A Ped’s Perspective: Managing a Cold
Our girl is just getting over her first cold, and it is always interesting when my NP and mama worlds collide. Surprisingly, everything I teach, is exactly what I applied IRL (I was secretly waiting to make a liar of myself when I actually had a kiddo of my own!).
But spoiler alert: there is no magic fix for a cold aside from time.
What is a cold?
A cold is a viral illness that causes symptoms like cough, congestion, runny nose, fever. There are a ton of different viral illnesses that circulate, especially in the winter months, but they are most often spread through airborne droplets (ie. cough, sneeze).
Did you know that it is not uncommon for kids to get 12 viral illnesses in a year- This is one illness per month (with most viruses lasting 10-14 days). This is especially true for the first few years of a kiddos life when they are building their little immune systems.
If you’re a parent who feels like you only get a 2 week reprieve without illness, it’s because you probably did only have a 2 week reprieve without illness 🫠
But the biggest take home is: it’s ok! Colds happen, and they are building those immune systems to fight off similar germs they are exposed to again later.
Let’s dive into the common symptoms that come along with a viral illness, and how I recommend managing them.
Congestion & Runny Nose
Congestion and subsequent runny nose are the most common cold symptom in kiddos. The added challenge in babies under 6 months is that they are obligate nose breathers, meaning they only breathe through their nose. Nasal congestion makes this difficult, and can lead to poor feeding and sleeping. Babies are smart and will choose breathing over both feeding and sleeping which is why both are challenging when they are sick.
The best way to manage nasal congestion and runny nose is with nasal saline and suctioning. Nasal saline will help thin out any thick congestion to make it easier to suck out. We like using a bulb syringe for suctioning (the ones from the hospital work great), but the nose frida is another great option that allows you to have better control of the suction.
the key to nasal suctioning is blocking the opposite nare- this helps to provide a better suction.
Steam is also very helpful to break up nasal congestion. I recommend bringing a few books or toys into the bathroom, shut the door, and let the steam build with the hot shower running.
A humidifier can also be useful for sleep at night. I have this 4 in one- diffuser, humidifier, nightlight, and noise machine. Two thoughts with humidifiers: (1) always a cool mist humidifier to avoid burns if a kiddo reaches up and grabs it (2) clean your machine properly to avoid mold accumulation.
Cough
Cough almost always goes hand in hand with nasal congestion. Why? Because since kiddos do not blow their nose, they have more post nasal drainage that leads to a cough. Coughs will always be worse at night when they are laying flat, so be sure to suction before bed to help with this.
Sitting or sleeping upright seems to help with the post nasal drainage and subsequent cough, but it is not recommended for babies or young kiddos to sleep with an elevated mattress. From recent experience, we spent two nights holding her upright to sleep on us, and we just didn’t sleep 😅
Cough medicine/ suppressants are not recommended in pediatrics, ESPECIALLY under the age of 6.
A cough suppressant is hindering the bodies natural response to cough up mucous and get it out which can put them at higher risk for developing pneumonia. Homeopathic OTC options like Zarbee’s are fine to use, but it is essentially honey with some extra flavoring. I would recommend using honey from your cabinet and saving 8 bucks.
It is not safe to give honey under the age of one year due to risk of infant botulism.
Simply offering something to drink can often help with the cough as well- breast milk or formula only for babies under 6 months.
In general, I recommend focusing on managing the nasal congestion with the recommendations above, and that will subsequently help with the cough as well.
Fever
It is not uncommon for a fever to present with a viral illness, especially in babies/young kiddos. Keep in mind that a true fever is considered anything >100.4 degrees Fahrenheit. Fever will occur with the onset of symptoms, and most typically last for 1-3 days. Certain viruses (like influenza) can cause fever for up to 5 days. Fever with a viral illness should not last more than 5 days, and your child should be seen/evaluated if the fever persists that long.
I recommend checking for a fever periodically throughout the illness to know how high the fever gets and how long it lasts, but I do not recommend hyper focusing on the number.
There is a fear with fevers, but keep in mind that a fever is simply the immune system fighting the virus.
Which brings me to my next point- treat the kiddo, not the number. My rule of thumb with antipyretics (fever reducer like Tylenol or Motrin) is to treat if they are fussy and uncomfortable, not simply to bring the number down.
Remember, it is only safe to give Tylenol under the age of 6 months.
When choosing medications, I try to buy dye-free options when possible.
When it’s time to have your kiddo seen:
• Any difficulty breathing or signs of distress: fast breathing, skin sinking in by their ribs or neck, nasal flaring, grunting with every breath, or skin color changes to blue or purple of course.
• Signs of dehydration- no urine for 6-8 hours is my general rule of thumb. It is not uncommon for your kiddo to have a decreased appetite when they are feeling yucky, but it is important to ensure they are drinking enough to stay hydrated.
• Fever persists for 5 days OR fever goes away for 24 hours+ and then returns. This could be a sign of a secondary bacterial infection.
• Your child is tugging at their ears or complaining of ear pain, especially if associated with a fever. Unfortunately, there is no way to know if there is an ear infection without having an experienced provider check them.
• Symptoms persist for >14 days without any break in symptoms. Remember, it is not uncommon to get what feels like back to back viral illnesses.
It is so hard having sick kiddos.
I hope you find this helpful to know when you can treat supportively at home vs when you need to schedule an appointment to be seen and evaluated in office.
