Related concepts:
Upper respiratory tract infection, URI, Nasopharyngitis, Viral rhinosinusitis.

Introduction to a common cold:

It’s called the “common cold” for a reason. Your child will probably have more colds than any other type of illness. Most kids have had eight to ten colds by their second birthdays and they continue throughout childhood (and their parents get them – usually from the kids). It’s the most common reason that children miss school and parents miss work. If anything, using the term “common” with cold is an understatement.

What is a common cold?

The body has a relatively small number of symptoms with which to respond to an ever-changing, wide variety of viruses. These symptoms are often the body’s attempt to get rid of the virus and to minimize damage. Sneezing ejects the virus from the nose, coughing from the lungs and throat, vomiting from the stomach, and diarrhea from the intestines. Fever makes it difficult for the virus to reproduce.
The common cold is our name for a specific constellation of symptoms, a pattern of illness that can be caused by a variety of different viruses.
Over 200 different types of viruses can cause a cold! Rhinoviruses, which means “nose viruses,” are the most common. Respiratory syncytial virus (RSV), adenoviruses, enteroviruses, and a host of others can produce colds.
Most people are sick with each specific strain of cold virus only once in their lives.

Who gets a common cold?

Colds are the most prevalent infectious disease. Children average 3 to 8 colds per year (younger children and boys are on the higher end of the range).
Children are the major reservoir of the many cold viruses. They usually get colds from other children. When a new strain is introduced into a school or day care, it quickly travels through the class.
Parents get about half as many colds as their children do. Moms tend to get at least one more cold per year than dads.
Colds can occur year-round, but they occur mostly in the winter (even in areas with mild winters). In areas where there is no winter, colds are most common during the rainy season.

What are the symptoms of a common cold?

The three most frequent symptoms of a cold are nasal stuffiness, sneezing, and runny nose. Throat irritation is often involved (but not with a red throat). Adults and older children with colds generally have minimal or no fever. Infants and toddlers often run a fever in the 100 to 102 degree range.
Once you have “caught” a cold, the symptoms usually begin in 1 to 5 days. Typically, irritation in the nose or a scratchy feeling in the throat is the first sign, followed within hours by sneezing and a watery nasal discharge.
Within one to three days, the nasal secretions usually become thicker and perhaps yellow or green. (This is a normal part of the common cold and not a reason for antibiotics.) During this period, children’s eardrums are usually congested and there may be fluid behind the ears (OME), regardless of whether or not the child will end up with a true bacterial infection.
Depending on which virus is the culprit, the virus might also produce a headache, cough, postnasal drip, burning eyes, muscle aches, or a decreased appetite. Still, if it is indeed a cold, the most prominent symptoms will be in the nose. (By the way, forcing a child to eat when he or she has a decreased appetite due to a cold is both unnecessary and unhelpful- but do encourage them to drink plenty.)
For children with asthma, colds are the most common trigger of asthma symptoms. They are also the most common precursor of ear infections.

Is common cold contagious?

When someone has a cold, the nasal secretions are teeming with cold viruses. Coughing, drooling, and talking are all unlikely ways to pass a cold. Sneezing, nose-blowing, and nose-wiping are the means by which the virus spreads. You can catch a cold by inhaling the virus if you are sitting close to someone who sneezes, or by touching your nose, eyes, or mouth after you have touched something contaminated by infected nasal secretions.

How long does a common cold last?

The entire cold is usually over all by itself in about 7 days, with perhaps a few lingering symptoms (cough) for another week. If it lasts longer, consider another problem, such as a sinus infection or allergies.

How is a common cold diagnosed?

A cold is defined as a short-term, contagious, viral illness with nasal stuffiness, sneezing, runny nose, throat irritation, and little or no fever. The diagnosis is based on identifying the appropriate symptoms, exposure, and time course.
Sometimes it is difficult to distinguish a cold from other problems such as allergies, influenza, strep throat, or sinus infections. A history and physical exam, sometimes with supporting lab work, will usually make the distinction.

How is a common cold treated?

