Upper respiratory infection

Upper respiratory tract infection also called “URTI”, upper respiratory infection (URI) or “the common cold” is an infection of the nose, sinuses (sinusitis), throat (pharyngitis), epiglottis (epiglottitis) or larynx and trachea (laryngotracheitis). Defining most of these upper respiratory infection diseases is difficult because the presentations connected with upper respiratory tract infections (URIs) commonly overlap and their causes are similar. Upper respiratory infections are usually caused by several families of virus; these are the rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus (RSV), adenovirus, human metapneumovirus and influenza ¹⁾, that is spread by coughs, sneezes, and direct contact. These cause a variety of patient diseases including acute bronchitis, the common cold, influenza, and respiratory distress syndromes ²⁾. Occasionally the enterovirus is implicated in summer. Recently, the newly discovered bocavirus (related to the parvovirus) has also been linked to upper respiratory infection ³⁾. The common cold is the most frequent kind of upper respiratory infection. The flu and sinus infections are other kinds of upper respiratory infections.

The term upper respiratory tract infection is probably a misnomer as it incorrectly implies an absence of lower respiratory tract symptoms. Upper respiratory tract infection (URTI) occurs commonly in both children and adults and is a major cause of mild illness. Upper respiratory tract infections account for an estimated 10 million outpatient appointments a year. Adults get a common cold around two to three times yearly whereas children can have up to eight cases yearly ⁴⁾. Respiratory infections are more common in the fall and winter when school starts and indoor crowding facilitates transmission. Fall months see a peak in incidence of common cold caused by the rhinovirus. Upper respiratory tract infections are accountable for greater than 20 million missed days of school and greater than 20 million days of work lost, thus generating a large economic burden ⁵⁾.

Infections of the respiratory tract are grouped according to their symptomatology and anatomic involvement. Acute upper respiratory infections (URI) include the common cold, pharyngitis, epiglottitis, and laryngotracheitis. These infections are usually benign, transitory and self-limited, although epiglottitis and laryngotracheitis can be serious diseases in children and young infants.

Almost all upper respiratory infections are caused by viruses, so antibiotics won’t cure them. But you can do things at home to help your child get better. With most upper respiratory infections, your child should feel better in 4 to 10 days.

Figure 1. Upper respiratory infection

Figure 2. Upper respiratory infections treatment guidelines

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Figure 3. Effective treatments for cold symptoms in children

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What are antibiotics?

Antibiotics are medicines that can fight or prevent bacterial infections. Upper respiratory infections are caused by two types of germs—bacteria and viruses. Antibiotics do not work against infections caused by a virus. A virus causes most coughs, colds, sore throats, and sinus infections. When you have a virus, ask your doctor what you can do to feel better. For example, if you have common cold caused by rhinovirus, respiratory syncytial virus (RSV), influenza virus, parainfluenza virus, adenovirus or enterovirus ⁸⁾, treatments in adults are limited to over-the-counter analgesics, zinc, nasal decongestants with or without antihistamines, and ipratropium for cough ⁹⁾. The American Academy of Pediatrics Choosing Wisely recommendation states that cough and cold medicines should be avoided for respiratory illness in children younger than four years ¹⁰⁾. And the only established safe and effective treatments for children are acetylcysteine, honey (for children one year and older), nasal saline irrigation, intranasal ipratropium, and topical application of ointment containing camphor, menthol, and eucalyptus oils ¹¹⁾.

The majority of acute upper respiratory infections (URIs) are caused by viruses and the use of antibiotic treatment is ineffective, inappropriate and potentially harmful ¹²⁾, ¹³⁾. However, proven upper respiratory infection caused by Group A Streptococcal disease (Strep throat) and pertussis (whooping cough) should be treated with antibiotic therapy. Symptomatic treatment for acute upper respiratory infections should be directed to maximize relief of the most prominent symptom(s).

How do antibiotics work?

