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Upper Respiratory Infection

What is An Upper Respiratory Infection

Probably the most common illness in childhood is the cold, which doctors sometimes refer to as “upper respiratory infection,” or URI. As the names suggest, these illnesses are infections that only involve the upper parts of the breathing system, like the nose and throat, and they do not usually cause high fevers. There are hundreds of different viruses that cause colds, so even after becoming immune to one kind of cold virus, a person can still get colds with another. This is the main reason why we are troubled by colds throughout our lives.

Direct contact, like hugging, kissing, or even handshakes are the most common way for cold viruses to spread. You can’t get a cold just by being in the same room with someone who has one, although some viruses can spread as far as six feet from someone with a cough or sneeze. Cold viruses always start by infecting the nose and throat, where they cause swelling and irritation of the tissue. This inflamed tissue swells up, and produces increased amounts of mucous in order to get rid of the virus. Infected cells die, and the body sheds these into the mucous. This process causes the soreness and pain we feel with a cold. Colds usually clear up within 3-5 days.

What is the biggest concern?

For the person with the cold, the general sense of misery, the runny nose, sore throat, headache, and cough are generally the biggest concerns. In healthy children older than 3 months, colds are usually not dangerous, so long as complications don’t develop. Children under 6 months are more susceptible to the complications of a cold, so have a conversation with your doctor about a cold in an infant of this age.

The complications of a cold can range from fairly mild to quite serious. The usual cause is a bacterial infection. Bacteria can take advantage of the damaged tissue to overcome a person’s immune system and cause their own infection. This is how we get sinus and ear infections, strep throat, pneumonia, and other common complications of colds. In people who have chronic diseases like asthma, sickle cell disease, or cystic fibrosis, colds can trigger acute attacks.

Some children tend to develop complications more easily than others, even if they have basically healthy immune systems. Many parents know, for example, that their child will develop an ear infection almost every time s/he gets a cold.

Upper Respiratory Infection Treatment

A simple cold or URI without a fever rarely requires any treatment at all except comfort measures. Very young babies (under 6 weeks) can have trouble breathing since they haven’t learned to breathe through their mouths yet. You can help them by using a bulb suction syringe to clear the nose, especially before feedings. Children at any age can develop dry, sore skin underneath their nostrils from the mucous and from frequent wiping. Have your child use the softest possible tissue (not toilet tissue or paper towels). It can help to have the child “blot” or “dab” the mucous away, rather than rubbing or wiping. You can try applying a little Vaseline® or Chap-Stick to the sore skin to protect it. A humidifier in your child’s room at night can help – remember to change the water and clean it every day. Please do not add medications to the water in the humidifier – these usually make matters worse. Generally, menthol-containing rubs or balms, such as “Vap-O-Rub” and others provide only temporary relief. Some doctors think they may make children worse. If you’d like to use one of these products, please check with your doctor before trying it. After you use it, see if you and your child think it helps. If it makes your child feel better, it is fine to continue using it.

Please do not give your child with a cold any aspirin or any product that contains aspirin or “salicylate.” These medicines can cause a rare but dangerous condition called Reye Syndrome in children with certain viral infections like chickenpox or flu. These can appear like a cold in the first few days. Some rubs or balms contain salicylate, so please check the label carefully.

You can use acetaminophen (Tylenol® and others) or ibuprofen (Advil® or Motrin® and others) to control fever in children over 3 months. Check with your doctor about using it in younger babies. Fever is not dangerous, but it can make your child uncomfortable. If your child seems comfortable there is no reason to give any medication just for fever. None of these medicines alone help cold symptoms.

Please check with your doctor before you use any of the many different cough and cold medicines available. Many doctors feel that cold medications and decongestants do not help younger children with colds. These medicines always increase heart rate and can make babies fussy. They may be harmful to very young children and infants. If you do decide to try one of the cough or cold medicines, whether over-the-counter or by prescription, please read the label carefully. Many of these medicines (such as Nyquil® or Theraflu®) contain multiple ingredients, and often contain acetaminophen (the active ingredient in Tylenol®, Feveral®, and other fever and pain medicines. If you give your child one or more of these medicines in combination with Tylenol® or other fever medicine, you can accidentally overdose your child on the Tylenol® type medicine. To make matters worse, Tylenol® and other fever medications also come in combination with cough or cold medicines (these include Tylenol Cold® and TylenolPM®). This means it is also possible to accidentally overdose a child on a decongestant or on one of the other ingredients. If you have any doubt about which medicines you can give in combination, please ask your doctor or pharmacist.