Antibiotics should not be used to treat a common cold. Thick yellow or green nasal discharge is not a reason for antibiotics, unless it lasts for 10 to 14 days without improving (possible sinusitis).
New anti-viral drugs could make runny noses completely clear up a day sooner than usual (and begin to ease the symptoms within a day). It’s unclear whether the benefits of these drugs outweigh the risks.
Most cold treatments are aimed at controlling troublesome symptoms. Over the counter cold medications are no longer recommended for children under 2 years of age, and are strongly discouraged for children under 6 years of age.
Chicken soup has been used for treating common respiratory illnesses at least since the 12th century. A study published in the October 2000 issue of Chest explains why this home remedy has held on so long — it may really help! In addition to the infection-fighting benefits of the heat, hydration, and salt that have previously been described, these researchers looked at the direct biologic activity of the soup itself.
Buckwheat honey (a form of dark honey) can help calm coughs caused by the common cold. One study found that buckwheat honey was better at treating coughs than dextromethorphan (a cough suppressant found in common cold medications such as Robitussin DM). The recommended dose is ½ teaspoon for children 2-5 years old, 1 teaspoon for children 6-11 years old, and 2 teaspoons for children 12-18 years old (Arch Pediatr Adolesc Med.; 2007; 161(12):1140-1145). Honey should not be given to children under 1 year of age, however, as it is associated with infant botulism.

How can a common cold be prevented?

It might seem overwhelming to try to prevent colds, but the number of colds can be decreased. Children average 3 to 8 colds per year. It is certainly better to get three than to get eight!
Colds can be spread by airborne, contact, and droplet transmission, as well as by fomites. They can be prevented, both by decreasing the exposure to germs and also by boosting your child’s immunity.
Here are 5 proven ways to decrease germ exposure and the number of colds:

• Switching: Using a day care of 6 or fewer children dramatically decreases the germ exposure (and illness), especially in the winter months. Unfortunately, this is not the most practical option.
• The Not-So-Secret Weapon: We all know that hand washing is a good idea, but when a day care actually does wash children’s and provider’s hands at key moments, the results are spectacular. Key moments? The most important times are after nose-wiping, after diapering or toileting, before meals, and before food preparation. Before a child picks his or her nose would be nice but is not quite practical.
• Instant Hand Sanitizers: Talk about convenient! A little dab will kill 99.99 percent of germs without any water or towels. It uses alcohols to destroy germs physically. It is an antiseptic, not an antibiotic, so resistance can’t develop. And here’s the cool part–it’s fun. Many kids think it’s a treat to get to use it! We asked our son’s day care to try it, and they began washing at all those important times.
• Disinfection: Cleaning commonly touched surfaces (sink handles, sleeping mats) with an EPA-approved disinfectant has been proven to decrease the number of colds.
• Paper Towels: Use paper towels instead of shared cloth towels.

Here are seven proven ways to prevent colds by supporting the immune system:
Avoid Unnecessary Antibiotics and Antibiotic Soaps: The more kids use antibiotics, the more likely they are to get sick, with longer, more stubborn infections caused by more resistant organisms.
Breastfeeding: Breast milk is known to protect against upper and lower respiratory tract infections even years after the breastfeeding is done. Kids who don’t breastfeed average 5 times more ear infections.
Cigarette Smoke: Keep your child as far away from it as possible! Exposure to second-hand smoke is responsible for many health problems, including millions of colds.
Sleep: Late bedtimes and poor sleep leave children vulnerable.
Water: Getting plenty of fluids supports immune function.
Yogurt: The beneficial bacteria in active yogurt cultures can help prevent colds (as well as tummy aches, diarrhea, food poisoning, food allergies, eczema, sinus infections, bronchitis, and pneumonia – among other things).
Zinc: Children who are zinc deficient get more infections and stay sick longer.

Related A-to-Z Information:

Adenovirus, Airborne Transmission, Allergies (Allergic Rhinitis), Asthma, Bronchiolitis, Conjunctivitis (Pink eye), Contact Transmission, Cough, Croup, Droplet Transmission, Ear Infection, Enteroviruses, Fomites, Headache, Influenza (Flu), Nosebleeds (Epistaxis), Otitis Media with Effusion (OME), Pertussis (Whooping cough), Pneumonia, Respiratory Distress, RSV (Respiratory syncytial virus), Sinusitis, Strep Throat, Tonsillitis, Wheezing

Related concepts:

Nasal allergies, Allergic rhinitis, Hay fever, Seasonal allergic rhinitis, Perennial allergic rhinitis, Pollen allergy, House dust allergy, Pet allergies, Mold allergies

Introduction to allergies:

Children with allergies tend to get more ear infections, more colds, and have more sleepless nights than their peers. Far too often, the underlying allergies are missed and children are treated for each symptom as it occurs.

