by Dr. Pamela Bandelaria, pediatrician

Coughs and colds are some of the most common complaints for which a parent seeks advice from their doctor for their baby. Most of the time, coughs and colds are harmless and go away independently, causing only minor inconveniences and minimal worry. However, there are times that coughs and colds become more serious and can disrupt your baby’s routines and daily activities. This article will describe what causes cough and colds, when you should see a doctor, and when you should worry about your child's symptoms.

What causes cough and colds?

Most coughs and colds are caused by viruses, half of which are caused by the Rhinovirus.   Other viruses can also cause colds, including respiratory syncytial virus, adenovirus, influenza, and parainfluenza virus. Because these viruses are more rampant during the colder months, many cases usually occur between the fall and spring.

The viruses are acquired and spread through different means. Infants can get the virus through the air or in the form of aerosol droplets released after a cough or sneeze.  They can also get it through direct contact after touching an infected person or object. Once the virus enters the nasal passages, it infects and destroys the nasal lining, triggering an inflammatory response leading to the symptoms which manifest after three to five days.

Infants and children usually get an average of seven to eight colds per year. In other cases, children can get as many as 12 episodes a year, especially in environments with greater exposure to the virus. It has been found that children in daycare centers contracted at least 50% more cases of colds than those that stay at home. The incidence of cough and colds gradually decreases as the child gets older, but viruses are the most common cause of infections in the respiratory tract.

How do I know if my baby has bronchitis or a cold?

The common cold usually affects the upper respiratory tract, including the nasal passages and upper airways. If the lower respiratory tract is affected, the most common condition found in infants and young children under two years old is acute bronchiolitis, which is the inflammation of the small airway passages (bronchioles) in the respiratory tract. Bronchitis is a similar condition to bronchiolitis and affects the airway passages called bronchi/bronchus. Bronchi are airway passages that connect the trachea to the lungs. Bronchi have a smaller diameter compared to the trachea. A common cold is thus inflammation of the nasal passages, and bronchitis is an inflammation of the bronchi or the airway passages. In all cases, viruses are the most common cause among children.

What are the symptoms of the common cold?

Symptoms of a cold usually appear after three to five days and result from the immune response and inflammation caused by the infection. The common cold usually presents as watery nasal discharge or rhinorrhea, especially in infants. This symptom is commonly known as a runny nose. Sometimes, due to the increased mucus production and swelling, there is a blockage of the nasal passages and a feeling of a blocked nose. Because infants cannot verbalize that their nose feels clogged, a clogged nose can sometimes present as difficulty breathing, noisy breathing, or breathing through the mouth, as well as irritability or difficulty in sleeping. Older children may experience mild headaches or body aches. Fever may be noted in infants but is usually not high grade. The common cold may also be associated with cough in around 60% of cases. Sore throat and a decreased appetite may also be observed in some cases. These symptoms can last for one to two weeks.

What are the symptoms of bronchitis?

Because the common colds cause inflamed nasal passages, and bronchitis causes inflammation of the airway passages, it is often difficult to distinguish between these two conditions. Although bronchitis may also begin with nasal discharge and nasal obstruction, other signs may also become noticeable as the course of illness progresses. Fever may or may not be present. Because of the inflammation in bronchitis, the airways swell, and the diameter of the airway passages becomes smaller. Mucus secretion from the inflammation can occur, which forces the body to try to expel it, leading to a cough.

Cough is the primary symptom of bronchitis and may occur three days after the nasal symptoms begin. The cough can last two to three weeks. Vomiting can also occur due to continuous coughing and because children tend to swallow phlegm. Older children may sometimes complain of chest pain, which is often worsened by persistent coughing.  As the illness progresses, the lower airway passages are also affected. This creates an airway obstruction that can generate a high-pitched musical sound called a wheeze. Wheezes are best heard with the aid of a stethoscope but sometimes can be heard as noisy breathing, especially if the narrowing of the passages is significant. In infants, wheezes and noisy breathing are common signs that accompany cough and colds because bronchiolitis is common in this age group.

How long do I wait to see a doctor for my baby’s cough?

There is no specific time frame for when you should wait to see a doctor for your baby’s cough. In mild cases, cough and colds mostly resolve on their own, even without a check-up. However, there are warning signs that you can look out for to ensure that the cough and colds are not due to other causes that are more serious and dangerous. Other conditions that can also present with cough and colds include foreign body in the respiratory tract, bacterial infections such as pertussis, or other inflammations such as allergic rhinitis or sinusitis. More severe conditions include cystic fibrosis, which is usually diagnosed by two years of age, or immune deficiency disorders. These conditions typically present with persistent or recurrent cough or colds which can lead to severe pneumonia. The common cold caused by viruses usually lasts for two weeks. In most cases, these resolve on their own. If the cough and colds persist beyond this time, or if you notice any other symptoms accompanying your baby's cough and colds, it is best to have your baby checked so that other causes may be investigated.

