The common cold: Addressing the everyday questions from the consulting room

In the last few weeks, I have received calls, texts, and WhatsApp messages from several understandably worried parents concerning their children experiencing cough, fever, runny nose, and loss of appetite.

Some parents add that their children have “red eyes”, and they want to know whether that is “Apollo”.  Others state that their children have been vomiting and passing watery stools. Apart from wanting solutions to their complaints, they also want to know if there is an “epidemic”/outbreak. The fear of many is whether Covid-19 is back.

These parents are not alone; many others have been coming to the consulting rooms with all their children with similar concerns.

So today, I would want to address these concerns.

I will say that, yes! their concerns are valid. Currently, there seems to be an upsurge of upper respiratory tract infections (URTI), “common cold (CC)”, “catarrh”, or simply “colds” on their own. However, there is no indication that this upsurge is more than what is usually known at this time of the year; this cannot be considered an outbreak.

So, what is the common cold?

It is an acute upper airway infection, mostly caused by over 200 viruses. The upper airways include the nostrils, sinuses, nasopharynx, tonsils, epiglottis, and windpipes. The most common viruses that cause CC are the rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus (RSV), adenovirus, human metapneumovirus, and influenza. In temperate countries, these viruses occur in seasons. In Ghana, there is little information on the seasonality.

However, research conducted in Kumasi showed that RSV infections are present throughout the year, albeit at peak infection rates around the minor rainy season (October). On the other hand, adenovirus infections have two peaks occurring in April and October.

Who is more likely to contract these viruses?

Both children and adults are affected by these viruses. However, infants not exclusively breastfed and those in daycare centres are more likely to have frequent infections.

How common is common cold in children?

Common colds are arguably the most common reasons why children, especially those under the age of 5, will be brought to the attention of a healthcare professional, like a pediatrician.  In high-income countries where data is available, it is reported that adults have two to four CCs, and children have between six and eight CCs per year. This is because children have little immunity.

Unfortunately, there is little data in developing countries like Ghana. However, in a study conducted in Uganda, the prevalence of CC in children was about 38%. It is known that children under five who are in preschools or daycare centres are more likely to acquire a common cold than those who are taken care of at home. However, they tend to get better as the time spent in the daycare increases.

How is cold transmitted?

Most often, CC spreads when a child’s hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the child touches his or her nose or eyes, the viruses gain entry and produce a new infection. In other instances, cold infections spread when children breathe air containing droplets that are coughed or sneezed out by an infected person and by fomites such as commonly touched surfaces.

For various reasons, nasal or respiratory secretions from children with URTI contain more viruses than those from infected adults. This increased production of viruses, along with the inability of children to maintain hygiene, makes children more likely to spread their infection to others. The possibility of transmission is further enhanced when many children are gathered together, such as in daycare centres and schools.

So, it is mainly known that children bring colds from their schools and pass them on to their parents. Some of the factors influencing the occurrence of CC are crowding and sociability (school, parties, church gatherings, funerals, public transport, cinemas, etc.), stress, secondhand smoking, low immunity, poor nutritional status, and poor quality of sleep).

Contrary to popular believes, factors such as becoming chilled, drinking cold water, becoming wet, or tired, do not cause colds and do not have strong scientific backing as causes of colds.

How will you know that your child has a cold?

Most children with colds will have coughs, sneezing, stuffy or runny nose, and sore throat. The nasal congestion and runny nose are due to the inflammation of the airways, which leads to mucous (phlegm) production. Other symptoms are fever (body temperature above 37.5 degrees Celsius or 99.9 degrees Fahrenheit), fatigue, decreased appetite, and body aches. Infants and young children may be unable to communicate their symptoms, making them cranky, irritable, and uncomfortable.

Again, because infants mostly breathe through their nostrils, those with stuffy nostrils find it difficult to breastfeed and breathe simultaneously, and as such, they may become dehydrated. Furthermore, some children afflicted by viruses, such as adenovirus, may also have red eyes, diarrhea, and vomiting.  Those with severe “flu-like illness” will have systemic symptoms such as fever, muscle aches, pains and malaise.

What will a doctor do for my child if I can purchase medications from a nearby drugstore?

A doctor or a clinician will want to ask when the cold started. He or she will ask you questions to know whether your ward has complications or another co-occurring condition. He or she will then examine your child to ascertain whether your child, for instance, has a middle ear infection, tonsil infection, or pneumonia.

Furthermore, children who are very sick and refuse to breastfeed, drink water, or take their usual food may become dehydrated, and the health care professional is well placed to determine that and intervene. Thus, the physicians are better positioned to know what is wrong with your child and proffer appropriate treatment.