What are allergies?

The lining of our noses contains tiny guardians called mast cells, whose purpose is to protect us from harmful particles in the air we breathe. People with allergies have hypersensitive mast cells that sound the alert in response to relatively harmless particles such as pollen, dust, or pet dander.
When pollen sticks to the membrane of a mast cell of someone with pollen allergies, the cell begins to swell and swell. Finally the mast cell bursts, spilling histamine and many other potent chemicals into the surrounding tissue. These produce the sneezing, swelling, itching, and congestion associated with allergies.

Who gets allergies?

Developing allergies involves a genetic and an environmental component.
Allergies tend to run in families. Asthma, eczema (atopic dermatitis), and allergic rhinitis (hay fever) often occur in the same families. Boys, firstborn children, those with eczema, those with food allergies, and those whose parents have nasal allergies are all more likely to develop nasal allergies. Early wheezing does not appear to increase the chances.
The environment also makes a difference. Allergic rhinitis is an over-exuberant response to substances in the environment. Both too much and too little immune response is unhealthy. Experiences in early childhood can teach the body to set the level of immune protection ‘just right.’
Children who are raised on a farm have a significantly reduced risk of asthma, eczema, and hay fever. Children in day care, those with older siblings, those with pets, and those who get plenty of colds are also less likely to develop nasal allergies.
Parents are often told that their children are too young to have allergies. While allergies do become more common from ages 2 to 7, they certainly can be present earlier.

What are the symptoms of allergies?

Nasal allergies typically feature a clear nasal discharge with sneezing. There may be itchy, watery eyes and/or a dry cough. Parents often notice a “rabbit nose” — a child crinkling her nose to relieve the itchy sensation inside. The “allergic salute” — rubbing the nose with the hand, sometimes leaving a horizontal crease on the nose — is another common sign. “Allergic shiners” — dark circles under the eyes — have long been associated with allergies, but are less predictive than the other symptoms.
The symptoms tend to be seasonal if exposure to the triggers is seasonal (like pollen), and year-round if the exposure is year round (like pets).

Is allergies contagious?

Probably not. However, we have discovered that some allergic reactions (hives) can be spread by blood transfusion.

How long does allergies last?

While some children outgrow nasal allergies on their own, most will continue to have nasal allergies unless they are treated with immunotherapy.

How is allergies diagnosed?

A careful allergy history and physical exam will usually point to the right diagnosis. Looking at a swab of the nasal secretions under the microscope can confirm the diagnosis.
Common triggers include pollens, molds, house dust mites, and animal dander (their shed skin cells, not their hair or fur!). Identifying your child’s specific triggers can be very important. This can be accomplished with skin testing or with a blood test (RAST). The skin test tends to be very sensitive with immediate results to a broad range of allergens. The results will be affected by allergy medicines the person is taking. The RAST test is less sensitive, more consistent, and offers something of a quantitative analysis of the results.
In infants, a positive result with either test is likely to indicate a real allergy, but a negative test does not give much information. In older children, the opposite tends to be true. A negative test tends to rule out an allergy, while a positive test does not prove one.
Most people think of specific allergies as black and white — something you either have or you don’t. The truth is much more complex. Being allergic to something is a continuum and that continuum changes over time. Most, but not all, food allergies get better over time. Most airborne allergies get more common as children get older. Some allergies peak before puberty and then disappear. Others don’t even begin until puberty is over. Most people who do get tested for allergies have a single round of skin testing. This can provide a valuable snapshot of allergies at a single moment in time, but this just ‘scratches the surface’ of a child’s long-term allergy story.

How is allergies treated?

Treatment revolves around avoiding allergens and irritants, immunotherapy to desensitize people to allergens, and medicines to control symptoms.
If antihistamines are to be used in children, non-sedating antihistamines (such as Claritin, Allegra, or Zyrtec) are usually the best choice in order to minimize the impact on learning. Your pediatrician may recommend nasal sprays and/or eye drops as very effective treatments for decreasing allergy symptoms.

