Cold & Flu Review

My son has been sneezing for the past few weeks and blows his nose constantly. How can I tell if he has allergies or just a lingering cold?
– Michelle

Seasonal allergies and the common cold can be so much alike that it’s sometimes hard to tell the two apart. But look closely and you can find clues about what’s going on.

Ask yourself these questions to help figure out if your child could have allergies or a cold:

1. Have the seasons changed? If yes, it could be allergies. Seasonal allergies come at the same time every year and around the same set of conditions (for example, when leaves start to fall in autumn or plants start to flower in spring). Allergy symptoms like sneezing, congestion, or a runny nose are the body’s response to breathing in airborne allergens (like plant pollen or mold spores).

   Colds, on the other hand, are caused by viruses that can turn up in any environment, at any time of year, but are most common in winter months.

2. Did symptoms come on suddenly? If yes, it could be allergies. Another sign that you might be dealing with seasonal allergies is if symptoms come on suddenly and last a long time. Cold symptoms tend to come on more gradually and usually go away within 7 to 10 days, but allergies last as long as someone is exposed to an allergen, which can be for weeks or months.
3. Does your son have itchy, watery eyes? If yes, it could be allergies. Many kids with allergies get this symptom when an allergen causes an inflammation of the conjunctiva (a clear membrane that covers the inner eyelids and eyeball).
4. Is there a fever? If yes, it could be a cold. Allergy symptoms are never accompanied by a fever, while colds sometimes are.
5. Is there yellow/greenish nasal discharge? If yes, it could be a cold. With an allergy, your son’s runny nose would have a thin, clear discharge rather than the thick yellow or greenish discharge that can come with a cold.

If you think that your son has an allergy, talk to his doctor. Exposure to animals, smoke, pollen, dust, foods, soaps, and mold are just a few of the things that can cause allergies. So try to note anything new that he’s been exposed to. Identifying and removing the cause can help prevent allergy symptoms.

Often the only way to know exactly what someone is allergic to is with an allergy test. This, if recommended for your son, would be done in an pediatric allergist’s office. The testing can be done on the skin (where an allergen is placed under the skin to check the body’s response) or through a blood test.

If your son does have allergies, the doctor will recommend reducing exposure to the allergen(s) and, perhaps, using an over-the-counter (OTC) or prescription allergy medicine to relieve symptoms.

And if it looks like your son has a cold, check with his doctor before giving him OTC cold medicines. There is little proof that they work, while serious side effects are a risk, especially in younger kids. You can give acetaminophen or ibuprofen to relieve fever or pain. The doctor may recommend running a cool-mist humidifier or vaporizer at night to help moisten the air. Also, using saline (saltwater) nose spray or drops can help loosen mucus for both allergies and colds.

The common cold catches all of us from time to time, bringing sniffles and sneezes and perhaps a sore throat and annoying cough.

Kids can get eight colds per year or more, making them the most common infectious disease in the United States and the top reason kids visit the doctor and miss school.

Causes

The common cold is a contagious viral infection of the upper respiratory tract. Most are caused by rhinoviruses carried in invisible droplets in the air we breathe or on things we touch. These viruses can get into the protective lining of the nose and throat, setting off an immune system reaction that can cause a sore throat, headache, and trouble breathing through the nose.

Dry air — indoors or outside — can lower resistance to infection by the viruses that cause colds. So can being a smoker or being around someone who smokes. Smokers are more likely to catch a cold than people who don’t smoke, and their symptoms probably will be worse and last longer, and can even lead to bronchitis or pneumonia.

But despite some old wives’ tales, not wearing a jacket or sweater when it’s chilly, sitting or sleeping in a draft, and going outside while your hair’s wet do not cause colds.

Signs and Symptoms

The first symptoms of a cold are often a tickle in the throat, a runny or stuffy nose, and sneezing. Kids with colds also might feel very tired and have a sore throat, cough, headache, mild fever, muscle aches, and loss of appetite. Mucus from the nose may become thick yellow or green.

