It’s that time of year. Or, these days, is it always that time of year? Cold and flu season. The season of upper respiratory tract infections. If your little one is feeling unwell, sometimes it’s hard to know what helps and what doesn’t. Today’s post will review the treatments that have evidence and science behind them. I’ll also briefly cover a few times when it’s best to seek medical attention outside the home. Lastly, I’ll list a few things that should not be used to treat colds.
Here’s the takeaway message. Good evidence only supports a few home treatments for the common cold in young kids:
- saline nasal spray
- vapor rub for over age 2
- humidified air
- honey for over age 1
Read on for the details, what additional treatments have some weak evidence, and what to definitely not use to treat a child’s cold.
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What is a common cold or upper respiratory tract infection?
For today’s post, we’re referring to an upper respiratory tract infection (URI) as a common cold. Colds are caused by many different viruses. Some of these same viruses can cause croup or other more serious infections. Here, we’re talking about a mild URI. The usual symptoms are runny or stuffy nose, sore throat, occasional cough, fever for a couple of days, and generally lower energy. A typical cold can last two weeks! And, the average child has six or more colds each year. Young kids in daycare may have up to 14 each year! So, sometimes it feels like they’re always either recovering or getting sick again.
A child with only a cold does not have any specific severe pain, like ear or belly pain.
When is it more than a cold?
A kid can have a cold AND something else. So if something feels off or more severe, please seek medical attention. Below are a few more reasons to call their doctor.
Other reasons to call a doctor or go to the ER:
- A baby under age 90 days has a fever (more than 100.4F).
- A child isn’t able to drink enough. They should pee or have a wet diaper at least every 6 hours or so. If they aren’t peeing and also aren’t drinking enough, they may need extra support. Remember that popsicles are a hydration source! Also, breastfed babies should continue to breastfeed, if possible.
- A child seems to have something in addition to a cold, like ear pain or worsening eye drainage.
- Things aren’t improving after a few days. (Even though the cold may last a couple of weeks, symptoms should start getting better around the 4th day in most cases. Of course this varies depending on the virus and the child).
- There is any trouble breathing which can include:
- A child is breathing faster than normal. Watch their chest. If it is rising and falling a lot faster than normal for more than a minute or two, seek care.
- Nasal flaring. This means their nostrils flare with every breath. This can happen if a child is crying or upset for a few breaths, but should not happen when they are resting and calm.
- Rib retracting. If their ribs are more visible than normal as they breathe, this is concerning too. It almost looks like they’re trying to suck in more air. (This isn’t what is actually happening, but it’s a good visual).
How best to treat the common cold in children at home?
For the common cold in little kids, there are a few things parents can do at home. Here are a few things backed by evidence:
Clear out the nose.
Babies breathe mostly through their nose. So, if it’s blocked up with mucous, they’re pretty uncomfortable. One of the first things to help is to clear that nose. In young kids and babies, this means using some kind of nasal suction, also known as a “booger sucker” or “snot sucker.” Some swear by the Nose Frieda. I think the bulb suction works well enough too. Many hospitals send newborns home with the bulb suction. It will be useful for years!
Here’s the key way to use the bulb suction. If the snot is a little dry or crusty, add a couple of drops of saline nose spray (more on that later). Just put the drops at the entrance of the nostril. Then, rub the nostrils together a little so the saline mixes with the dry mucous. (If the snot is runny already, you can skip this step).
Then, using your finger, block one nostril gently. With the other hand, use the suction to suck out the mucous (snot) from the other nostril. Generally, you do not need to put the suction tip in very far at all! Repeat on the other nostril.
Many kids really dislike the snot sucking. So, if they are not having trouble breathing and are able to rest comfortably, you don’t have to use the suction. However, if they’re struggling, it’s an important first step to help them clear their airway. If a child is struggling to eat enough, it’s a good idea to clear the nose before trying to feed.
Older kids can just gently blow their nose. They can also use some saline drops to help loosen dry mucous.
Saline nasal spray
Saline nasal spray is a good option for all ages. It helps clear out and moisten the nostrils. For babies and young kids, they may need help sucking it out. (See previous section). For older kids and teens, though, a squirt in each nostril helps clear things out. They may lean over a sink and let it drain out. It’s normal (expected!) for it to drip down the back of the throat or out the other nostril. This helps clear out the mucous, open the airways and relieve their cough.
Humidifier or Vaporizer
This is an option for some children. Moist air also keeps their nose moist and makes it easier for mucous to drain. This could mean less snot sucking! Sometimes children with asthma may not respond the same way, so please follow your child’s doctor’s advice. Of course, if it seems that a humidifier or vaporizer isn’t helping or making things worse, please stop even though it helps other kids.
A steamy bathroom can have the same effect. I often suggest someone hold their baby in the bathroom while a hot shower runs. This can also loosen mucous.
We do have evidence that Vick’s VapoRub (or generic equivalent) helps kids with URIs. Such clear evidence is so rare in URI treatments that it’s worth mentioning! Unfortunately, this only applies to children over age 2. To use, parents can apply a dab of the vapor rub on the skin between the child’s upper lip and nose. For kids with sensitive skin, you can put a little vapor rub on their clothing instead of directly on their skin. As with all medications, it’s best to ask a child’s doctor before using, especially if they have asthma or a history of seizures (due to the ingredients).
Honey for kids over age 1.
