Sunday, December 12, 2010

Coughs, stuffy noses, and fevers – Welcome to Winter!

“How can I help with the cough?” is one of the most common questions I get in the office during the winter cold season. 

When cold weather arrives, we all stay indoors and we share our germs.  Viruses love the winter season because it’s the best time to travel from one person to another and then to another.   Kids who are around many other people tend to catch more colds and viruses than ones who are not.   Common exposures come from daycare, school, and their brothers and sisters. 

Children build immunity by fighting illnesses from viruses.  Their immune systems learn how to fight these bugs, and then hopefully, will be more protected in the future as they encounter new viruses.  Any pediatrician will tell you that they’ve never been sicker than their first few years in training or in practice due to the large number of viruses that we’re exposed to.  If you’ve never been exposed to a virus, then your chances of catching it is much higher.  However, once you’ve battled the illness, then your immune system has a memory that will help it to fight future similar viruses.

So, when a baby is born, EVERY virus is new to his system.  It’s no wonder that babies will catch colds.  When a baby or toddler starts childcare, very often they have a new cold or illness every two weeks for a while.  Then when they reach elementary school, they are less likely to get sick because they’ve already had many of the viruses.

When a new virus emerges, like the H1N1 flu virus, we are all susceptible since none of our immune systems are prepped to fight it off. 

Most cold viruses can last up to two weeks.  Many people get concerned if their child is still congested or coughing a little after one week.  However, two weeks is still reasonable.  Fevers should be less than 103-104 F and should only occur during the first three days of illness.  If your child has a fever later, has a high fever, is breathing fast, or working hard to breathe, you should call your doctor immediately for guidance. 

Most coughs are protective.  The cough reflex is designed to protect your lungs from drainage that is trying to go down into them.  However, occasionally coughs can be more ominous and can be a sign of infection (bronchitis, pneumonia) or wheezing/asthma.  If your child seems to have a bad cough, has a fever with the cough or has difficulty catching his/her breath, call your doctor.

So, what to do when your child has a cold?  Well… it depends on the age of your child.

Young Infants (under 6 months of age):  At this age, colds can be especially miserable because they can’t clear their own noses.  If congested, it is hard for your baby to feed since your child has to breathe through his/her nose when drinking or eating. Putting a few drops of nasal saline in each nostril and then suctioning the nose will help.  Sleeping upright in car seat or elevating your baby’s mattress may be helpful (do not use a pillow).   A humidifier (cool or warm) next to where your baby sleeps will also help.  Hydration is important, so small frequent feeds are good if your baby can’t eat his/her usual amount.  While fevers may be part of a viral illness, young babies need to be checked if they have a fever to rule out other illnesses (especially babies under 3 months of age).   Call your doctor if your baby has ANY fever>100.4 (rectally), has trouble feeding, is breathing fast, has coughing fits, is vomiting or is not improving.   No over-the-counter cough medications are recommended at this age.

Older Infants and Toddlers:  Children this age also have difficulty when their noses are stuffy and they are coughing.  Sleeping is a challenge and often they will lose their appetites and drink less.  While eating less is okay, it is important that your child drink enough fluids and stay hydrated.  Clear fluids, like Pedialyte, will help to hydrate without increasing the mucous production like milk-products can.  Nasal saline is also useful to clear stuffy noses.   Suctioning your child’s nose will help him/her to breathe easier.  A humidifier (cool or warm) will help to quiet coughs and make nighttime easier to manage.   Sometimes, babies tend to collect mucous in their throats or upper airway and then vomit the mucous after coughing.  While messy, this can be normal and is their way of getting rid of the drainage.  However, if your baby has a high fever (>103-104), has difficulty drinking, is working hard to breathe, is vomiting other than with cough, or has a fever after the first three days of illness, call your doctor.  No over-the-counter cough medications are recommended at this age.

Preschool-aged children:   Kids aged 2-5 often have colds in the winter, especially if they are in preschool.  The sharing of viruses is inevitable when every child seems to have a runny nose in class!  For this age, you can help by taking care of the symptoms.  Again, nasal saline is useful and teaching your child to blow his/her nose is important to prevent secondary infections such as sinusitis or ear infections.  To help with sleeping, use a humidifier and have your child sleep upright on pillows.  A teaspoon of dark honey has been shown to be as effective as cough suppressants.  Over-the-counter cold medications are not recommended at this age.  If your child has high fever (>103-104), has difficulty breathing, or has a fever after the first three days of illness, call your child’s doctor. 

School-aged children:  For older children, it’s primarily night time that is difficult.  Run a humidifier, keep your child hydrated, and use nasal saline sprays to help.  A teaspoon of dark honey can be effective for quieting coughs at this age.  Over-the-counter cold medications can be used sparingly.  It is important to pick a medicine that specifically treats your child’s symptoms.  Multi-symptom cold medicines have active ingredients for each symptom – fever, cough, congestion, runny nose, and so on.  Do not give your child medication for symptoms that your child doesn’t have.  Also, while cough suppressant might make it easier to sleep, try not to use it during the day.  Cough has a purpose (to protect your lungs from drainage), so suppressing it may lead to further complications.  High fevers (>104), fever after the 1st three days of the cold, or difficulty breathing are all symptoms for which you should call your child’s doctor.

Hope you and your family have a safe and healthy holiday season!  Thanks for reading!