Many people use “natural” or nutritional treatments for colds in adults, and some people use these in children as well. Vitamin C and Echinacea and are two of the most common. Children do need vitamin C every day, but large doses do not seem to make colds better. Fortunately, vitamin C is safe in moderately large doses (less than about 2000mg per day), so if you feel that it could help your child you may want to use it. Higher doses can cause kidney stones and other side effects. Echinacea can be helpful in adults, but recent studies in children show no benefit, and a slightly higher risk of a rash. The “natural” drug, ephedra, has been taken off the market because it can be dangerous. It is still present in some teas and infusions, however. In general, please be sure to discuss any natural, alternative, complementary, or integrative treatment you are using with both your doctor and your complementary medicine health advisor. This will help to prevent accidental interactions.

When should I be worried?

Colds clear up in 3-5 days no matter what we do, unless complications develop. Signs of complications include any of the following:

  • High fever (over 102.4° F or 39.0° C) in children older than 3 months; any fever over 100.4° F or 38.0° C is a concern in younger infants
  • Difficulty breathing or swallowing
  • Changes in skin color such as pale or blue
  • Abnormal breathing patterns (very slow or with long pauses), especially in very infants under 6 months of age
  • Stiff neck or severe headache
  • Rash of any kind
  • Noisy breathing with wheezing, or a “barky” cough like a seal
  • Cough that lasts more than 24-48 hours
  • Cough that will not stop, or cough that produces mucous or phlegm (pronounced “flem” or “flame”)
  • Pain in any one part of the body, such as an ear, the throat, the head, or the chest
  • Redness, swelling, or tenderness above or around an eye
  • A change in nasal mucous color from clear or white to thick yellow or green
  • Foul-smelling breath
  • White or gray patches in the mouth or throat
  • Large, red, or painful lumps on the neck

If any of these occur, please be sure to call your doctor or respiratory therapist right away. If your child or infant is difficult to awaken or seems unconscious, or if s/he has a rapidly spreading red or purple rash, please go directly to the emergency room.

Other points of concern

Healthy children have an average of six colds in the first two years of life! This can make it seem as if you child always has a cold. Colds and URIs are more common in children who go to daycare than in children who do not. Most daycare providers will ask you to keep your child home with a cold, to keep from infecting other children. Daycare is often very important to working families – please do not feel that you are a bad parent if you child in daycare got a cold! Some employers are not very understanding about a parent’s need to stay home with a child who has a cold. Your doctor will probably be happy to write you a note for your employer if it would help.

Children who live in houses where people smoke are much more likely to get colds, and even more likely to get serious complications of colds, than children who live in smoke-free houses. Smoking is a serious addiction and is one of the hardest to quit. During your child’s illness with a cold you will feel even more stressed than usual. This is not a good time to try to quit smoking – but it is an excellent time to decide to quit smoking. Your doctor or clinic can give you information on stop-smoking programs that work. Many of these programs are free. Your insurance or Medicaid may cover all or part of the cost of programs that are not free. Please try to follow up on a stop-smoking program after your child feels better. It is a great way to show your love for him or her.

If your child older than two years seems to get colds very frequently (more than 2 or 3 times a year), if s/he gets ear infections frequently with colds, or if s/he has had pneumonia more than once, please check with your doctor. These frequent infections are sometimes signs of an immune system problem.

Other Conditions that Might Be Present with an Upper Respiratory Infection

Many serious conditions start out like colds and then get worse. These include pneumonia, meningitis, and other bacterial infections. During winter, infants can get “bronchiolitis,” a lung infection usually caused by a virus called RSV. Infants as well as older children and adults can get influenza, which usually involves a fever, headache, sore throat, and muscle aches and pains. If a cold doesn’t clear up in 3-5 days, or gets worse, please check with your doctor.

Children with allergies to things in the environment often look as if they have a cold, with runny nose, tearing eyes, sore throat, and often a cough. Allergies are usually seasonal, and after a year or two parents learn when to expect symptoms. Itchy, watery eyes are usually the tip-off that a child has allergies instead of a cold – but not all children with allergies have them. Children with allergies usually do not have fevers.

A child with drainage of mucous or pus from one side of the nose only may well have an object stuck in the nose. Children put a surprising variety of things in their noses! If your child has this kind of drainage, with or without bad breath, please take him or her to see the doctor, even if you did not see him or her put anything in the nose.