Duration

Cold symptoms usually appear 2 or 3 days after exposure to a source of infection. Most colds clear up within 1 week, but some last a bit longer.

Contagiousness

Colds are very contagious, especially in the first 2 to 4 days after symptoms begin. They can even spread for a couple of weeks after someone starts feeling sick.

Colds spread through person-to-person contact or by breathing in virus particles, which can travel up to 12 feet through the air when someone with a cold coughs or sneezes. Touching the mouth or nose after touching skin or another contaminated surface can also spread a cold.

Prevention

Because so many viruses cause colds, there isn’t a vaccine to protect against them. To help avoid catching one, kids should:

• steer clear of anyone who has a cold
• avoid secondhand smoke
• wash their hands well and often, especially after blowing their noses
• sneeze or cough into a tissue or their elbow, not into their hands
• not share towels, drinking glasses, or eating utensils with someone who has a cold
• not pick up other people’s used tissues

Experts aren’t sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects. Studies on herbal remedies, like echinacea, are either negative or aren’t conclusive. Few properly-designed scientific studies of these treatments have been done in kids.

Talk to your doctor before you give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.

Treatment

“Time cures all.” That may not always be true, but in the case of the common cold, it’s pretty close. Medicine can’t cure the common cold, but it can be used to relieve symptoms like muscle aches, headache, and fever. You can give your child acetaminophen or ibuprofen based on the package recommendations for age or weight.

Never give aspirin to children younger than 12, or to kids and teens under age 19 who have a viral illness. Such use has been linked to Reye syndrome, a rare but serious condition that can be fatal.

You might be tempted to give your child over-the-counter (OTC) decongestants and antihistamines to try to ease the cold symptoms. But there’s little or no evidence to support that they actually work. In fact, decongestants can cause hallucinations, irritability, and irregular heartbeats, particularly in infants, and shouldn’t be used in kids younger than 4 years old without first consulting a doctor. Many experts now believe that there’s usually no reason to use these medicines in any child younger than 6.

Some ways you can help ease cold discomfort include:

• put saline (saltwater) drops in the nostrils to relieve nasal congestion
• run a cool-mist humidifier to increase air moisture
• dab petroleum jelly on the skin under the nose to soothe rawness
• give hard candy or cough drops to relieve sore throat (for kids older than 3)
• run a warm bath or use a heating pad to soothe aches and pains
• run a hot shower to create a steam-filled bathroom where your child can sit to help clear stuffiness

What about chicken soup? There’s no real proof that eating it can cure a cold, but sick people have been swearing by it for more than 800 years. Chicken soup contains a mucus-thinning amino acid called cysteine, and some research shows that chicken soup helps control congestion-causing white cells, called neutrophils.

The best plan, though, is not to worry about whether to “feed a cold” or “starve a fever.” Just make sure your child eats when hungry and drinks plenty of fluids like water or juice to help replace the fluids lost during a fever or from mucus production.

When to Call the Doctor

Your doctor won’t be able to identify the specific virus causing cold symptoms, but can examine your child’s throat and ears and take a throat culture to make sure the symptoms aren’t from another condition that may need treatment. If symptoms get worse instead of better after 3 days or so, the problem could be strep throat, sinusitis, pneumonia, or bronchitis, especially if your son or daughter smokes.

If symptoms last for more than a week, appear at the same time every year, or happen when your child is around pollen, dust, or animals, an allergy could be to blame. Kids who have trouble breathing or wheeze when they catch a cold could have asthma.

Always call the doctor if you think your child might have more than a cold, your child gets worse instead of better, or if your child has any of these symptoms:

• coughing up a lot of mucus
• shortness of breath
• unusual lethargy/tiredness
• inability to keep food or liquids down or poor fluid intake
• increasing headache or facial or throat pain
• severely painful sore throat that interferes with swallowing
• fever of 103°F (39.3°C) or higher, or a fever of 101°F (38.0°C) or higher that lasts for more than a day
• chest or stomach pain
• swollen glands (lymph nodes) in the neck
• earache

Like most viral infections, colds just have to run their course. Getting plenty of rest, avoiding vigorous activity, and drinking lots of fluids — juice and water — all may help your child feel better while on the mend.

