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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:
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.
Dr. Sears suggests: To prevent burns keep your hot mist vaporizer out of reach of infants.
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.
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.
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:
Dr. Sears suggests: Eye drainage during the course of a cold usually means a sinus infection and is a clue that a doctor should examine your child.
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.
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:
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:
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.
Dr. Sears suggests: If your child has a past history of "colds always going to his ears or chest" you may want to consult your doctor and begin medication earlier in the course of the cold.
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:
You should take your child into an ER right away if:
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.