Colds and Fevers

On Colds

My child has had a runny nose for a week, how do I know when it is more than just a cold?

Most upper respiratory infections (URIs) or colds will last between one and two weeks. Oftentimes they are associated with a low grade temperature (100-101) in the beginning of the illness. In general, children should be seen if the cold is associated with difficulty breathing or shortness of breath, high fever (>102), fever that lasts more than 72 hours, or a fever that appears at the end of a cold. Of course, if your child is complaining of earache or sinus pain/pressure, a visit to the doctor would also be advised.

My child’s runny nose has been thick and green,… does that mean he/she has a sinus infection?

No. Most colds will go through a purulent phase, when the nasal secretions appear thick and green. This often occurs at the beginning and the end of colds, and in the morning, when the nasal mucosa tends to be drier. Sinus infections will also produce thick nasal secretions, but are usually associated with sinus pain or pressure.

What can I do to treat my child’s cold?

The treatment of a cold depends on the child’s age. Children below the age of 2 years should not use over-the-counter cold medications. Decongestants may be used in children over 2 years of age, to decrease the amount of mucus production, although strong evidence of effectiveness is lacking. A cough suppressant may be used, especially at nighttime, to help your child sleep. Reading Pediatrics does not recommend the use of cold/flu products that combine decongestants or cough suppressants with fever reducers, such as Tylenol or Motrin. Combination products may mask symptoms of fever and may result in over-dosing of fever reducers if subsequent doses of Tylenol or Motrin given. It is recommended that all children drink plenty of fluids to prevent dehydration and to keep nasal secretions thin. Saline nose drops may also be used at any age to thin nasal secretions. Humidifying the air, especially while your child sleeps, may also help to keep secretions thin.

Will an antibiotic help my child’s cold?

No. A cold is caused by a virus. Antibiotics only help bacterial infections. Sometimes a cold can lead into an ear infection or a sinus infection. These infections may be bacterial, and therefore, may need an antibiotic.

Why not treat all colds with an antibiotic, because my child always gets a sinus infection or an ear infection?

Antibiotics can have many potentially harmful side effects. For many years, doctors over-prescribed antibiotics to treat infections that were not bacterial. This over-prescribing has led to the development of bacteria that are resistant to the commonly-prescribed antibiotics. The more antibiotics your child is prescribed, the greater the likelihood that bacteria will develop resistance. Antibiotics can also kill many good bacteria that live in our intestines and aid with digestion. By killing these bacteria we can harm our digestive tracts and cause diarrhea. Of course if an ear infection were to occur during a cold, the risks of an untreated ear infection would usually outweigh the potential side-effects of the antibiotic.

Would culturing my child’s nasal secretions tell you what is causing their infection?

No. Many bacteria normally live in our noses. Even a completely healthy person will grow some bacteria from their nose.

On Fever

How high of a fever is dangerous to my child?

In general, a fever itself is not dangerous to a child; what is causing the fever may be dangerous. But there is no absolute number above which one must panic; or a number below which, one can be assured of being safe. In general, treat your child, not the thermometer! Pay attention to how the child is acting, if they are in pain, and if they are drinking fluids. Also pay attention to the associated symptoms. The child with a temperature of 101 but who is listless and not drinking, is more of a concern than the child with a temperature of 103, who is playful and well-hydrated. Anytime a fever is accompanied by a severe headache, or is associated with a stiff neck, please notify the pediatrician’s office.

How high of a fever will cause a seizure?

A small percentage of children are susceptible to having seizures when they have a fever. These are called febrile seizures and are related not only to how high the fever goes, but also how quickly it rises. Most children do not experience febrile seizures, even with high fevers. If your child does experience a seizure with fever, please notify your pediatrician.

Can my baby take ibuprofen?

Ibuprofen (Motrin, Advil) is not recommended below the age of 6 months.

What is the best way to take my child’s temperature?

The most accurate temperature will be obtained via a rectal thermometer reading, especially in young babies. Pacifier thermometers are strongly influenced by the temperature of food/drinks the child recently had, and are not accurate if the child is opening their mouth (such as when crying). Oral thermometer readings are acceptable in older children who are able to keep their mouth closed, did not have any recent hot or cold drinks, and who are able to keep the thermometer tip beneath their tongue. Axillary (under the arm) temperatures are inaccurate and highly dependent on how well the arm is held against the body. The newer ear thermometers are acceptable for older children, but give very inconsistent results with young babies’ ears.