Keeping up regular activities like going to school probably won’t make a cold any worse. But it will increase the likelihood that the cold will spread to classmates or friends. So you might want to put some daily routines aside until your child is feeling better.

One dose or two? With so much information floating around about the flu vaccine, it’s easy to get confused about the current recommendations for kids. Use our tool to figure out if your child needs no dose, one dose, or two doses of flu vaccine.

And for more information about the flu — prevention, treatment, and guides — check out our Flu Center.

Acetaminophen (uh-see-tuh-MI-nuh-fen) is an over-the-counter medicine taken to relieve fever and pain. It’s a safe drug when used correctly for a wide variety of problems, but taking too high a dose can make a child very sick. Overdosing can lead to liver damage and, in rare cases, even death. So it’s important to know how to properly give the medicine.

If you have any questions about giving acetaminophen to your child, ask your doctor or pharmacist. Never give this medicine (or any other kind of medicine) to a child younger than 2 years old without getting a doctor’s OK first.

What Is Acetaminophen Also Called?

Acetaminophen is the generic name of this drug. In some other countries, acetaminophen is known as paracetamol. Many generic brands of acetaminophen are available.

The most common brand name for this medicine is Tylenol®, but it is also sold under the names Panadol®, FeverAll®, and Tempra®.

What Types Are Available?

For kids, this medicine is available in oral suspensions (liquid form) and also chewable tablets. Chewable tablets are not recommended for children younger than 2 because they are a choking hazard. Rectal suppositories (FeverAll® or Tempra®) are available for children who have trouble taking medicine by mouth or can’t keep medicines down due to vomiting.

Tylenol® makes Infants’ Tylenol® (“drops”) and Children’s Tylenol® oral suspensions, as well as Jr. Tylenol® chewable tablets. Many generic brands of acetaminophen are available in similar forms.

Tylenol® and other brands that make infant drops used to offer them in a more concentrated formula, which was 80 mg/0.8 ml per dose. These drops were taken off the market because babies were getting sick after parents mistakenly gave too much medicine while using kitchen teaspoons or measuring cups from Children’s Tylenol®. If you have Infants’ Tylenol® or a similar product in the 80 mg strength, throw the product away and do not give it to your child. The new infant drops have the same concentration as Children’s Tylenol® (160 mg/5 ml per dose).

Giving Acetaminophen

Refer to the following dosage charts for the correct dosage of acetaminophen. And be sure to:

• Check the expiration date to make sure it’s not expired. If it is, throw the medicine away and buy a new product. For proper disposal, remove the medicine from its original container and place it in an undesirable substance that children or animals wouldn’t be tempted to eat, like coffee grounds or kitty litter. Then, put it in a sealable bag inside a garbage can.
• Make sure your child isn’t already taking medicines with acetaminophen in them. Acetaminophen is a very common ingredient in cough, cold, and allergy medicines. If your child is taking one, talk to your doctor or pharmacist before giving your child more acetaminophen. Too much acetaminophen can damage a child’s liver.
• Check the concentration and recommended dosage, and give your child a dose from the dropper, syringe, or cup that came with the product. This will help ensure that your child gets the right amount of milliliters, or ml (also called cc, or cubic centimeters), and doesn’t overdose. Never use a measuring spoon from the kitchen or a cup or dropper from a different product. Chewables are not recommended for children younger than 2 years old due to the risk of choking.
• When giving for a fever, consider the child’s temperature and age. If you have an infant 3 months or younger with a rectal temperature of 100.4°F (38°C) or higher, call your doctor or go to the emergency department immediately. If your child is between 3 months and 3 years old and has a fever of 102.2°F (39°C) or higher, call your doctor to find out if he or she needs to see your child.
• If your child spits up or vomits up a dose of acetaminophen within the first 20 minutes, it’s usually safe to give your child another dose (check with a doctor if you’re unsure). If your child holds the first dose down for longer than 20 minutes before spitting up, you should wait 4 hours or more before giving your child another dose.
• Give acetaminophen every 4 to 6 hours as needed, but never give your child more than five doses in 24 hours.

