Colds

Viral respiratory infections causing nasal congestion, runny noses, and coughs are usually all clumped together into this “colds” category. It can then be further broken down into terms I hear all the time from parents, head colds vs chest colds. In the medical world, we would associate head colds with upper respiratory infections and chest colds with lower respiratory infections. Whether you get a head cold or a chest cold or both has a lot to do with what pesky fall/winter cold virus you get as well as your age/size.

Most of the colds we see as pediatricians and parents are head colds. The virus is infecting/targeting the upper airway. From the upper throat to the nose, the virus will do its thing. Your body will then do its thing to fight and get rid of that virus and this will often cause fevers and lots of snot. The kiddo’s and parents’ jobs are to keep the child hydrated to allow the mucus to be as runny as possible and to get the mucus out, whether it is with nose suckers like the NoseFrida or by having older kiddos blow their nose all the time. The more snot that comes out the nose, the less trickles to the back of the throat to cause postnasal drip coughs. These occur mainly when kiddos are lying down as that is when the back of the nose is in the perfect position to just keep dropping snot on the back of the throat, causing your upper airway to want to cough to get that snot out of town. The dripping in the back of the throat can also make a kiddo’s throat really sore and irritated. Warm apple juice (if a kiddo is old enough) is a great stand-in for cough drops or Mucinex as in study after study, the combo of pectin sugar and citric acid is a one-two punch in protecting and soothing the throat and cutting through mucus. Take a look at the back of that kid-friendly natural cough medicine, and I bet you will see apple juice/cider or something very similar as the main ingredient for this very reason. So, save your money and just buy some natural apple juice at the store and always have a bit ready to go at home for those coughs and colds. The same thing goes for having nasal saline spray ready. This natural remedy is great at breaking up tough mucus in the nose as well as tricking the blood vessels in the nose to squeeze down a bit to decrease congestion and allow more snot to come out of the nose, but this effect is rather temporary. 

A big bummer with these colds is that often the younger you are, the more a normal cold looks more like an extreme cold. The younger a kiddo is, the more likely they are lying down for more of the day to allow for that postnasal drip we were talking about, and the less likely they are able to blow their nose or cough up the secretions to clear them. Also, their noses are so small that even a tiny bit of congestion can sound horrendous, even though they are smiling back at you and acting playful. Remember to always ask yourself before doing that nose spray or nasal sucker on the kiddo, Am I doing this because they are uncomfortable, or am I doing this because I am uncomfortable seeing and hearing it?

With head colds, if we don’t move the mucus out fast enough, the body will try to store/hide the mucus/snot. When kids are older (usually over 6 years), they have large enough sinuses where the snot will be stored for the body to get rid of, so you may not see a runny nose, but the kiddo may still be coughing or blowing their congested nose and still getting rid of snot days to weeks after they are feeling much better. The younger kids, though, have tiny sinuses (that’s why their heads are so heavy), so there is not much room to store the snot except in a few places. One of those places is in the middle ear, and that is how ear infections happen. If the snot sticks around for too long in the ear, bacteria love that and will start to grow, and then we will have little Jimmy or Julie waking up at 2 AM with a fever and saying their ear hurts. If a kiddo is big enough, there are pretty good studies that they have a good shot at clearing an ear infection on their own with just supportive care and time, and we don’t need to rely on antibiotics as much as pediatricians used to. So always be sure to discuss options with your pediatrician regarding symptomatic care and monitoring-at-home criteria for when a kiddo gets an ear infection, often called the watchful waiting method. I know that kids getting ear infections when they are young is no fun for anyone. But I would much rather have kids get exposed to these colds when they are smaller and don’t have sinuses and when I can see, diagnose, and treat an ear infection way easier than an older kid or teen with a sinus infection, which is notoriously difficult to diagnose and treat with antibiotics. For example, the usual course for antibiotics for an ear infection is 5-10 days, depending on the kiddo. A teen with a sinus infection requires an antibiotic course that is usually 14-21 days or longer, sometimes with multiple different antibiotics if symptoms don’t improve.

Now that we have talked about head colds, let’s move down the respiratory tract to chest colds, also known as lower respiratory infections. If the viral infection is of the bronchioles (the very small ends of the lower airways in the lungs), it is called bronchiolitis (see post on bronchiolitis for more info). Due to the size and proportions of the different lung parts to one another, bronchiolitis is an illness of the very young: until about 18 months of age. There are only a few viruses that like to do their dirty work in the bronchioles and the most notable of those is the respiratory syncytial virus, AKA RSV. You will often hear pediatricians, especially hospital and emergency room pediatricians, discuss RSV season as their most busy and trying time. Like the common cold, it spreads easily among kids. The older you are, the more like a normal cold it is. But the younger you are, the more RSV causes a bronchial infection that makes a lot (and I mean a lot) of really sticky mucus that plugs up the airways. 

What are things that we look for in kiddos with lower respiratory infections to let us know that things are getting worse and not better? We look for things like an increase in breaths per minute over a long period of time, an increase in work of breathing, a decrease in feeding, and a concurrent decrease in wet diapers. Increased work of breathing often manifests itself as what are called retractions, where the kiddo is trying to suck air into their lungs so hard that they are sucking their skin near their ribs under their ribs as well. Kids can also present with nasal flaring, where they try to open their nares (the holes on the bottom of the nose) wider than usual to let more air in. Or we can see what is called a tracheal tug, where the skin in the lower center of the neck sucks in every time a kiddo breaths to draw more air in the lungs. If a kiddo is doing these things, it’s time to bump up care with a visit to the doctor’s office or the emergency room for a good lung examination.