Antibiotics kill off the weaker bacteria the first few times you take them. At first you will start to feel better. However, the stronger bacteria are still alive. If you stop taking these medicines too soon (as soon as you start to feel better), the stronger bacteria can keep growing, and the antibiotic won’t work anymore.

When do I need antibiotics?

You need antibiotics to stop an infection caused by bacteria, such as Strep throat (Group A Streptococcal disease), pertussis (whooping cough) and some sinus and ear infections (see Figure 2).

Upper respiratory infection causes

Most upper respiratory infections are caused by viruses, such as rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus (RSV), adenovirus, human metapneumovirus and influenza. Bacteria may cause roughly 15% of sudden onset pharyngitis presentations. The most common is Streptococcus pyogenes, a Group A streptococcus ¹⁴⁾. Epiglottitis and laryngotracheitis are likely caused by Haemophilus influenzae type b ¹⁵⁾. Haemophilus influenzae type b vaccine is commercially available and is now a basic component of childhood immunization program. These organisms gain entry to the respiratory tract by inhalation of droplets and invade the upper respiratory mucosa. Epithelial destruction may ensue, along with redness, edema, hemorrhage and sometimes an exudate.

Influenza

The incubation period for influenza is 1 to 4 days, and the time interval between symptom onset is estimated to be 3 to 4 days. Viral shedding can occur 1 day before the onset of symptoms. It is believed that influenza can be transferred among humans by direct contact, indirect contact, droplets, or aerosolization. Short distances (<1 meter) are generally required for contact and droplet transmission to occur between the source person and the susceptible individual. Airborne transmission may occur over longer distances (>1 m). Most evidence-based data suggest that direct contact and droplet transfer are the predominant modes of transmission for influenza ¹⁶⁾.

Common Cold

Common colds are the most prevalent entity of all respiratory infections and are the leading cause of patient visits to the physician, as well as work and school absenteeism. Most colds are caused by viruses. The pathogens responsible for causing the common cold include rhinovirus, adenovirus, parainfluenza virus, respiratory syncytial virus, enterovirus, and coronavirus. The rhinovirus with more than 100 serotypes, a species of the Enterovirus genus of the Picornaviridae family, is the most common cause of the common cold and causes up to 80% of all respiratory infections during peak seasons ¹⁷⁾. Dozens of rhinovirus serotypes and frequent antigenic changes among them make identification, characterization, and eradication complex. After deposition in the anterior nasal mucosa, rhinovirus replication and infection are thought to begin upon mucocilliary transport to the posterior nasopharynx and adenoids. As soon as 10 to 12 hours after inoculation, symptoms may begin. The mean duration of symptoms is 7 to 10 days, but symptoms can persist for as long as 3 weeks. Nasal mucosal infection and the host’s subsequent inflammatory response cause vasodilation and increased vascular permeability. These events result in nasal obstruction and rhinorrhea whereas cholinergic stimulation prompts mucus production and sneezing.

Coronaviruses may be responsible for more than 10% of cases. Parainfluenza viruses, respiratory syncytial virus, adenoviruses and influenza viruses have all been linked to the common cold syndrome. All of these organisms show seasonal variations in incidence. The cause of 30% to 40% of cold syndromes has not been determined.

Sinusitis

Sinusitis is an acute inflammatory condition of one or more of the paranasal sinuses. Infection plays an important role in this affliction. Sinusitis often results from infections of other sites of the respiratory tract since the paranasal sinuses are contiguous to, and communicate with, the upper respiratory tract.

Acute sinusitis most often follows a common cold which is usually of viral origin. Vasomotor and allergic rhinitis may also precede to the development of sinusitis. Obstruction of the sinusal ostia due to deviation of the nasal septum, presence of foreign bodies, polyps or tumors can predispose to sinusitis. Infection of the maxillary sinuses may follow dental extractions or an extension of infection from the roots of the upper teeth. The most common bacterial agents responsible for acute sinusitis are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Other organisms including Staphylococcus aureus, Streptococcus pyogenes, gram-negative organisms and anaerobes have also been recovered. Chronic sinusitis is commonly a mixed infection of aerobic and anaerobic organisms.

