(UPPER RESPIRATORY INFECTION (URI))

Runny or stuffy nose, sometimes with a fever, sore throat, cough, hoarse voice or swollen glands in the neck.

• Colds are caused by viruses, and antibiotics do not cure viruses.
• Transmission is by hand-to-hand contact, sneezing, coughing and they can persist on surfaces of objects for many hours. The virus is shed from the nasal discharge.
• People are contagious a day or two before the onset of symptoms and for an average of  7 to 10 days. As the cold progresses, contagiousness gradually decreases. Shedding of the virus from nasal discharge may last as long as 2 or 3 weeks. The incubation (time from exposure to the virus and the start of symptoms) is less than a week.
• Colds are not caused by cold air, drafts, or swimming.
• Some newborns sound stuffy on and off, but there is no nasal discharge. They are having dried mucous developing in the nasal passage which can be cleared with salt water drops and bulb syringing. Infants under about 4 months must breathe through their nose and sucking can become difficult with a cold. They may be at risk of becoming dehydrated if they are not feeding well.
• Most children get about six to ten colds per year. The frequency is higher if the child is in daycare, has siblings in school or is around a lot of other children.
• If a child is chronically congested (more than two or three weeks), allergies or sinusitis may be present. A foreign body placed in the nose may cause a one-sided foul smelling thick runny nose. Discuss these possibilities with your doctor if the runny nose is more than 10 to 14 days or if you suspect a foreign body in the nostril.
• Most colds last 7 to 10 days. Fevers usually last less than 3 or 4 days. The cough is usually the last symptom to go away (sometimes up to 2 weeks).
• Nasal discharge can be clear, white, yellow or green. It is often more colored in the mornings or after a nap. Sometimes at the end of the cold, the discharge is more green. The color alone does not necessarily mean an infection that requires antibiotics.
• Milk does not usually need to be eliminated with colds, unless allergies are being suspected.

• Breathing is difficult and does not improve with suctioning of the nose, especially in a young infant under 4 months
• Is becoming dehydrated because of inability to feed or vomiting
• (See other sections on fever, earache, cough if appropriate)

• Nasal discharge is more than 10 to 14 days, especially, if the child appears to be getting worse
• Skin under the nose becomes scabbed/crusted
• Yellow eye discharge (See eye problems)
• Earache or very sore throat
• Fever more than three days
• Having difficulty eating because of stuffiness in infant under 4 months
• Suspicion of a foreign body in the nose

Runny nose with lots of discharge. For young infants, use a bulb syringe to clear the secretions. It is especially helpful before a baby nurses or takes a bottle. Use a humidifier at night. Cool mist humidifiers are safer than steam vaporizers because of the risk of a curious toddler burning himself with the steam. Elevate the head of the crib or bed. This is best done in cribs or bassinets by placing a pillow underneath the mattress. Never place infants on pillows.

Stuffy nose with little discharge. Warm nose drops with a solution of salt water (use 1 teaspoon of salt in a cup of warm water) or purchased saline drops can be placed in each nostril. This will often help to break up the mucous and the child can then be suctioned with the bulb syringe. For best results, block the opposite nostril when bulb suctioning. In an older child they can be told to blow the nose after the drops have been in for a minute. This may need to be repeated a few times. In addition, having the child sit with the parent in a steamed up bathroom with the shower running is also helpful. Use the humidifier at night.

Allergies. Occasionally, a child may have allergies that is causing a stuffy or runny nose.  Things that may make you think about allergies:

• recent introduction of new formula or milk products
• family history of allergies, asthma or eczema
• runny nose more than 2 weeks, often associated with sneezing, or itchy eyes
• runny nose is on and off
• child does not seem ill
• dark circles under the eyes, called "allergic shiners" or a crease on the nose from rubbing an itchy nose

If you have concerns about allergies, contact your doctor during office hours.

Complications of a cold. Ear infections, sinusitis and pneumonia may be complications of a cold. All green noses do not mean infections which need antibiotics. Sinusitis is a bacterial infection of the sinus cavities (small spaces in the bones of the face).  Symptoms of sinusitis may include: clear, green or yellow congestion for two or more weeks and nighttime or morning cough from a postnasal drip.  Sometimes, they have a fever, foul breath, fussiness and headaches.  One way to diagnose this is by obtaining a sinus x-ray.  Infants under one year of age do not have well-developed sinuses and are not as prone to getting sinusitis.  Treatment involves antibiotics and topical nasal steroid sprays.

Over-the-counter medications. Over-the-counter medications may or may not be helpful. They do not shorten the course of the cold and they may not prevent ear infections. Some of these medications will cause a child to be either jittery and "hyper" or sleepy. They are recommended when the child is very miserable and having difficulty drinking or sleeping. Please discuss with your doctor during office hours about their philosophy and recommendations for these medications, because this may vary according to your doctor. Acetaminophen or ibuprofen may be used for fever and may be given at the same time as a over-the-counter cold medicine.

Diet. Milk does not necessarily need to be eliminated with a cough or cold, unless milk allergy is suspected. Fluids do need to be encouraged and solid foods are not as important. Make sure the child is staying well-hydrated.

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