How can allergies be prevented?

Breastfeeding is very effective at decreasing the risk of allergies. Exposure to other children and animals in the first year of life can also lower the risk of allergies.
Once some allergies have developed, avoiding known allergens can calm the immune system and decrease the risk of new allergies.

Related A-to-Z Information:

Adenovirus, Asthma, Common cold, Conjunctivitis (Pink eye), Ear infection, Eczema, Food allergies, Hives, Nosebleeds (Epistaxis), Peanut allergy, Poison ivy/oak/sumac, Sinusitis

I heard from a reader about an extremely common practice that most of us have been warned never to do:

My wife was cleaning our three-year old daughter’s ear with a cotton swab. She turned into the swab causing it to penetrate her ear causing bleeding. How severe can this be? She doesn’t seem to be experiencing any pain or hearing loss. Why do parents use cotton swabs in kids’ ears?

We want our children’s ears to be clean and when we do try using a white cotton swab we vividly see how much wax there is to remove. Cotton swabs do remove the ear wax, but the irritation they cause also silently stimulates the body to create excess new ear wax, confirming parents’ sense that the swabs are necessary. A cycle develops.

Most of us have not been told why ear wax is good, and how the body is designed to dispose of it.

A slow-flowing river of ear wax is created by our bodies to protect, lubricate, and clean our ear canals. Hairs within the ear canal move the wax out to the surface of the ear where it is visible and may easily be wiped away. If there is too much wax or the wax is too thick, the natural flow can be restored with ear drops that thin the wax. Cotton swabs are absolutely unnecessary. They can also be harmful.

When a cotton swab is introduced into the ear, it can cause infection in the ear canal, injury to the skin lining the ear canal, or injury to the eardrum. Eardrum perforations might heal on their own or might require surgery to repair. If the eardrum is torn there will be pain, but that will disappear quickly (while minor torn skin in the canal might remain tender). There will be hearing loss, but parents may not notice it at home. Thus, painful foreign body injuries in the ear, especially those with bleeding, should be checked.

A study in the August 2000 issue of the Archives of Disease in Childhood found that parents who smoke increase the risk of meningococcal meningitis for their children by about 200% for every 20 cigarettes smoked at home on an average day (220% if the mother smokes, 170% if only the father smokes).

Meningitis can strike suddenly and without warning.

Keeping your kids in a smoke-free environment is one way you help keep them safe — from this and from other childhood problems ranging from ear infections to SIDS.

Testing a baby’s cord blood for levels of maternal antibodies to pneumococcal bacteria can predict the frequency of ear infections.

Information presented at the May 2000 American Society of Pediatric Otolaryngology meeting in Orlando, Florida indicates that low levels of antibodies mean more ear infections.

Perhaps routinely giving the pneumococcal vaccine to women will enable them to produce the antibodies that can protect their children. This may prove to be even more effective at preventing ear infections than giving it to babies and depending on their immature immune systems to create the antibodies over time.

The Great American Smokeout is the American Cancer Society’s call to stop smoking. We all know that smoking leads to serious health problems for adults, but many people just don’t get that being in a room that smells like smoke increases and prolongs colds, coughs, sinus infections, and asthma in children. Secondhand smoke is responsible for 2 million ear infections in children each year.

I know smoking is a tough habit to quit. If adults choose to continue to smoke, please don’t do it in the same room as a child. Invest in HEPA air filters, houseplants, and a fresh coat of paint.  Even better — use the Great American Smokeout as a time to give yourself and your child a tremendous gift by starting a new, smoke-free life.

Bacterial meningitis can occur at any age, but 95 percent of cases are in children under 5 years old.

Boys are more likely to get it than girls.

Together, three types of bacteria account for over 90 percent of bacterial meningitis: H. influenza type b, meningococcus, and pneumococcus.

These bacteria are transmitted by person-to-person contact through respiratory secretions. Many people carry these bacteria with no serious consequence. (Pneumococcus, for instance, is the most common cause of ear infections.) A few people get very sick. Pneumococcus causes meningitis in about 3 per 100,000 people. (Textbook of Pediatric Infectious Disease, Saunders 1998)

Sudden onset meningitis features shock, internal bleeding, purple spots, and reduced consciousness at the very outset, with a rapidly progressive course often resulting in death within 24 hours.

