COLDS / UPPER RESPIRATORY TRACT INFECTION / URI

A cold or upper respiratory tract infection is characterized by runny nasal discharge, a low grade fever, a cough and follows a generally benign course. Everyone has had a cold and will continue to have colds throughout their life making it easy to diagnose.

Colds are caused by viruses. There are probably hundreds of different viruses and the immunity we develop after having one is short-lived. This is why we seem to never become immune to the cold and why there is such variability in the symptoms. There is good evidence that poor nutrition, poor hygiene and an "altered" immune system can contribute to catching a cold. By altered I am mainly referring to a weakened state of the immune system that can be caused by any stress to that system. For example; hypothermia, being overly thin, being exposed to cigarette or fireplace smoke, vitamin deficiencies, or even having recently recovered from another illness. We are continually exposed to viruses and bacteria and our body's immune system generally does a good job of preventing that infection from "catching" on and hurting us. The above factors weaken that system making it more likely to get sick, while they do not cause the infection themselves. Therefore, the wives tale of catching a cold from the cold is actually partially true. Exposure to a cold and then warm environment will cause your nose to run for a little while. We call this vasomotor rhinitis and it is simply a temporary physical phenomenon, not an infection. The reason we catch more colds in the winter has more to do with the coldness outside pushing us inside and closer together and with the natural cycles that infections follow. Most children have about 5 to 8 colds a year. When children attend daycare that number increases by 50 to 100% and when they are exposed to cigarette smoke it increases by 50 to 200%. The surest way to catch a cold is to touch someone's infected nasal secretions from them or an object and then touch those infected secretions onto your eyes, nose or mouth.

The nasal, eye and oral secretions of someone with a cold are contagious for about 3 to 5 days. It is impossible for that person to wash enough to keep their secretions off their hands and the objects they touch. When you touch those objects, shake that person's hand or walk through the cloud of water droplets they just coughed up, then you have contacted that virus. But contact itself does not make you sick. If you touch those secretions to your mucus membranes (eye, nose, mouth), then you will get infected. How your immune system is functioning currently will determine if you actually get ill and how ill you will become. If you touch your mucus membranes frequently, then you will probably get colds frequently. If you are in general good health, have good nutrition, perhaps take vitamins and generally keep your hands off your face, then you will probably not get colds often, but you will still get them.

Because their are so many viruses that cause colds, their is some variability in the symptoms and their time course. Most colds last about 7 to 10 days, but some are as short as 5 days and some last up to 1 month. Generally a cold starts out with a clear profuse runny nose and a low grade (<102) fever. The fever lasts about 1 to 2 days at most and never returns. The nasal secretions change from clear to cloudy white, then cloudy and thicker yellow, then sometimes green while continually thickening and then just slowly reducing in amount until resolving. The nasal mucus may actually stay green for up to a month, but will be small in amount and will slowly resolve (while a sinus infection will have profuse and worsening green nasal discharge and a face ache). About the time the secretions start to thicken, the cough starts. The cough is generally congested or productive sounding at first and then over the next few days becomes dry and hacky and then slowly resolves over the next 7 to 21 days. Occasionally a sore throat develops from the nasal secretions draining into the back of the throat. Usually the sore throat develops because the nasal secretions block the nose making you breath through your mouth at night. When the air is dry, the mouth dries out, the lips dry out and the throat gets sore.

This is a heavily loaded area so bear with me. Vaccination is one hope, but try developing a vaccine to cover a few hundred viruses that is safe and effective and cost effective. After reading this you can see that we actually have already the treatment for the cold ...time and knowledge.

• Colds are caused by viruses and antibiotics have no effect on them.
• The symptoms we feel are also our bodies mechanism of fighting that infection on its own and killing the virus, even f we could, will not usually stop this.
• There has not been a single medical study that has proven any cold medicine to have any beneficial effect for children. (not relieving symptoms, making them feel better or preventing anything).
• Approximately 100,000 children must go to the emergency room every year due to a COLD MEDICINE SIDE EFFECT.
• Approximately 100,000 Americans die every year due to drug resistant infections caused by doctors giving out too many antibiotics.
• Approximately 100,000 Americans die every year by prescription drug reactions.
• Fevers are GOOD FOR YOU.
• The fever helps your body fight the infections.
• Fevers are not dangerous until they get over 108 degrees F. (yes that is an eight)
• At least one study showed that cold symptoms last 2 days longer when you give fever reducing medicines.
• 60-80% of physicians will give you an antibiotic for a simple cold or green nasal discharge that has lasted more then 2 days. (neither of which will be helped in any way by the antibiotic). THEREFORE ASK QUESTIONS OF YOUR DOCTOR ABOUT WHY YOU NEED THE ANTIBIOTIC.

Regardless of what you do the cold will resolve in a week or so. One of my favorite old time sayings is, “If you treat a cold is will last 7 days and if you don’t treat it then it will last a week”. Think about it! What you do for the cold should be aimed at causing no further harm, soothing the symptoms and watching for complications. I have been asking grandmothers for 30 years, “Have you ever used a cold medicine that did any good at all?” I am waiting for my first yes!