Dosage Charts

Doctors recommend using a child’s weight instead of age when figuring out how much medicine to give. Before giving your child a dose, check the label to make sure the recommended dosage and concentration agree with the numbers below.

This chart is based on doctors’ and the manufacturers’ recommendations and is not intended to replace the advice of a doctor. If your child is age 2 or younger, get approval from the doctor before giving the medicine. And always call your doctor with any questions or concerns about giving medicine.

Your child is sent home from school with a sore throat, cough, and high fever — could it be the flu that’s been going around? Or just a common cold?

Although the flu (or influenza) usually causes symptoms that make someone feel worse than symptoms associated with a common cold, it’s not always easy to tell the difference between the two.

Symptoms Guide

The answers to these questions can help determine whether a child is fighting the flu or combating a cold:

If most of your answers fell into the first category, chances are that your child has the flu. If your answers were usually in the second category, it’s most likely a cold.

But don’t be too quick to brush off your child’s illness as just another cold. The important thing to remember is that flu symptoms can vary from child to child (and they can change as the illness progresses), so if you suspect the flu, call the doctor. Even doctors often need a test to tell them for sure if a person has the flu or not since the symptoms can be so similar!

Some bacterial diseases, like strep throat or pneumonia, also can look like the flu or a cold. It’s important to get medical attention immediately if your child seems to be getting worse, is having any trouble breathing, has a high fever, has a bad headache, has a sore throat, or seems confused.

While even healthy kids can have complications of the flu, kids with certain medical conditions are at more of a risk. If you think your kid might have the flu, contact your doctor.

Treatment

Some kids with chronic medical conditions may become sicker with the flu and need to be hospitalized, and flu in an infant also can be dangerous. For severely ill kids or those with other special circumstances, doctors may prescribe an antiviral medicine that can ease flu symptoms, but only if it’s given within 48 hours of the onset of the flu.

Most of the time, you can care for your child by offering plenty of fluids, rest, and extra comfort.

And if the doctor says it’s not the flu? Ask whether your child should get a flu vaccine.

The flu vaccine is a good idea for all families. It does not cause the flu and it helps keep kids and parents from getting sick. Getting the flu is worse than having a cold and can make a person sick for a week or more.

Babies younger than 6 months old can’t get the vaccine, but if their parents, other caregivers, and older kids in the household get it, that will help protect the baby. This is important because infants are more at risk for serious complications from the flu.

Who Should Be Immunized?

The Centers for Disease Control and Prevention (CDC) recommends a flu vaccine for everyone 6 months of age and older.

But it’s especially important for those who are at greater risk of developing health problems from the flu, including:

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
• anyone 65 years and older
• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
• anyone whose immune system is weakened from medications or illnesses (like HIV infection)
• residents of long-term care facilities, such as nursing homes
• anyone (adults, teens, and kids) with a chronic medical condition, such as asthma
• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan Natives

Certain things might prevent a person from getting the flu vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination
• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another type (called quadrivalent) protects against four strains.

The vaccine is given to kids by injection with a needle (the flu shot). This vaccine is safe and effective.

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Vaccine shortages and delays sometimes happen, so check with your doctor about availability and to see which vaccine is right for your kids.

The nasal spray version of the flu vaccine is no longer recommended by the US Centers for Disease Control (CDC), for kids or adults. The nasal vaccine did not prevent people from getting the flu between 2013 and 2016. Researchers aren’t sure why recent versions of the vaccine no longer work well, but at this time, doctors can no longer recommend the nasal spray version.

Egg Allergy and Flu Vaccine

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

Still, a child with an egg allergy should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist’s office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu shot.

When Should Kids Get Vaccinated?

Flu season runs from October to May. It’s best to get a flu shot as early in the season as possible, as it gives the body a chance to build up immunity to (protection from) the flu. But getting a shot later in the season is still better than not getting the vaccine at all.

