Common sense for the common cold
By Roger R. Badillo II, MD
Correspondent
Viral rhinitis. Watery rhinorrhea. The ubiquitous common cold apparently is not "common" for nothing. Over 200 different viruses can cause what are technically known as upper-respiratory-tract infections, the more common of which are the rhino- and adenovirus types, and are responsible for as many as half of all short-term illnesses. They cause coughing, headache, nasal congestion with watery discharges, sneezing, and a scratchy throat with fever, aches, and pains that are typical of viral infections.
Although everyone catches a cold, children, especially those six years old and younger, are most susceptible to it.
Cough and cold seldom trigger a rush to the emergency room or a call to a doctor in the middle of the night. A physician, however, should evaluate a healthy child with a common cold when the following symptoms are present: dehydration, vomiting, abdominal pain, persistent irritability, unusual sleepiness or irritability, severe headache, difficulty breathing or swallowing, swollen glands, high-grade fever and chills (> 103°F or 40°C for three days), blue lips, skin, and fingernails, facial pain near the sinuses, skin rash, earache.
Lingering cold symptoms may be an indication of a more serious ailment such as sinusitis, secondary bacterial infection such as streptococcal pneumonia, chickenpox, allergies, or even an exacerbation of asthma that will not go away without treatment.
Natural, nonspecific treatment
There is no proven specific treatment for a cold since viruses are not treatable with antibiotics. Antibiotics will only treat the bacterial complications. Neither will the medications available for colds speed up recovery. For the most part, the child is made more comfortable and monitored for possible complications.
Some over-the-counter medicines can relieve the uncomfortable symptoms associated with the common cold. But it is advisable to consider medicating only when recommended by the physician and when symptoms significantly interfere with the child's daily life or keep him awake at night.
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NASAL DECONGESTANSTS
(phenylephrine, pseudoephedrine, oxymetazoline). These act by decreasing mucus secretion and alleviating the swelling in the nasal passages, thus clearing up the nose to ease breathing. They should not, however, be used for more than a few days at a time. Chronic use leads to "rebound" congestion often worse than the original symptoms. Systemic stimulatory effects (sympathomimetic) may also "wire" the child a bit and interfere with sleep.
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ANTIHISTAMINES (chlorpheniramine, brompheniramine). These drugs help in drying up a very runny nose when it is caused by an allergy such as allergic rhinitis or hay fever. The most likely side effect is drowsiness, which may be good at night but particularly troublesome during the day. Newer preparations now cause less sedation.
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COUGH SUPPRESSANTS (dextrometorphan, codeine). Suppressing the cough reflex in the throat and lungs so the irritation won't trigger paroxysms of coughing may help for a more comfortable sleep at night, but it is often best to allow the child to clear his lungs by hawking mucus during the day. Codeine is a regulated prescription narcotic but with low addictive liability in doses for cough suppression.
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EXPECTORANTS (guaifenesin). They loosen thick congestion and may make it easier for the child to cough thick mucus out.
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ANALGESICS AND ANTIPYRETICS (acetaminophen, ibuprofen). General pain relievers ease fever, headaches, and other minor pains. Acetaminophen may lack antiinflammatory activity but is available as a liquid, thus is used primarily for infants and children. Aspirin, however, is not recommended for children since it may trigger Reye's syndrome.
Worrisome complications
Decreased resistance and mucus in the airway during a cold provide fertile breeding ground for bacteria to build up over a few days. Secondary bacterial infection is suggested by a change in the color and consistency of the mucus from clear and watery to mucoid and yellow or green. The sinuses, ears, or lungs may be infected with Streptococcus pneumoniae, Hemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis. Treatment requires appropriate antibiotics and medical attention.
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EAR INFECTIONS. A sensation of plugged ears with ear pain occurs in acute otitis media, when there is bacterial infection of the middle-ear space behind the eardrum. Fluid and mucus accumulate in the auditory tube, especially in children because they have narrower and more horizontal tubes than adults.
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SINUS INFECTIONS. Swelling causes obstruction of a sinus drainage tract,
resulting in accumulation of mucous secretions that become infected by
bacteria. Sinusitis, occurs when pus accumulates in the sinus, giving rise
to greenish nasal discharge (> 10 days) with sinus headaches.
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BRONCHITIS. Although productive cough is usually part of the cold spectrum,
some signs may herald the onset of bacterial bronchitis when associated with
productive cough: fever for more than five days and chest pains associated
with coughing, rapid breathing, and wheezing.
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PNEUMONIA. It is important to clear the airway of mucus to prevent bacterial
growth in the lungs. Some signs that the simple cough and cold may have
invaded the lungs and developed into pneumonia: fever for more than five
days, shortness of breath or labored breathing with rib retractions, chest
pain, bluish discoloration of the lips, and unusually sick look.
For the most part, the discomfort posed by the common cold will not vanish overnight, but must be allowed to run its course. It is self-limiting, and complications are avoided or identified early with patient education and prompt medical attention.
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