First, cause no further harm. All medicines have side effects. I stopped counting long ago the emergency room reports of my patients who were there simply because of the side effects of the cold medicine they were using. Even when using the generally agreed upon safe doses, you can still have an idiosyncratic (unexplained, not dose related) side effect from the cold medicine. Therefore, if you are going to use a cold medicine at all, then pick one drug to treat the symptom most bothersome to you. This approach will risk the least side effects while offering the most chance of benefit. Do remember that the cold medicine will not cure, prevent, eliminate, reduce or do anything except possibly reduce symptoms a little and risk a side effect. Most people also mistakenly believe a fever is harmful and should be reduced. Our bodies evolved the fever to help fight infection. Fevers are not harmful until they get well over 108 (yes eight) and I have never seen a fever over 106. As my patients have heard me say a million times, "fevers don't hurt you, what causes the fever is what hurts you". When you reduce that fever with medicines, studies show that colds symptoms may take as much as 2 days longer to resolve. So when should you treat a fever, many experts in infectious diseases would argue never. We often will reduce a fever to see how sick a child really is. For instance, if the fever is 105 in a 1 year old, but when reduced the child is playing and has no other symptoms, then we ignore it. If the fever does not come down, or they still look very ill when the fever is down, then there is a problem. You may also reduce a fever if you feel your child is "too" uncomfortable, but remember the illness will just last that much longer.

Second, soothe the symptoms. The time honored remedies often are the best ones here. See the nasal congestion page for how to help that (suction, saline, humidity, elevate the head of bed). If the child is old enough, then offer chicken noodle soup. Sorry the soup must be homemade. A study actually showed that one woman's homemade chicken noodle soup did have antiviral activity. More importantly though, the Tender Loving Care factor of making the soup probably helped more than the soup. The sauves you put on the chest work by this same TLC method, otherwise offer no benefit, but are not harmful unless taken internally. "COLD" medications have not only been proven of no benefit, they have been proven harmful and finally in 2007, the FDA started pulling some of them off the store shelves.

HOMEOPATHIC MEDICATION: The short answer is that they are highly unlikely to hurt and have no evidence that they help. The short version of homeopathy is this: take some plant extract someone thinks might help, dilute it down so that there is almost none of it detectable, and give that as a medicine, and do absolutely no scientific study on whether is safe or effective. I heard a radio ad for one homeopathic medicine that stated: “claims based on traditional homeopathic practice, NOT ACCEPTED SCIENTIFIC EVIDENCE”. That is not to say all homeopathic medications are safe. Do check poison control web sites for the active ingredients in the medicine if they even list them.

Allergies: This gives a runny nose, not generally a stuffy one. There often will be pinkness to the eye lids and clear runny eyes.

Influenza: Influenza has a higher fever (103 to 105), muscle aches, a head ache and minor if any runny nose and cough at first. Eventually influenza gives a mild runny nose and cough after the first day or so. Influenza also last about 5 to 7 days.

Nasal Congestion: Nasal congestion is simply a stuffy nose. It is not runny and is not associated with a significant cough or fever.

Sinus infection: This is usually a profusely runny nasal discharge that is green, worsens over a few days and is associated with a "face ache" and low grade fevers.

Others: There are a great deal of other illnesses that look like colds. I would only get concerned if your child's illness does not follow the above course or unusual symptoms show up.

All of us have experienced colds. You should simply watch for unusual signs or a deviation from what you expect a cold to do. This is basically how you should view all illnesses in life. When something appears to be what you expect and you are comfortable with it, then observe it. When that illness changes into something you have not seen, then you should think about seeking help. First, try the resources quickly available, such as; home medical books, relatives, the Internet (reputable sites, like webbed, cdc, American academy of pediatrics, and finally if your concern cannot be calmed, then call your doctor. Please remember that after hours phone calls should be placed only if you are unsure whether to go to the emergency room or wait until office hours and to find out how to make your child comfortable until then. We cannot diagnose over the phone, only advise you what action to take at that minute given a set of symptoms. Doctors on call are not just awake waiting for your call. We are enjoying our families just like you. Please be considerate and unless your call is that important, then call during office hours. On the other hand, we understand how hard it is to see your new baby ill. We understand that common sense does not seem that common when its your new baby that's ill. If you are genuinely worried about your child's well being, then call your pediatrician ANYTIME. If you are still genuinely worried about your child even after talking to your pediatrician, then you should take you child to see a physician immediately. Your intuition as a parent is more valuable than a medical degree over the phone.

CALL DURING BUSINESS HOURS:

• If your child develops a profuse green runny nose that is worsening over a few days
• your child's temperature is higher than 102 for more than 2 days
• your child has moderate problems feeding even after using the above treatment
• your child is urinating less than usual

CALL IMMEDIATELY:

• Your child has difficulty breathing that cannot be cured by clearing out the nose, that is breathing hard or fast
• your child's temperature is >105
• your child has not urinated in over 8 hours and is less than 6 months old
• your child has not urinated in over 12 hours or has a dry mouth (not the lips, I mean on the inside)
• your child is difficult to arouse or acts confused (in this case consider calling 911 or going straight to the emergency room if close)