Infections caused by viruses or bacteria impair the ciliary activity of the epithelial lining of the sinuses and increased mucous secretions. This leads to obstruction of the paranasal sinusal ostia which impedes drainage. With bacterial multiplication in the sinus cavities, the mucus is converted to mucopurulent exudates. The pus further irritates the mucosal lining causing more edema, epithelial destruction and ostial obstruction. When acute sinusitis is not resolved and becomes chronic, mucosal thickening results and the development of mucoceles and polyps may ensue.

Pharyngitis

Pharyngitis is an inflammation of the pharynx involving lymphoid tissues of the posterior pharynx and lateral pharyngeal bands. The etiology can be bacterial, viral and fungal infections as well as noninfectious etiologies such as smoking. Most cases are due to viral infections and accompany a common cold or influenza. Type A coxsackieviruses can cause a severe ulcerative pharyngitis in children (herpangina), and adenovirus and herpes simplex virus, although less common, also can cause severe pharyngitis. Pharyngitis is a common symptom of Epstein-Barr virus and cytomegalovirus infections.

Group A beta-hemolytic streptococcus or Streptococcus pyogenes is the most important bacterial agent associated with acute pharyngitis and tonsillitis. Corynebacterium diphtheriae causes occasional cases of acute pharyngitis, as do mixed anaerobic infections (Vincent’s angina), Corynebacterium haemolyticum, Neisseria gonorrhoeae, and Chlamydia trachomatis. Outbreaks of Chlamydia pneumoniae causing pharyngitis or pneumonitis have occurred in military recruits. Mycoplasma pneumoniae and Mycoplasma hominis have been associated with acute pharyngitis. Candida albicans, which causes oral candidiasis or thrush, can involve the pharynx, leading to inflammation and pain.

As with common cold, viral pathogens in pharyngitis appear to invade the mucosal cells of the nasopharynx and oral cavity, resulting in edema and hyperemia of the mucous membranes and tonsils. Bacteria attach to and, in the case of group A beta-hemolytic streptococci, invade the mucosa of the upper respiratory tract. Many clinical manifestations of infection appear to be due to the immune reaction to products of the bacterial cell. In diphtheria, a potent bacterial exotoxin causes local inflammation and cell necrosis.

Epiglottitis and Laryngotracheitis

Inflammation of the upper airway is classified as epiglottitis or laryngotracheitis (croup) on the basis of the location, clinical manifestations, and pathogens of the infection. Haemophilus influenzae type b is the most common cause of epiglottitis, particularly in children age 2 to 5 years. Epiglottitis is less common in adults. Some cases of epiglottitis in adults may be of viral origin. Most cases of laryngotracheitis are due to viruses. More serious bacterial infections have been associated with H influenzae type b, group A beta-hemolytic streptococcus and C diphtheriae. Parainfluenza viruses are most common but respiratory syncytial virus, adenoviruses, influenza viruses, enteroviruses and Mycoplasma pneumoniae have been implicated.

A viral upper respiratory infection may precede infection with H influenzae in episodes of epiglottitis. However, once H influenzae type b infection starts, rapidly progressive erythema and swelling of the epiglottis ensue, and bacteremia is usually present. Viral infection of laryngotracheitis commonly begins in the nasopharynx and eventually moves into the larynx and trachea. Inflammation and edema involve the epithelium, mucosa and submucosa of the subglottis which can lead to airway obstruction.

The syndrome of epiglottitis begins with the acute onset of fever, sore throat, hoarseness, drooling, dysphagia and progresses within a few hours to severe respiratory distress and prostration. The clinical course can be fulminant and fatal. The pharynx may be inflamed, but the diagnostic finding is a “cherry-red” epiglottis.

