up the mucus so it doesn't sit in her lungs. It is also better to tolerate a runny nose or some nasal congestion during the day if it isn't bothering your child.
• Treat your child's specific symptoms. If your child simply has a bad cough, but no nasal congestion, then you don't need a fancy combination cough and cold medicine. You simply need a cough suppressant. Here are the four major types of cold medicine:

  1. Nasal decongestant. This acts by decreasing mucus production and shrinking the swelling in the nose, thus clearing up the nose to allow breathing. It helps mostly with stuffy noses. The most likely side effect is it may wire your child a bit and interfere with sleep.

  2. Anti-histamine. This type of medication decreases mucus production in the nose if it is caused by an allergy and not a cold. It helps mostly with drying up a very runny nose. The most likely side effect is drowsiness, which is fine at night, but may interfere during the day.

  3. Cough suppressant. This acts by suppressing the cough reflex in the throat and lungs so that the mucus or irritation there won't trigger coughing. There are no likely side effects. One particularly good brand is Delsym. It tastes great and lasts 12 hours. Yet, it's often best to allow your child to clear his lungs by coughing during the day, yet give a cough suppressant before bedtime.

  4. Expectorant. This acts by loosening thick mucus, thus making it easier to cough up. It helps when your child seems to have thick chest congestion that he is unable to cough up. There are no likely side effects.

  Cough and cold medications come either as one of the above medicines, or a combination of two, three, or all four medications.

• Choosing the right medication. The name brand of the medication is not important. Underneath the brand name will be written one or more of the above four types of medication. That is how you know what it is for. It is okay to use more than one medicine at the same time, just as long as you are not overlapping any of the above four types of medications. Realize that most only last 4 to 6 hours, so you may need to repeat it during the night.
• Prescriptions. For severe coughs your doctor can prescribe a cough suppressant with codeine.
• See Medicine Cabinet for a listing of cough and cold medications.

The mucus sitting in the nose and chest during a cold is a breeding ground for bacteria. These bacteria normally live in the nose and throat in very small numbers. During the course of a cold, the bacteria will slowly build up over a period of 7 to 10 days. By this time, either the cold starts to resolve and all the mucus goes away, thus taking the bacteria with it, or the bacteria overgrow enough to take hold and cause what is called a secondary bacterial infection (the primary infection is the cold virus). This can occur in the sinuses, the chest, or the ears. This is why it is important to keep the nose and chest cleared out throughout the course of a cold. Be aware of these complications:

1. EAR INFECTIONS
Children may experience a feeling of plugged ears and mild ear pain. This occurs because the middle ear space behind the eardrum gets congested with mucus, just as the sinuses get congested with mucus. This can cause pressure and a plugged feeling that can hurt a little bit. When bacteria overgrow in this mucus, an ear infection flares up and becomes more painful. So if your child complains of occasional mild ear pain or a plugged feeling, it may not be an ear infection yet. If the pain is moderate to severe, have your doctor check it out. Infants, who are too young to report ear pain, will be unusually fussy, sleep and feed poorly, may or may not have a fever, and may pull on their ears. Keep in mind; if your infant is pulling on the ears, but is not very fussy and has no fever, then the ears probably are not infected yet. For more information on how to diagnose and treat ear infections see ear pain or ear infection.

2. SINUS INFECTIONS
This occurs when the bacteria in the sinus cavities around the nose build up enough to take over and cause an infection. Remember, this usually takes around 10 days of a cold to occur. Signs of a sinus infection include:

• Green nasal discharge for more than 10 days. Any green drainage before this is probably just due to the cold virus.
• Sinus headaches. Pain or severe pressure behind and around the eyes, forehead, and upper cheeks can be a sign of sinus infection. Remember, it is normal to have some headache at the beginning of a cold, or during the worst part of a cold. Green discharge from the eyes. If this is the only symptom, then it may be pink eye (or conjunctivitis). Eye drainage accompanied with all these other symptoms can mean sinus infection.

• Cough. The thick mucus produced during a sinus infection will drip down into the upper chest, thus causing a cough. A cough will almost always be present during a sinus infection. If your child does not have a cough, then there probably is no sinus infection.
• Fever. Infants and young children will usually have a fever during a sinus infection. Children older than 6 and adults may not have fever. Remember, fever can be normal for up to five days during a cold.
• Fatigue. Older children and adults will usually feel very worn out during a sinus infection. This fatigue can be part of a normal cold as well, but if it persists or is extreme, it could be the sinuses.
• Sinusitis face. Most children with a sinus infection have a "pekid" looking face, puffiness below the eyelids, hold their mouth open while breathing and have foul-smelling breath due to the snotty post-nasal drip.

If your child has the first symptom above (green nose for more than 10 days), plus three of the remaining symptoms, than it's probably a sinus infection. Consult your doctor.