More commonly, meningitis begins with several days of upper respiratory symptoms or gastrointestinal symptoms. Most children have high fevers, severe headaches, and poor feeding. They may also have muscle aches, nasal congestion, vomiting, neck stiffness, and seizures.

Children with meningitis become increasingly irritable and/or lethargic. The presence of petechiae (purple spots that indicate internal bleeding) is a sign that the infection may be raging out of control.

Pneumococcal meningitis is a devastating disease. Of all causes of meningitis, it is the most likely to have a negative outcome (Pediatric Infectious Disease Journal, May 1993). The overuse of antibiotics is resulting in increasingly resistant strains of pneumococcus every month.

In 1991, a vaccine against the H. influenzae Type b (HIB) bacteria was incorporated into the routine immunization schedule beginning at 2 months of age. The amount of meningitis plummeted. Arkansas Children’s Hospital had about 27 cases of HIB meningitis per year in the 1980′s before the vaccine was used. By 1993, the number had dropped to only 1.7 per year (Southern Medical Journal, Jan 1994). During the same period the number of cases dropped by 95 percent in the United States as a whole (Textbook of Pediatric Infectious Diseases, Saunders 1998).

The new pneumococcal vaccine for infants is now FDA approved and recommended by the American Academy of Pediatrics for all children less than 2 years of age. Vaccination of children between 2 and 5 years of age may also be considered on an individual basis. In large clinical studies, the vaccine has been shown to decrease the risk of invasive pneumococcal infection (i.e. meningitis and blood infections) by more than 93%. It has also been shown to decrease the risk of pneumonia and otitis media (ear infections). More information about the vaccine can be found at www.cdc.gov/.

Dr. Greene’s Answer:

Parents need to know about this gentle, effective solution – especially if their children get ear infections. Xylitol (pronounced zie-lit-tall) is a sweet substance found naturally in raspberries and plums. What is it, exactly, and what does it do? The xylophone is a percussion instrument consisting of a series of wooden bars of increasing lengths, which when struck makes sounds of the musical scale. The “xyl” in xylophone comes from the Greek word xylan, meaning wood. A xylophone makes sound from wood; xylitol is a sugar made from wood.

Xylitol, also called wood sugar, can be made from the cell walls of most land plants. Xylan, the naturally occurring substance that yields xylitol when refined, is found most commonly in straw, corncobs, oat hulls, cottonseed hulls, and wood. Xylitol is a common food sweetener. Unlike most sugars which have 6 carbon atoms, this naturally sweet substance has only five.

While other sugars tend to promote the growth of bacteria, xylitol has been proven to inhibit the growth of bacteria. In particular, it has been shown to be effective in preventing dental cavities by inhibiting Streptococcus mutans, the main bacteria responsible for cavities.

Since the major cause of ear infections is Streptococcus pneumoniae, a species of bacteria closely related to Streptococcus mutans, it was thought that perhaps xylitol would prove effective in preventing ear infections. Researchers from Finland tested this hypothesis and published the results of their investigation in the British Medical Journal (November 1996).

The study included 306 children in day care nurseries, most of whom had a history of repeated ear infections. Half of the children chewed xylitol-sweetened gum (2 pieces, 5 times a day — after all meals and snacks); the other half chewed ordinary gum at the same frequency. During the 2 months of the study, 21% of the regular gum chewers, but only 12% of the xylitol group, had one or more ear infections. Gum chewing by itself, by promoting swallowing and thus clearance of the middle ear, probably prevents some ear infections. The sugar in the regular-sugar-sweetened gum may have offset this effect by promoting bacterial growth in the children who chewed this ordinary gum. By contrast, in this study, xylitol dropped the incidence of ear infections by almost half!

In the xylitol group, children took a total of 8.4 grams of xylitol daily. Most experienced no side effects, but two of them developed diarrhea — a known side effect of xylitol and other sweeteners.

A small number of children, almost all of them of Jewish descent, have a congenital enzyme defect making them unable to digest xylitol. This condition is called pentosuria. There are no associated disabilities.