A history of preceding cold-like symptoms is typical of laryngotracheitis, with rhinorrhea, fever, sore throat and a mild cough. Tachypnea, a deep barking cough and inspiratory stridor eventually develop. Children with bacterial tracheitis appear more ill than adults and are at greater risk of developing airway obstruction.

Haemophilus influenzae type b is isolated from the blood or epiglottis in the majority of patients with epiglottis; therefore a blood culture should always be performed. Sputum cultures or cultures from pharyngeal swabs may be used to isolate pathogens in patients with laryngotracheitis. Serologic studies to detect a rise in antibody titers to various viruses are helpful for retrospective diagnosis. Newer, rapid diagnostic techniques, using immunofluorescent-antibody staining to detect virus in sputum, pharyngeal swabs, or nasal washings, have been successfully used. Enzyme-linked immunosorbent assay (ELISA), DNA probe and polymerase chain reaction procedures for detection of viral antibody or antigens are now available for rapid diagnosis.

Upper respiratory infection prevention

To keep your respiratory system (and especially your lungs) healthy:

• don’t smoke
• avoid harmful environmental factors such as smoke, dusts and chemicals
• exercise (check with your doctor first if you have a health condition), preferably away from busy roads with high air-pollution
• wash your hands regularly to prevent infections
• eat a healthy, vitamin-rich diet
• drink plenty of water
• introduce plants into your living spaces
• practise good hygiene
• consider having the flu vaccine each year

Upper respiratory infection signs and symptoms

Initial symptoms of a cold are runny, stuffy nose and sneezing, usually without fever. Other upper respiratory infections may have fever. Children with epiglottitis may have difficulty in breathing, muffled speech, drooling and stridor. Children with serious laryngotracheitis (croup) may also have tachypnea, stridor and cyanosis.

Acute upper respiratory tract infections include rhinitis, pharyngitis, tonsillitis, and laryngitis. Symptoms of upper respiratory infections commonly include:

• Cough – you may bring up mucus (phlegm)
• Sore throat
• Runny nose
• Nasal congestion
• Breathlessness, tight chest or wheezing
• Headaches
• Low-grade fever
• Facial pressure
• Sneezing
• Malaise
• Myalgias (muscle aches)
• Feeling generally unwell

The onset of symptoms usually begins one to three days after exposure and lasts 7–10 days, and can persist up to 3 weeks.

Upper respiratory infection complications

Complications of upper respiratory tract infections are relatively rare, except with influenza. Complications of influenza infection include primary influenza viral pneumonia; secondary bacterial pneumonia; sinusitis; otitis media; coinfection with bacterial agents; and exacerbation of preexisting medical conditions, particularly asthma and chronic obstructive pulmonary disease. Pneumonia is one of the most common complications of influenza illness in children and contributes significantly to morbidity and mortality.

Upper respiratory infection treatment

Most upper respiratory infections pass within 1 to 2 weeks. You can usually treat your symptoms at home. Viral infections are treated symptomatically. Epiglottitis is a medical emergency, especially in children. All children with this diagnosis should be observed carefully and be intubated to maintain an open airway as soon as the first sign of respiratory distress is detected. Antibacterial therapy should be directed at H influenzae. Patients with croup are usually successfully managed with close observation and supportive care, such as fluid, humidified air, and racemic epinephrine. For prevention, Haemophilus influenzae type b conjugated vaccine is recommended for all pediatric patients, as is immunization against diphtheria. Streptococcal pharyngitis and epiglottitis caused by Haemophilus influenzae are treated with antibacterials.