Will bronchitis go away on its own?   

Bronchitis can go away on its own if it is caused by a virus. Just like the common cold, viral illnesses usually last one to two weeks. Viral bronchitis is self-resolving. However, if your baby's cold persists beyond this time period, it is best to have them checked up. Bronchitis that is caused by bacteria will require antibiotic therapy prescribed by your physician to improve.

When should you worry about a cough?

In general, when your baby has cough and colds, an immediate consult with a physician must occur if there are any signs of respiratory distress. Respiratory distress indicates poor oxygen exchange and that your baby's body is compensating for the poor flow of air in the respiratory tract. Signs of respiratory distress include labored breathing, including deep breathing with flaring of the nostrils, the use of accessory muscles in between the ribs or under the clavicle, and changes in your baby's color (turning blue, termed "cyanosis" or pale, which is termed "pallor").

The following signs suggest that the cold is caused by other conditions:

• Secretions that are foul-smelling and only noted on one side of the nose suggest the presence of a foreign body in the air passages.

• Constant allergen exposure might cause allergic rhinitis.

• If the cough and colds last longer than 10-14 days, it may be due to sinusitis or other bacterial infections such as pertussis.

• Persistent or recurrent coughs and colds that last for months can also indicate more severe conditions such as cystic fibrosis or immune deficiency disorders.

If you notice these signs and symptoms, it may be best to have your baby evaluated by a healthcare professional.

How do you manage cough and colds?

The American Academy of Pediatrics recommends supportive treatment for cough and colds because cough and colds are generally caused by viral illnesses and are more likely to resolve independently. Therefore, treatment is geared towards alleviating or minimizing the symptoms and their effects. Antimicrobial therapy is generally not recommended and, if misused, can have side effects or lead to antibiotic resistance.

Supportive care includes ensuring that your baby is well hydrated, drying secretions, and boosting immunity. Oral hydration can also help in thinning the consistency of secretions and aid in improving nasal obstruction. Nasal saline and other nasal decongestants may be used to alleviate nasal symptoms and help improve your baby’s breathing. Increased intake of vitamins also helps in boosting immunity against colds. Zinc syrup was found to decrease the duration of colds, especially if started within 24 hours of symptom onset. If your baby has a fever, you may give them medications to lower it, although fever is an uncommon symptom.

Part of managing cough and colds is prevention.  In most cases, babies get viral illnesses from infected caregivers who touch and hold them. This is important because the immune system of babies and infants are not yet fully developed, and their vaccines are not yet complete, which makes them susceptible to all kinds of illnesses. Even if an infected person does not present with symptoms yet, they already carry the microbes and germs and can transfer them to their baby. Therefore, it is essential to maintain good hygiene, especially when handling babies. Washing your hands is advised, in addition to ensuring that all items that your baby uses are clean.  Keeping your baby clean by washing their hands and giving baths is also helpful to maintain good hygiene. If you or somebody caring for the baby is not feeling well, keep them away from your baby to prevent the spread of infection.

Do I need antibiotics for a persistent cough?

Antibiotic intake is generally not recommended for cough. Furthermore, colds due to viral illnesses are self-limiting and usually resolve on their own. As mentioned, colds typically last for up to two weeks, and the improper administration of antibiotics can have more risks than benefits. Antibiotics have side effects, just like any other medication. The misuse of antibiotics can also lead to antibiotic resistance, wherein the effectiveness of the antibiotic decreases because the disease-causing microbes develop defense mechanisms against the antimicrobial medications. When microbes become antibiotic-resistant, they will not be eradicated by the antibiotics and will continue to grow and multiply, causing the further spread of the infection.

What is the best thing to do if the cough is persistent?

The best thing to do is to bring your baby to your physician. Your physician can do a proper and complete physical examination which includes listening to the breath sounds of your baby with a stethoscope. Certain signs are indicative of a bacterial infection that can be treated with antibiotics. Moreover, your physician can request laboratory examinations to investigate whether the cause of your baby’s cough is due to a bacterial infection. Only bacterial infections will improve with antibiotic therapy.

Conclusion

In conclusion, coughs and colds will be some of the most common symptoms that you would see in your baby. In most cases, the cough and colds are not life-threatening. However, it is important to know what to look for if the symptoms are more severe. It is also important to know when a consult with your doctor is warranted. As long as your baby is active, eating well, and has no other worrying signs and symptoms, the cold is most likely be due to a viral infection and will resolve on its own. However, if there are signs of difficulty in breathing and if the cough and colds persist for more than two to three weeks, it is best to consult a doctor so that more serious illnesses can be ruled out.