As we’ll discuss below, cough medicines are not useful or recommended for most children. However, for children over age 12 months, honey is a great option. It’s a natural cough suppressant! And, it is naturally anti-infective. In fact, it performs better than cough syrup. Honey is the main ingredient in many “natural” kids’ cough medicines.
(Babies under age one year should never have honey due to the risk of botulism).
Beyond these treatments, there’s not a lot of solid evidence for many other treatments for the common cold in children. Rest and fluids are very important, especially if a child has a fever.
A Note on Supplements and Vitamins and the Common Cold in Children
I’ve been asked about many supplements and other remedies. And, while the evidence isn’t as robust, there are some worth considering. The following have some evidence they may be helpful. It’s not enough information to recommend these to everyone.
- Vitamin C
Any of the above may help a child fight an infection. Most of the research is either in adults or in a lab, so we can’t say for sure that it’s useful for children. And, specific dosing is hard to recommend due to the lack of great research in kids. I list them here so you have a starting point if you’d like to discuss with your child’s pediatrician. (Of note: supplements in the US aren’t regulated by the FDA, so choose sources carefully).
It seems obvious, but a well-balanced diet is really one of the best things to prevent and fight infection. For example, being deficient in zinc makes someone much more likely to get sick. Zinc deficiency is less common in developed countries.
Do I use supplements in my family?
The studies on elderberry are pretty impressive to me. They showed that elderberry targets viruses (and some bacteria too). Another study that showed elderberry shortened how long someone was sick by four days! This is an especially big deal for people who go to work and school.
So, if someone in my family looks like they’re coming down with a cold, I’ll give them elderberry syrup. I’ll also give a multivitamin, and yogurt (for the probiotics). To be clear, these aren’t AAP recommendations to give any of these vitamins or supplements. More research in kids and dosing is needed. However, I personally think they’ve been worth using in my family. The multi-vitamin can be helpful when a child isn’t eating a normal balanced diet. Eating normally is hard when they’re sick! The most important thing really is rest and fluids. This allows the immune system to do its job of fighting the infection.
Which things should you not give your kids with a common cold?
Colds are the perfect example of where less is more. Many believe that the following are treatments might help, but they can actually make things worse.
Cough and cold medicines are not for kids under age 4.
Ugh, I know. The cold medicine aisle is so hopeful. And, it’s marketed so well. But the reality is these medicines for younger kids don’t work.
Children under age 4 should not take over-the-counter (OTC) cough and cold medicines. (OTC means a prescription is not needed). At these young ages, the medicines don’t work better than a placebo. And some (depending on the medicine and ingredients) may have unpleasant or dangerous side effects. Children ages 4-6 should use only if specifically recommended by their physician.
When I saw kids with colds in the clinic, many had tried these cold medicines before coming in for an appointment. Most parents shrugged when I asked if they helped. (I genuinely hoped they’d say yes). If the medicines did improve symptoms, it was usually medicines with honey in it. Of course this is just anecdotal. I share because my experience matched the research.
Between ages 6 and 12, cough and cold medicines sometimes help, but not consistently with most kids. So, at these older ages, if your child has tried something over the counter, labeled for their age, and it seems to help, it’s usually okay to continue. The benefits are so spotty and inconsistent that I don’t universally recommend cough medicines at this age either.
Children with the common cold should not use someone else’s albuterol prescription.
Albuterol is a prescribed medicine. In young kids, it’s usually for asthma. It also has side effects. If it has been prescribed to your child, please use it. It is life-saving. However, for a child with just a runny nose and a mild cough who has never needed it before? It shouldn’t be used unless recommended by their doctor. I say this because many families have tried a sibling’s albuterol with a nebulizer machine. They thought it helped. It’s likely that plain saline in the machine would have helped just as much. In other words, if they had used a humidifier or a vaporizer, it would have had the same effect. The medication wasn’t needed.
Antibiotics are not used to treat the common cold in children.
Colds are caused by viruses. Antibiotics treat bacteria. They won’t help a cold. However, antibiotics can (and do) cause diarrhea making hydration more challenging. Some evidence shows that antibiotics early in life puts kids at risk for other health challenges in the future. In other words, if they’re not needed, it’s best to avoid them. As I mentioned earlier, sometimes kids with colds go on to develop other infections. Ear infections, eye infections, and sinus infections are all more common after or with a URI. Sometimes, these infections do need antibiotics. And, thank goodness for antibiotics! We use them when we need them. However, it does more harm than good to use them unless they’ve been prescribed to your child for a specific reason.
Rubbing alcohol sponge baths are dangerous.
Many home remedies are helpful! We just don’t have a lot of data to recommend them all. So, if there is something your family does to help colds, it may truly be beneficial. Just because it’s not listed here doesn’t mean it’s not helpful. For better or worse, not everything has been studied.
However, at least one home remedy is dangerous and should not be used. Wiping or massaging a child’s skin with rubbing alcohol is not safe. The skin can absorb the rubbing alcohol (also known as isopropyl alcohol) and cause poisoning, especially for young kids and babies.
Summary: when treating a child with a common cold at home, less is more.
Thankfully, most common colds get better on their own within a couple of weeks. To support a child or baby with a URI, we can focus on keeping their nose clear, using saline spray if needed. If they’re over age 1 year, honey can help with the cough. For over age 2, vapor rub can be helpful too. Avoid cough medicines and medications that were prescribed to someone else.
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Photo by Diana Polekhina on Unsplash
About the Author: Maya Mahmood, D.O., F.A.A.P. is a board-certified pediatrician and mom. She is passionate about parents having evidence-based information to help their families be healthier.
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