No treatment, and no dietary restriction, is necessary for pentosuria. The xylitol is absorbed into the body and then excreted in the urine. The only problem arising from pentosuria is that children having this sugar in the urine are sometimes mistakenly diagnosed with diabetes, and receive diabetic treatment. Pentosuria has no relationship to diabetes. Children with pentosuria could still use xylitol to prevent ear infections.

This Finnish study, making use of the natural, gentle antibiotic properties of plants, is an exciting development. A similar study conducted by the same authors in 1998 (Pediatrics) confirmed the results found.

In 2004 (Journal of Antimicrobial Chemotherapy), researchers showed that xylitol causes damage to Streptococcus pneumoniae, one of the major causes of ear infections. By damaging the bacteria, it is thought that xylitol works by weakening the bacteria and preventing it from growing.

A large study involving 663 children in 2007 found that the frequency of xylitol use was essential to its effectiveness. Instead of using xylitol 5 times a day, children in the study were given a higher total daily dose of xylitol (9.6 grams instead of 8.4) divided 3 times a day. Even though the total daily dose was greater, ear infections were not reduced on a 3 times a day regimen. Hence, it appears that xylitol must be used at least 5 times a day in order to effectively reduced ear infections (Pediatr Infect Dis J. 2007 May;26(5):423-7).

While much research remains to be done (e.g. the optimal amounts and delivery systems), xylitol seems to be a safe and effective way to reduce the number of ear infections. I suspect it will also prove useful in preventing sinus infections, because the same bacteria are involved.

Since ear infections are the most common diagnosis in pediatrics, it is worthwhile for a parent to learn to become a Sherlock Holmes — able to notice the clues and suspect an ear infection before it becomes advanced. Here are some important things every parent should know about ear infections:

• Throughout the United States, and in the United Kingdom, ear infections are markedly more common in December through March. Their incidence is particularly low from July to September.
• Shockingly, careful studies (e.g. Pediatrics December 1992; 90:1006) have found that 0% of children with ear pulling as the primary sign had ear infections. Even in conjunction with other important clues, such as fever, only 15% of those brought in for ear pulling actually had ear infections. Most commonly, children pull their ears from itching (caused by soap or shampoo in the canal, or by a healing infection), teething, exploration, comfort, or habit.
• Most ear infections hurt. The pain builds as the pressure in the ear builds, from a dull ache to a sharp stabbing pain. The pressure is relieved intermittently, so the pain comes in waves. The pain is worse at night. Most ear infections occur in children under age two. The best clue is evidence of pain, such as crying or screaming (usually less than half an hour), fussiness or irritability (worse when lying down), or suddenly increased difficulty sleeping, especially at night. They often have no pain the following morning.
• In an ear infection, fluid fills the middle ear. Older children often mention a feeling of fullness or decreased hearing in the affected ear. This is difficult to detect in an infant, but you might notice shaking of the head.
• Only one third to one half of children with an ear infection will develop a fever. Temperatures over 104 occur in fewer than 5% of ear infections. Fevers are more common in infants and toddlers than in older children. By itself, a fever is not a powerful clue; but in conjunction with the clues outlined above, it is quite incriminating indeed (the combination of fever and pain is most often an ear infection in infants and toddlers).
• Don’t let other symptoms, such as loose stools or vomiting, throw you off the trail. Ear infections are sometimes accompanied by systemic symptoms.
• Something must plug the Eustachian tube for an ear infection to occur. An upper respiratory infection is often the culprit. The accomplice might also be a change in elevation, allergies, an irritant (such as cigarette smoke), reflux, or drinking a bottle while lying on the back.
• Even with the above clues, only objective evidence can clinch the diagnosis. There is now a wonderful device that uses sonar-like technology to detect fluid in the ear. The device, called an EarChek, is inexpensive, accurate, and simple to use at home. If there is no fluid, there is no ear infection. If fluid is present, only direct visualization of the eardrum by a skilled observer can determine if this is an acute ear infection.
• Remember, it is possible to have an ear infection in an infant with no clues. Here, a positive reading on the EarChek may be the first sign. Also, regular well-child pediatric visits in the first two years screen for these silent episodes.