Flu season runs from October to May, with most cases happening from late December to early March. But the flu vaccine is usually offered from September until mid-November. Getting vaccinated before the flu season is in full force gives the body a chance to build up immunity to (protection from) the virus.

Even though it’s best to get vaccinated as soon as the flu vaccine is available, getting the vaccine later can still be helpful. Even as late as January, there are still a few months left in the flu season, so it’s still a good idea to get protected.

Who Should Get the Flu Vaccine?

The flu vaccine is recommended for everyone age 6 months and older. It’s especially important for people who are at greater risk of developing health problems from the flu to get vaccinated. They include:

• all kids 6 months through 4 years old (babies younger than 6 months are also considered high risk, but they cannot receive the flu vaccine)
• anyone 65 years and older
• all women who are pregnant, are considering pregnancy, have recently given birth, or are breastfeeding during flu season
• anyone whose immune system is weakened from medications or illnesses (like HIV infection)
• residents of long-term care facilities, such as nursing homes
• anyone (adults, teens, and kids) with a chronic medical condition, such as asthma
• kids or teens who take aspirin regularly and are at risk for developing Reye syndrome if they get the flu
• caregivers or household contacts of anyone in a high-risk group (like children younger than 5 years old, especially those younger than 6 months, and those with high-risk conditions)
• Native Americans and Alaskan Natives

Kids under 9 years old will receive two doses this flu season if they have received fewer than two doses of flu vaccine before July 2016. This includes kids who are getting the flu vaccine for the first time. Those under 9 who have received at least two doses of flu vaccine previously (in the same or different seasons) will only need one dose. Kids older than 9 only need one dose of the vaccine.

It can take 1 to 2 weeks for the flu vaccine to become effective, so it’s best to get vaccinated as soon as possible.

Types of Flu Vaccine

Different types of vaccines are available. One type (called trivalent) protects against three strains of the flu virus (usually, two types of influenza A viruses and one influenza B virus). Another (called quadrivalent) protects against four strains.

The vaccine is given to kids by injection with a needle (the flu shot). This vaccine is safe and effective.

Some vaccines are approved only for adults at this time, such as egg-free vaccines and intradermal shots, which are injected into the skin (instead of muscle) with a smaller needle.

Although the flu vaccine also came in a nasal spray (or mist) form in the past, the nasal spray is not currently recommended. The Centers for Disease Control and Prevention (CDC) found that it didn’t prevent cases of the flu between 2013 and 2016.

Those Who Should Not Get the Vaccine

Certain things might prevent a person from getting the vaccine. Talk to your doctor to see if the vaccine is still recommended if your child:

• has ever had a severe reaction to a flu vaccination
• has Guillain-Barré syndrome (a rare condition that affects the immune system and nerves)

In the past, it was recommended that anyone with an egg allergy talk to a doctor about whether receiving the flu vaccine was safe because it is grown inside eggs. But health experts now say that the amount of egg allergen in the vaccine is so tiny that it is safe even for kids with a severe egg allergy. This is especially important during a severe flu season.

Still, a child with an egg allergy should get the flu shot in a doctor’s office, not at a supermarket, drugstore, or other venue. And if the allergy is severe, it might need to be given in an allergist’s office.

If your child is sick and has a fever, talk to your doctor about rescheduling the flu vaccine.

Are There Side Effects?

Most people do not have any side effects from the flu shot. Some have soreness or swelling at the site of the shot or mild side effects, such as headache or low-grade fever.

Where Can My Family Get the Vaccine?

The flu vaccine is available at:

• many health care settings, including doctors’ offices and public, employee, and university health clinics
• some pharmacies
• some supermarkets
• some community groups or centers
• some schools

If you have an HMO insurance plan, be sure to check with your primary care doctor before having your kids vaccinated outside the office, since most HMOs will pay for shots only if they’re given through their plan.

The flu vaccine is covered by Medicare for senior citizens and is generally covered by insurance for people in other high-risk groups. Otherwise, the vaccine may cost anywhere from $10 to $50.