How long does cold take to resolve?

The symptoms typically worsen by day 2-3 of the cold and then gradually clear by day 7-10, though the cough can persist for 3 weeks. Depending on the type of virus implicated in the cold, the fever may last just a day or more. If the fever takes too long to subside, it may be that there is a co-infection ( (e.g., another virus, a bacterial infection, or even malaria) or there is a complication (e.g., acute middle ear infection, infection of the sinuses, or an infection of the lungs)

Are there any complications?

Colds as viral infections are largely self-limiting. However, some children may develop middle ear infections or infections of the sinuses. Children who live with asthma, and particularly those who are not taking their preventive/controller or maintenance medications (inhaled steroids), are likely to develop an asthma attack. Other children may develop lower respiratory tract infections (pneumonia).

Are there any laboratory investigations that can tell me what the cause is?

Mostly viral infections, in this case, those that cause colds, affect many people simultaneously, and there could be a seasonality to that; as has been already stated, the disease is short-lived. So, with this knowledge, most healthcare professionals will not conduct any laboratory investigation and will use their prior knowledge and experiences to provide treatment. However, in some instances, doctors will conduct tests that will give an indication that the cause of the infection is viral or bacterial, such as the Full/Complete Blood Count, popularly known as FBC or CBC if you are used to the American system.

Healthcare professionals sometimes conduct studies to determine which viruses are the main culprits, especially in the early days of an epidemic. For example, during the COVID-19 pandemic, which started in China, the Chinese authorities had to isolate the virus and then compare it to other viruses to know the behaviour of the affecting agent. Based on the early investigations, they were able to provide guidance as to how cases of Covid-19 should be managed.  A test called polymerase chain reaction (PCR), which can detect the particles of the viruses, could be a quick test to determine the cause of the cold. However, it is very expensive and not frequently available.

If the child’s symptoms are still not improving or if the patient appears quite unwell, your healthcare professional will perform additional tests to ascertain the reason for the lack of improvement and provide suitable treatment. For instance, they might request a malaria test, a blood or urine culture, or a chest X-ray (if they suspect a chest infection), to name just a few.

What is the treatment for a child with a cold?

Remember that colds are short-lived; viruses cause them, and most viruses have no medication for treatment. Therefore, most colds are self-diagnosed and self-treated at home. The body produces antibodies (your body’s soldiers) to combat the infection; in this regard, treating a child with a cold is primarily supportive.

Patients with colds who present at hospitals benefit from reassurance, education, and guidance on managing symptoms at home. The focus of treatment is to alleviate fever, nasal congestion, runny nose, and cough.

Managing the fever.

Many parents fear fever, which is a primary reason they take their children to the hospital. It can be managed with paracetamol and/or ibuprofen. Paracetamol acts as a pain reliever and reduces fever; it can be administered orally or rectally, every 4-8 hours. Ibuprofen is taken orally and administered every 8 hours, and it alleviates fever, pain, and inflammation. Although ibuprofen has occasionally been observed to reduce fever more effectively than paracetamol, it should be used with caution.

This is because some individuals may be allergic to it; it can irritate a child’s stomach if consumed on an empty stomach, and it may impact the kidneys if the child is not adequately hydrated. For both medications, if the child’s temperature is normal (temperature between 36.5 and 37.5 degrees Celsius) and they are not in pain, it is advisable to refrain from administering them. Always remember to keep your medications out of the child’s reach and ensure it is child-proof.

Managing the cough.

Cough could be a worrying symptom associated with colds, and for that matter, most parents seek treatment for it.  The cough is an important defensive mechanism that the body uses to clear secretions and particles from the airways, and it protects the lower part of the airway from the aspiration of foreign bodies. There are varieties of medications that are used to treat it. They serve as cough suppressants such as dextromethorphan, expectorants (guaifenesin), and decongestants such as pseudoephedrine and phenylpropanolamine.

Some of these medications are also combined with, for example, an antihistamine,  paracetamol, or ibuprofen to make them more effective, but they may end up causing drug-drug interactions with potentially serious side effects. Some of these medications (first-generation antihistamines (diphenhydramine, chlorpheniramine, promethazine) can cross the blood-brain barrier and enter the brain, causing drowsiness and other side effects. This sometimes makes it difficult to tell if a child with a cold is sick or drowsy from the medication.  It also makes it difficult to dose appropriately.

