Pediatrician’s word: Children and colds: dismantling myths about symptoms and treatments
Well yes, we are in autumn and winter is lurking and that cannot mean anything other than buckets of snot, coughs and peaks of fever… A space of 3 or 4 months opens up in which parents will have the sensation of living a “special snot” groundhog day that seems to be repeated forever or at least for a quarter.
I write this text to show you support and understanding (here one will prefer a pat on the back, another perhaps a hug…) and secondly to explain a little about what a cold consists of, why it occurs, what its symptoms are and, above all, what it is. their treatment (truths and lies about antibiotics and mucolytics).
I hope it is helpful to you and that it at least partially alleviates parents’ anxiety when it is suddenly 3 in the morning again and there is no shortage of peak fever and bucket of snot.
What is a cold?
Cold, common cold, rhinopharyngitis, upper respiratory tract infection, upper respiratory tract infection or upper respiratory tract infection… Billions of names to say the same thing: runny nose and cough, sore throat and sometimes fever.
This is the most frequent cause of consultation in primary care, and in hospital emergencies. They are very common in the first years of life, we are talking about 8 to 10 colds that usually concentrate in the autumn-winter period, although this number often increases considerably if the child goes to daycare.
Why do I get a cold? real culprits
Here we will have to apologize to cold drinks, ice cream, the pool and drafts, because they are not to blame for our catching a cold. Colds are viral infectious diseases in which very different types of viruses are involved and which therefore require contact with an infected person or with infected objects (called fomites). One of the viruses most frequently involved in this pathology is the rhinovirus, it is transmitted through nasal secretions (sneeze near me, touch me with dirty hands, saliva falls from a cough…). This virus remains alive for up to 2 hours and ready to infect patients’ hands and several days on inanimate surfaces (for example, if a child sneezed on a table, the rhinovirus camps there waiting for its next victim). It seems logical to think that hand washing is an indispensable weapon in this battle against the cold, and in the same way we understand that daycare is a place of continuous war.
What is happening, what are the symptoms?
The virus invades the mucous membranes and a fight begins in which the body arms itself through different chemical signals that will end up causing inflammation, edema and nasal obstruction. Mucus is secreted at different levels (nose, mouth, ears, bronchial epithelium…) and coughing occurs (as a mechanism to mobilize that mucus). Other symptoms may also appear such as sore throat, ear pain, sneezing, increased eye secretions (rheum), or the dreaded fever.
This clinic usually lasts 7-10 days (14-15 days are also normal) although, as we pointed out at the beginning, you will believe that it is an infinite continuum in which not a single day has been without mucus. However, when you think about it carefully, it may be that you have never been completely “clean” of mucus, but you have had periods of improvement before the new worsening. This is not going to be easy…
No anticold drug has proven effective in children under 7 years of age. In children under 2 years of age, they may present serious adverse effects and their use is not recommended.
The enemies to beat
3. Sore throat
4. Sneezing, watery eyes, eye congestion
Regarding mucus, there are many mucolytic syrups that promise to combat rhinorrhea and yet, they are completely useless in 99% of cases. Children’s mucus is usually liquid and simply hydrating them well (giving water) facilitates its elimination. And here most of you say: “My child doesn’t expel them.” There is an obvious mucus that falls from the nose, which you see and that you can remove with nasal washes, and another that drips after the nose, directly to the throat and that no matter how much you want, you cannot eliminate. The child coughs up this mucus (cough is our friend) and it comes to his mouth (the well-known “rafts of mucus”), he either ends up vomiting or swallows it and when it is very abundant we can see it in the poop, which They become softer and mucous.
In conclusion, no snot syrups. Lots of water and lots of nasal washing (that’s where many fail, “The child gets angry…”), washed before each meal and before sleeping.
Before I said “cough is our friend” and that is how it is as long as it is a wet cough (of phlegm) that mucus is being torn out, it is being moved thanks to the cough mechanism. Therefore, let us not give anything to cut it. There is no proven efficacy in children under 7 years of age of any cough suppressant on the market; and yes adverse effects especially in children under 2 years of age. In fact, most will say on the leaflet “Not recommended for children under 2 years of age” so… Don’t use it!
Sore throat is very common in older children as a symptom of the onset of a cold. When it is very intense, we can give some anti-inflammatory (ibuprofen, Dalsy for friends). But let’s not abuse it, only if there is intense pain!
Sneezing, tearing and eye congestion… Nasal washes, and eye washes with saline solution. Only if the eye becomes very red, or if the rheumatoid changes to greenish yellow and very thick is it worth re-evaluating it in case there has been a superinfection and some eye drops are needed (which rarely happens).
He has fever! And here the parents tremble because no one explained to them that fever is a defense mechanism, another weapon. Here we are at war and the body reacts. Those bugs die in high temperatures and try to kill them! Fever is very common, especially between 3 months and 3 years of age, and often precedes the rest of the symptoms. It is possible that if you go to the emergency room or to the doctor’s office very soon due to fever, the focus is still not clear and it will be a few hours later when the cold begins.
The fever will occur in more or less frequent peaks and of course will last several days, usually between 3 and 5. It will go down with the antipyretic and then rise again. When there is fever (38º), we will give paracetamol.
It is normal to have a fever, viruses cause fever. It is not necessary to have a bacteria for the temperature to rise. The normal thing in viral fevers is that the temperature oscillates between 38-39º, more in the evening, that it subsides with the antipyretic and that the child maintains a good general condition outside of the feverish peak.
What do we do when the child has a cold?
In pediatrics, the answer has to do primarily with age. If we are talking about an infant under 3 months, the ideal is for her to be evaluated soon, even more so if she has a fever, because fever in a child under 3 months is an emergency. Younger children may spread an infection earlier and may present more serious or uncomfortable symptoms.
If the child is older than three months and has no fever, there is no need to rush to the emergency room, but it would not be bad for his pediatrician to see him in consultation. At any age, a fever of 40º requires prompt evaluation.
What if it ‘goes down to the chest’?
This phrase is said a lot by parents, although most do not understand exactly what “going to the chest” means. It is the fear of the girl on the curve, without really understanding what the issue consists of. In general, there are different areas in which the common cold can cause damage and from there different complications.
1. Upper respiratory tract catarrh: mouth-nose-ear, this will occur in 90% of cases. A lot of mucus, coughing up mucus, mucus in the ears, with or without fever, with or without sore throat… Treatment: water and nasal washes
2. At the level of the larynx: Laryngitis. Our son coughs like an old car horn and is hoarse.
3. Bronchi: The famous “lowering to the chest”, “the whistles”. The small bronchus (bronchioles) closes and bronchitis or bronchiolitis appears. These whistles are audible with a stethoscope and only in extreme cases without a stethoscope, so it is very rare for parents to be able to hear them. Yes, you can notice indirect signs of it: breathing speeds up and the child “bumps”, breaks his ribs, rejects food… This is an emergency.
4. Lung: pneumonia. The mucus camps in the lung and becomes superinfected. High fever and poor general condition usually appear.
Thus, you have to go to the pediatrician’s office, but without running, unless: fever of 40º, poor general condition or lower respiratory difficulty.
When should I return for consultation?
Whenever the pediatrician indicates it and whenever fever appears (if there was none before) or fever returns after an afebrile period (48 or 72 hours without fever and then it reappears)
If in doubt, you should preferably go to the pediatrician or to the emergency room if it is not possible to go to a consultation. This is only intended to be informative to help understand what a cold is, but when a child is sick, if there are questions, you should always go to the doctor.