3. BRONCHITIS
As stated above, this productive, junky cough is usually just part of the cold virus. The signs that your child may have bacterial bronchitis are junky sounding cough plus:

• Fever for more than 5 days and/or
• Chest pains, especially with coughing
• Rapid breathing
• Wheezing

4. PNEUMONIA
This occurs when bacteria overgrow in the mucus down in the lungs. That is why it is important to cough up this mucus. Here are the signs that your child's cold and cough may have developed into pneumonia:

• Fever more than 5 days. Fever means a temperature over 101, not just 99 or 100 degrees. However, if your child has the remaining symptoms along with fever, consult your doctor. Most, but not all, children with bacterial pneumonia will spike temperatures over 102º.
• Shortness of breath. Signs of this include rapid breathing, labored breathing, moving the shoulders up and down to assist in breathing, or sucking in below the ribs or at the base of the neck.
• Chest pains. Your child will complain of a specific area of pain in the chest.
• Children with pneumonia act and look sick. If during the course of a cold your child "Takes a turn for the worse," seek medical attention.

If you feel your child fits into any of the above four complications, you should see your doctor.
Click here for more information on pneumonia.

1. Croup – is a virus that causes hoarse voice, a cough like a seal barking, fevers, and raspy breathing sounds. Click on croup if this describes your child.

2. Whooping cough or pertussis – is a special type of infection in the lungs caused by the pertussis bacteria. Children are routinely immunized against this, but the shot may not always totally prevent whooping cough. It starts off as a normal cold for the first week or two a clear runny nose and typical cough. Then the cough worsens into coughing fits that last between 30 seconds and two minutes. During the fit, your child is coughing continuously to the point where he can barely take a breath. When he finally takes a deep breath, there may be an audible "whooping" sound, and then the coughing fit continues. After as long as two minutes, your child will often throw up, and then the fit is over and he may seem better between coughing episodes. If your child has a horrible cough with throwing up, but the fits are only 10 to 20 seconds, then it is probably not whooping cough. This is not an emergency, and can wait until you can see your doctor in the office.

If your child doesn't really fit into any of the four above complications and you still aren't sure if he should see the doctor, here are 6 signs to watch for:

1. Temperature and length of fever. Fever greater than 103 for more than 3 days, or fever greater than 101 for more than 5 days. Remember, it is normal for a cold virus to cause fever through 5 days. However, if your child keeps getting fevers more than 103 for more than 3 days, it would be prudent to take him to the doctor to be sure there are no bacterial complications yet. It could still just be the cold virus, but it is better not to go more than 3 days with such a high fever without seeing a doctor. See fevers for a detailed discussion on evaluation and treatment.

2. Unusual lethargy and irritability. Especially in infants. Lethargy means more than just not wanting to run around and play. It means your child can't make eye contact or is unable to focus on you or doesn't respond to your voice. She simply lies on your lap limp and lifeless with her eyes barely open.

3. Ear infections. Your child has a history of frequent ear infections.

4. Moderate to severe ear pain. Remember, infants and young children may tug at their ears simply due to ear congestion, not infection. See ear pain for info on how to treat ear pain overnight.

5. Overall acting sick. If you have a gut feeling that you child is unusually sick, take him to the doctor.

6. Wheezing. This does not mean the junky, rattling sound of chest or nasal congestion. Wheezing is a high-pitched whistling sound, when your child takes a breath. If your child is a "happy wheezer" then do not worry. If your child is struggling to breathe, then seek medical attention.

You should seek medical attention if:

• After hours, your child has one of the four complications of a cold (ear infection, sinus infection, pneumonia, bacterial bronchitis) with a fever for more than 5 days over 101 degrees. Your doctor may call in an antibiotic and check your child during regular office hours, or he/she may want your child evaluated in a clinic or ER first.
• Your child has moderate wheezing that is causing some tugging in the front of the neck and ribs, but it doesn't seem to be slowing him down or causing much distress. Your doctor can probably prescribe some medication over the phone to help with the wheezing until the morning. If this happens in the middle of the night, try steaming him before you page the doctor. No need to page the doctor if the wheezing is mild and not troubling your child at all. This can wait to be seen in the office.
• Your child has moderate croup. See Croup for more info on how to treat this and what signs warrant a call to your doctor.

You should take your child into an ER right away if:

• Your child has severe wheezing that is causing him significant difficulty breathing.
• Your child has severe croup and is having significant difficulty getting air in.
• Your child's lips or mouth are turning blue due to labored breathing or shortness of breath.
• Your child's breathing is rapid and labored. Count the number of breaths he takes in 30 seconds, multiply it by two, and this gives you his breaths per minute. Go to the ER right away if the breaths are greater than 60 per minute for children under a year, greater than 50 for children 1 through 4, and greater than 40 for children 5 and older. Be aware that fever alone can cause rapid breathing (and a rapid heartbeat). Reduce the fever first and then evaluate your child's breathing.
• Your child seems to have whooping cough and during these severe coughing fits turns blue around the mouth and lips.

Above all, if you are not certain about the status of your child's breathing, and feel he is in urgent need of an immediate medical decision, then call your doctor.