Again, some of them (first-generation antihistamines) have been shown to compromise performance at school.  These cold medicines are sold over-the-counter, meaning you can walk into a pharmacy and purchase without a doctor’s prescriptions and instructions.

However, it is interesting to note that, although they provide symptom relief, there is no conclusive evidence that cough syrups shorten the duration of the disease. Furthermore, some of these medications (e.g.,  pseudoephedrine) have been implicated in the death of children, particularly children under the age of 5 years. Again, in  September 2022, in the Gambia, they detected unacceptable levels of toxic chemicals (diethylene glycol and ethylene glycol) in some cough and cold medicines that led to the death of many children.

Due to these reasons, cough and cold medicines are generally not recommended for children under six (6) years of age, particularly those under the age of two (2).  Consequently, healthcare professionals, particularly pediatricians,  are very cautious in prescribing these medications.

You are unlikely to get a cough and cold medication prescription the next time you visit a doctor with your child who is less than 6 years old. However, second-generation antihistamines (loratadine, cetirizine, and fexofenadine) have excellent safety profiles in children, are less sedative, and, in recommended doses, may help manage the itching, sneezing, and runny nose in young children with colds.

Managing the nasal congestion/runny nose

Salt-water solutions (physiological saline) or seawater-based preparations for nasal drops, spray, or irrigation are beneficial as they provide moist to the airways and help in mucus clearance, and it has been found to reduce the duration of cold symptoms, particularly if they are used at the onset of the symptoms. Salt is made up of sodium and chloride.

The chloride part is used by the cells lining the nostrils and the windpipes to produce hypochlorous acid (HC) within the cell. These cells use this HC to fight against viral infection. By providing more chloride to the cells, they can produce more of the HC, which helps to reduce viral replication and, consequently, shorter the duration of the cold. It has been reported that fewer household contacts catch a cold when children get salt-water solution drops.

Nasal drops are easy and safe to administer to parents, giving them some control over their children’s illnesses. In contrast, nebulisation of salt-water solutions can be cumbersome and costly; one must purchase a nebuliser and maintain a constant power supply. Nebulisation can potentially cause suffocation, necessitating constant supervision by parents.

The World Health Organisation (WHO) cautions against using aerosolising nebulisation and procedures as they may facilitate viral spread through the droplets of secretions generated. However, your child’s physician may prescribe nebulisation in necessary cases, such as during an asthma attack.

Your doctor may prescribe intranasal steroids to patients with moderate to severe congestion. However, nasal decongestants have not been beneficial in children in most situations.

Are antibiotics needed in the treatment of colds?

The role of antibiotics in the treatment of colds is contentious, as over 90% of colds are of viral origin. Antibiotics are unnecessarily overprescribed for CC, and it contribute to antibiotic resistance in the community. The reasons for overprescription are that parents put pressure on their physicians for some instant solution, they have great expectations of the antibiotics, and some see them as a social status.

On the part of the health care professionals, they sometimes give in to the heavy pressures they receive from parents to prescribe antibiotics; it may be due to diagnostic challenges and being weary of litigations.  It is interesting to note that antibiotics do not reduce the clinical course or complications associated with CC. However, there are indications for the use of antibiotics in CC, such as when there is an acute middle ear infection and infection of the sinuses.

Are there any complementary and alternative medicine (CAM) for treating colds?

Traditionally, CAM has been used in the treatment of colds. However, results from scientific studies on herbal remedies are conflicting. Some of these medications are said to boost the child’s immunity. However, the impact on the immune system of children is not known. Honey has been rated most favourable in symptomatic relief of the child’s nighttime cough and sleeping difficulty compared to cough and cold medicine like diphenhydramine and no nighttime treatment.

The thinking related to this finding is that honey has antioxidant and antimicrobial properties, while another school believes it induces natural opioid production. However, it should not be given to children less than 12 months. This is because honey can be contaminated with a bacterial called Clostridium botulinum, leading to a rare disease called infant baptism. One of the major problems in the use of CAM is standardisation.  It appears that everyone is pursuing their own approach.

Are there specific treatments for the viruses that cause CC?

There are no licensed and effective antiviral agents for most of the viruses that cause CC. Moreover, the side effects of some of the few antiviral agents cause symptoms indistinguishable from CC.

Can everyday supplementation of vitamin C prevent CC?

Vitamin C (ascorbic acid) has been touted as a cold prevention for over 70 years. However, research suggests that daily vitamin C intake does not reduce the risk of acquiring colds in the general population. Still, regular consumption can shorten the duration and severity of colds It is more effective for those with severe symptoms compared to mild ones.

