They're the most common acute illness in children, especially among infants and toddlers. Most are caused by one of a large assortment of viruses. Some URIs are caused by bacteria. More often these organisms are secondary invaders that infect locations such as the ears or sinuses during or shortly after a cold caused by a virus.


Since most colds are caused by viruses, they are usually self-limited. That is, they go away by themselves within two to seven days, although some symptoms may last as long as two weeks. Unless there is specific evidence that bacteria are involved, antibiotics will not help a cold resolve more quickly. The best approach is to provide supportive care and observe your child for any complications. Adequate or increased fluid intake (water or juice) might help keep drainage from becoming thick and difficult to clear. Breast or formula feedings can be maintained or even increased in frequency. Solids may be continued if your child is interested in them, but don't force the issue. Appetite sometimes decreases during a cold (especially when the body's temperature is elevated), and it is not uncommon for an infant or child to lose a little weight during a cold.

Acetaminophen (Tylenol and other brands) can be given as often as every four hours to reduce fever if your child appears uncomfortable. As an alternative, ibuprofen (Children's Motrin, Children's Advil and other brands) not aspirin can be given every six to eight hours to reduce fever and in some children appears to be more effective. Irritability will typically improve and activity will increase as the fever resolves.

Decongestants such as pseudoephedrine (Sudafed and several other formulations) may or may not reduce nasal congestion and help your child feel more comfortable. Their effectiveness varies widely with the particular child and illness. Similarly, antihistamines such as diphenhydramine (Benadryl and other brands) or chlorpheniramine (Chlor-Trimeton and many other formulations) may also be useful in keeping the nose dry, especially when allergies are involved. These and other antihistamines often cause sleepiness. In babies and children younger than 2 years of age, side effects can be more unpredictable, so it is wise to contact your child's doctor before using these medications. In very young infants, using saline nose drops and suctioning the nose with a bulb syringe is recommended to allow easier breathing. Some recent research has suggested that decongestants and antihistamines are unlikely to relive cold symptoms in infants and young children.

Decongestant nose drops, which directly shrink the lining of the nose, are sometimes helpful in older children who are very congested, especially when it interferes with sleep. These drops should be used only for short periods of time. If used regularly for more than two or three consecutive days, the drops may not only lose their effectiveness but may create a rebound effect in which the nose becomes even more congested when the last dose wears off.

If coughing is disruptive, especially at night, a cough syrup containing guaifenesin (an expectorant that tends to loosen secretions) and/or dextromethorphan (a cough suppressant) may provide a few hours of relief. If a nonprescription preparation is not effective, your child's doctor may prescribe a stronger formulation after seeing your child.

When to call the doctor

Most colds can be managed at home without any specific input from or examination by your child's physician. However, there are a few exceptions to this general rule. Call your child's doctor, regardless of the hour, if :

  • a baby younger than 3 months of age has a fever of 100.4 F or higher (taken rectally):
  • your infant or child appears unusually listless and unresponsive, or is extremely irritable and won't stop crying despite your efforts to comfort her;
  • your infant or child appears to have difficulty breathing (beyond that produced by a stuffy nose). This would be manifested by noisy, labored breaths and in some cases by visible inward movement of the spaces between the ribs.

You should call your child's doctor during office hours if :

  • a cold lasts more than seven to 10 days;
  • nasal drainage is persistently thick and discolored;
  • your older child complains of significant ear or throat pain;
  • your older infant or child has a fever over 102 F for more than 24 hours;
  • a cough persists for more than a few days or disrupts sleep and cannot be controlled using nonprescription cough syrup.

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