Most upper respiratory infections go away in a few days. Some things you can do to take care of yourself with an upper respiratory infection include:

• Get plenty of rest
• Drink lots of water to loosen any mucus and make it easier to cough up
• Drink a hot lemon and honey drink to help soothe a cough (not suitable for babies)
• Gargle with warm salty water if you have a sore throat (children shouldn’t try this)
• Use an air humidifier or inhale steam from a bowl of hot water (adults only) – you can add menthol or eucalyptus oil
• Raise your head up while sleeping using extra pillows to make breathing easier and clear your chest of mucus
• Use painkillers to bring down a fever and help ease a sore throat, headaches and muscle pain
• Over-the-counter (OTC) cold and cough medicines may help ease symptoms in adults and older children. They do not make your cold go away faster, but can help you feel better. These OTC medicines are not recommended for children under age 4.
• Antibiotics should not be used to treat a common cold.
• Many alternative treatments have been tried for colds, such as vitamin C, zinc supplements, and echinacea. Talk to your health care provider before trying any herbs or supplements.

DON’T

• DO NOT let children breathe in steam from a bowl of hot water as there’s a risk of scalding
• DO NOT give aspirin to children under 16
• DO NOT smoke – it can make your symptoms worse

Medicine for upper respiratory infection

Analgesics (pain relievers) such as nonsteroidal anti-inflammatory drugs (NSAIDs) (e.g., ibuprofen) have been shown to reduce headache, ear pain, muscle pain, joint pain, and sneezing but do not improve cough, cold duration, or total symptom score ¹⁸⁾. Ibuprofen is more effective than acetaminophen (paracetamol) for reducing fever-related discomfort ¹⁹⁾. Acetaminophen (paracetamol) may provide short-term relief of runny nose (rhinorrhea) and nasal obstruction but has no effect on sore throat, malaise, sneezing, or cough ²⁰⁾.

Nasal decongestants (oral and intranasal) may relieve nasal congestion, but there is no evidence that they reduce cough ²¹⁾. Topical oxymetazoline, which is included in many over-the-counter intranasal decongestants, reduces the duration and severity of nasal congestion after multiple doses ²²⁾. Patients should be warned about the risk of rhinitis when intranasal oxymetazoline is used for more than three days ²³⁾.

Combination antihistamine medications such as antihistamines combined with oral decongestants and/or analgesics may provide some relief of cold symptoms, although the effect on cough is limited ²⁴⁾, ²⁵⁾, ²⁶⁾. Anti-histamines (H1-receptor antagonists) may offer a modest reduction of rhinorrhea (runny nose) and sneezing during the first 2 days of a cold treatment in adults ²⁷⁾, ²⁸⁾. First-generation antihistamines are sedating, so advise the patient about caution during their use. Topical and oral nasal decongestants (i.e., topical oxymetazoline, oral pseudoephedrine) have moderate benefit in adults and adolescents in reducing nasal airway resistance ²⁹⁾. When started on the first day of symptoms, medications containing ibuprofen and pseudoephedrine may reduce the severity of cold symptoms ³⁰⁾. Antihistamine monotherapy is not effective for relieving cough ³¹⁾, ³²⁾.

Evidence-based data does not support the use of antibiotics in the treatment of the common cold because they do not improve symptoms or shorten the course of illness ³³⁾. There is also a lack of convincing evidence supporting the use of dextromethorphan for acute cough.

Intranasal ipratropium is the only medication that improves persistent cough related to upper respiratory infection in adults ³⁴⁾, ³⁵⁾. Inhaled ipratropium in combination with albuterol improves cough during the first 10 days of treatment, but there is no benefit at 20 days compared with placebo ³⁶⁾.

According to a Cochrane Review ³⁷⁾, ³⁸⁾, vitamin C used as daily prophylaxis at doses of 200 milligrams or more had a “modest but consistent effect” on the duration and severity of common cold symptoms (8% and 14% decreases in duration for adults and children, respectively). In children, 1 to 2 gram/day vitamin C shortened colds by 18% ³⁹⁾. The severity of colds was also reduced by regular vitamin C administration ⁴⁰⁾. When taken therapeutically after the onset of symptoms, however, high-dose vitamin C has not shown clear benefit in trials ⁴¹⁾, ⁴²⁾.