Additionally, it may benefit individuals subjected to brief periods of intense physical exercise, such as marathon runners and military personnel. When vitamin C is administered at treatment doses and initiated at the onset of symptoms, research has shown no consistent effect on the duration and severity of cold symptoms. Only a few treatments or therapeutic trials have been conducted, and none included children, although preventive vitamin C intake has proven effective in this age group.

Therefore, the conclusion is that there is no justification for regular vitamin C supplementation. Nevertheless, given its consistent impact on duration and severity, along with its low cost and safety profile, individual patients might consider trying treatment doses to see if it benefits them. Vitamin C is a naturally occurring antihistamine that reduces the number of histamines the body produces in response to allergens, which may alleviate symptoms of colds such as sneezing, runny nose, nasal congestion, and watery eyes.

Natural sources of vitamin C include oranges, lemon, grapefruits, lime, pawpaw, guava, strawberries, blueberries, raspberries, potatoes, broccoli, green pepper, etc.)

Since my child caught the cold, he refuses to eat his food; what should I do?

Most people, particularly children who are not well, will have some loss of appetite. Infants and young children with nasal stuffiness find it difficult to breathe and breastfeed at the same time because they are compelled to breathe through nostrils most of the time.  For these reasons, if your infant or child less than two years old only wants to breastfeed, make sure you nurse him or her frequently at the breast.

You can also express breastmilk and feed him with a cup and spoon. For the older children who are refusing to eat, you can feed them with small quantities but frequent meals, and offering them what they want to eat is advisable.

What other things can I do to help my child recover?

Drink plenty of fluid.

Give your child plenty of water. You can also give him or her juices, warm lemon and honey drinks, and soups. These may help thin mucous secretion and prevent the child from becoming dehydrated, especially in those with high body temperatures. Oral Rehydration Salt (ORS) and zinc are recommended for concomitant diarrhoea.

Make sure your child gets some rest. Your child’s body needs rest to recover.

Children with a sore throat can get relief by gargling with warm water and salt and licking on hard candies, popsicles, cold beverages, and ice cream.

How do I prevent my children from contracting a cold?

Research suggests that exclusively breastfed babies are less likely to catch colds.

Make sure your child eats a healthy and well-balanced diet.

Regular hand washing and sanitisers (at least 60% alcohol) are recommended.

During outbreaks, face masks are effective in preventing the spread of infections (e.g., Covid-19).

Observing social and physical distance in case of an outbreak is advisable.

We are advised to practice cough etiquette (cover your mouth with your elbow or tissue when coughing).

Most of the time, the human body can produce antibodies (body soldiers) to fight most of the viral infections. However, antibodies against respiratory infections are short-lived, so reinfection may occur when antibody levels decline and when the virus evolves into a new type, which may be more potent than the previous.

For certain viruses, scientists have managed to weaken or modify them to develop vaccines (e.g Covid-19, influenza viruses). When introduced into the human body, these vaccines can stimulate the production of antibodies, which will subsequently combat that specific virus when it attacks anyone who has been administered the vaccine.

These vaccines undergo rigorous quality assurance processes and are safe for human use (e.g., the Covid-19 vaccines). It is, therefore, recommended that we take our children for immunisation as scheduled by health authorities.

When should I be worried about my child’s cold?

You should be worried if your child is less than 3 months old, the fever persists for more than 3 days, your child is weak and refuses every food, he is breathing faster than usual, the lips are blue, and the cough goes beyond two weeks.

In conclusion

The common cold is a leading cause for parents taking their child to see a pediatrician and is primarily of viral origin. An affected child may experience a cough, runny or stuffy nose, sneezing, fever, and a sore throat. Other symptoms include watery eyes, vomiting, body pain, and malaise. The common cold typically resolves within 7 to 10 days. Supportive treatment aims to alleviate fever, nasal congestion, runny nose, and cough.

Paracetamol and ibuprofen are commonly used to control fever, while salt-water solutions can be effective in treating nasal blockage. Your child’s doctor may not prescribe cough syrup, especially if the child is under 5 years old. Ensure your child drinks plenty of fluids, such as water, soups, and juices, and gets adequate rest. Exclusive breastfeeding, handwashing, hand sanitizers, and vaccinations for certain viruses can help prevent colds in your child. Although self-limiting, the common cold can be associated with middle ear and sinus infections and may trigger acute asthma attacks in children with asthma.

Author: Dr. Kojo Ahor-Essel
Consultant Paediatrician, The Bank Hospital, Cantonments, Accra, and a member of the Paediatric Society of Ghana

I declare no competing financial interest.

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