Neither steam nor vitamin D supplementation improves symptoms of the common cold ⁴³⁾, ⁴⁴⁾, ⁴⁵⁾. Vitamin E can actually make symptoms worse in older adults aged 60 years or older ⁴⁶⁾. Although echinacea was previously thought to provide benefit, high-quality studies have not shown that echinacea reduces the duration or severity of cold symptoms ⁴⁷⁾, ⁴⁸⁾, ⁴⁹⁾, ⁵⁰⁾. Based on low-quality evidence, Pelargonium sidoides (South African geranium) does not shorten time to resolution of cold symptoms in adults ⁵¹⁾.

Early antiviral treatment for influenza infection shortens the duration of influenza symptoms, decreases the length of hospital stays, and reduces the risk of complications. Recommendations for the treatment of influenza are updated frequently by the Centers for Disease Control and Prevention based on epidemiologic data and antiviral resistance patterns. Give antiviral therapy for influenza within 48 hours of symptom onset (or earlier), and do not delay treatment for laboratory confirmation if a rapid test is not available. Antiviral treatment can provide benefit even after 48 hours in pregnant and other high-risk patients ⁵²⁾.

Vaccination is the most effective method of preventing influenza illness. Antiviral chemoprophylaxis is also helpful in preventing influenza (70% to 90% effective) and should be considered as an adjunct to vaccination in certain scenarios or when vaccination is unavailable or not possible. Generally, antiviral chemoprophylaxis is used during periods of influenza activity for (1) high-risk persons who cannot receive vaccination (due to contraindications) or in whom recent vaccination does not, or is not expected to, afford a sufficient immune response; (2) controlling outbreaks among high-risk persons in institutional settings; and (3) high-risk persons with influenza exposures ⁵³⁾.

How you can care for your child at home

Safe and effective treatment options for symptoms of the common cold in children vary somewhat from those for adults (see Figure 3). Nasal saline irrigation, analgesics, and time are the mainstays of treatment for upper respiratory infections in children. Avoid cough preparations in children ⁵⁴⁾.

To help your child cope with a cough or cold:

• Give your child acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for fever, pain, sore throat or fussiness. Although ibuprofen and acetaminophen reduce fever-related discomfort, ibuprofen may be more effective ⁵⁵⁾. If you give your child a pain reliever, follow the dosing guidelines carefully. Always read and follow all instructions on the label. Alternating these medications may reduce daycare absences in children with fever. For children younger than 3 months old, don’t give acetaminophen until your baby has been seen by a doctor. Don’t give ibuprofen to a child younger than 6 months old or to children who are vomiting constantly or are dehydrated. Also, use caution when giving aspirin to children or teenagers. Though aspirin is approved for use in children older than age 3, children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin. This is because aspirin has been linked to Reye’s syndrome, a rare but potentially life-threatening condition, in such children.
• Acetylcysteine. The mucolytic acetylcysteine may safely decrease cough after six to seven days in children two years and older ⁵⁶⁾.
• Intranasal ipratropium may decrease runny nose (rhinorrhea) but not nasal congestion related to upper respiratory infections in children five years and older. It should not be used in children younger than five years. The main adverse effects are nosebleeds, nasal dryness, and headache, although these are self-limited ⁵⁷⁾.
• Nasal saline irrigation. Over-the-counter saline can keep nasal passages moist and loosen mucus. Rinsing your child’s nasal passages with saline (nasal irrigation) is a quick and effective way to relieve nasal congestion. One large trial found that children who use saline nasal washes six times per day have faster resolution of nasal secretions and nasal obstruction and reduced use of antipyretics, decongestants, and antibiotics ⁵⁸⁾. This regimen also reduces school absences. Saline irrigation solutions can be purchased ready-made or as kits to add to water. You can also use a homemade solution. Look for a squeeze bottle or a neti pot — a small container with a spout designed for nose rinsing — at your pharmacy or health food store. To make up the saline irrigation solution, do not use tap water, as it can contain organisms that could cause infection. Use water that’s distilled or sterile. You can also use water that was boiled and cooled. Another option is using water that has been filtered using a filter with an absolute pore size of 1 micron or smaller. To prevent infections, wash the bottle or pot with hot soapy water and rinse it after every use and leave it open to air-dry. Do not share a container with other people.
  • In younger children, apply saline nasal drops, wait for a short period and then use a suction bulb to draw mucus out of each nostril.
  • For older children, use a saline nasal spray or saline nasal irrigation.
• Complementary and alternative treatments. Application of ointment containing camphor, menthol, and eucalyptus oils on the chest and neck of children at bedtime can relieve nasal congestion and reduce nighttime cough frequency and severity, improving sleep for both the child and parents ⁵⁹⁾. The use of menthol alone may also improve perceived nasal patency but may not help with cough ⁶⁰⁾. Menthol is safe for use in children two years and older. The use of honey before bedtime may also reduce the frequency and severity of cough ⁶¹⁾, ⁶²⁾. Honey should not be given to children younger than 12 months because of the risk of exposure to botulinum spores.
• Be careful with cough and cold medicines. Don’t give them to children younger than 6, because they don’t work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
• Be careful when giving your child over-the-counter cold or flu medicines and Tylenol at the same time. Many of these medicines have acetaminophen, which is Tylenol. Read the labels to make sure that you are not giving your child more than the recommended dose. Too much acetaminophen (Tylenol) can be harmful.
• Over-the-counter cough and cold medicines are intended to treat the symptoms of coughs and colds, not the underlying disease. Research suggests that these medicines haven’t been proved to work any better than inactive medicine (placebo). More important, these medications have potentially serious side effects, including fatal overdoses in children younger than 2 years old.
• Don’t use over-the-counter medicines, except for fever reducers and pain relievers, to treat coughs and colds in children younger than 6 years old. Also, consider avoiding use of these medicines for children younger than 12 years old.
• Make sure your child rests. Keep your child at home if he or she has a fever.
• Run a cool-mist humidifier. Place a humidifier near your child’s bed or close to your child. This can add moisture to the air, which might decrease the drying of the nasal passages and throat. This may make it easier for your child to breathe. Follow the directions for cleaning the machine. Clean the humidifier after every use.
• Keep your child away from smoke. Do not smoke or let anyone else smoke around your child or in your house.
• Wash your hands and your child’s hands regularly so that you don’t spread the disease.
• Give your child lots of fluids, enough so that the urine is light yellow or clear like water. This is very important if your child is vomiting or has diarrhea. Liquids such as water, juice and broth might help thin secretions. Give your child sips of water or drinks such as Pedialyte or Gastrolyte. These drinks contain a mix of salt, sugar, and minerals. You can buy them at drugstores or grocery stores. Give these drinks as long as your child is throwing up or has diarrhea. Do not use them as the only source of liquids or food for more than 12 to 24 hours. Warm liquids, such as tea or chicken soup, might have a soothing effect, increase the flow of nasal mucus and loosen respiratory secretions.
• Offer cold or frozen drinks or foods. Ice cream, frozen fruit pops, ice or cold beverages might feel good on a sore throat.
• Encourage gargling with salt water. For children age 6 years and older, gargling with warm salt water might soothe throat pain.
• Offer hard candy. For children age 5 years and older, sucking on a piece of hard candy might soothe throat pain. Hard candy is probably as effective as medicated lozenges and less likely to have harmful effects. However, hard candy is a choking hazard and shouldn’t be given to younger children.

What about antibiotics?

Antibiotics can be used to combat bacterial infections but have no effect on viruses, which cause colds. If your child has a cold, antibiotics won’t help. Remember, the more your child uses antibiotics, the more likely he or she is to get sick with an antibiotic-resistant infection in the future.

Is codeine OK?

No. The Food and Drug Administration (FDA) limits the use of prescription cough and cold medicines containing the opioids codeine or hydrocodone to adults age 18 and older. This is due to the potential for slowed or difficult breathing, misuse, risky use, addiction, overdose and even death.