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Upper Respiratory Infection (URI, or Common Cold)

What is an upper respiratory infection (URI)?

An upper respiratory infection (URI), also known as the common cold, is one of the most common illnesses, leading to more doctor visits and absences from school and work than any other illness every year.

Colds are caused by viruses that inflame the membranes in the lining of the nose and throat. Although more than 200 different viruses can cause colds, rhinoviruses and coronaviruses cause the majority of colds.

The Cold Viruses

The rhinoviruses and the coronaviruses are the most common causes of a cold. According to the National Institute of Allergy and Infectious Diseases (NIAID), the rhinoviruses cause about one-third of all colds (30 to 35 percent), while the most common causes of adult colds are the coronaviruses. However, the cause of 30 to 50 percent of colds remains unidentified.

Rhinoviruses

There are more than 110 different rhinoviruses that cause most colds in early fall, spring, and summer. Named after the Greek word "rhin" for "nose," rhinoviruses thrive in the human nasal mucosa.

Coronaviruses

More than 30 different strains of the coronavirus exist, with three or four types affecting humans. The virus is most active in the winter and early spring.

Facts about an URI or cold

• Most children will develop at least six to eight colds a year. This number is higher for children who attend daycare.
• Colds do not happen as much after the age of 6.
• Adolescents get colds about two to four times a year.

When is the "cold" season?

Children are most likely to have colds during fall and winter, starting in late August or early September until March or April. The increased incidence of colds during the cold season may be attributed to the fact that more children are indoors and close to each other. In addition, many cold viruses thrive in low humidity, making the nasal passages drier and more vulnerable to infection.

What causes the common cold?

There are many different types of viruses that cause the common cold. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus.

After the virus enters your child's body, it causes a reaction—the body's immune system begins to react to the foreign virus. This, in turn, causes:

• An increase in mucus production (a runny nose).
• Swelling of the lining of the nose (making it hard to breath and causing congestion).
• Sneezing (from the irritation in the nose).
• Cough (from the increased mucus dripping down the throat).

How did my child catch a cold?

In order to catch a cold, your child must come in contact with one of the viruses that cause a cold, from someone else who is affected. The cold virus can be transmitted in the following ways:

• Through the air - if a person with a cold sneezes or coughs, small amounts of the virus can go into the air. Then, if your child breathes in that air, the virus will adhere to his nasal membrane.
• Direct contact - this means that your child directly touched a person who was infected. A cold is easy for children to spread, because they touch their nose, mouth, and eyes often and then touch other people or objects and can spread the virus. Viruses can be spread through objects, such as toys, that have been previously touched by someone with a cold.

What are the symptoms of a common cold?

The symptoms of a cold start from one to three days after your child has been in contact with the cold virus. Usually, the symptoms last about one week, but this varies from child to child, and may last even up to two weeks. The following are the most common symptoms of a cold:

Infants

• Unable to sleep
• Fussiness
• Congestion in the nose
• Sometimes vomiting and diarrhea
• Fever

Older children

• Stuffy, runny nose
• Scratchy, tickly throat
• Satery eyes
• Sneezing
• Mild hacking cough
• Congestion
• Sore throat
• Achy muscles and bones
• Headaches
• Low grade fever
• Chills
• Watery discharge from the nose that thickens and turns yellow or green
• Mild fatigue

The symptoms of the common cold may resemble other conditions or medical problems. Always consult your child's physician for a diagnosis.

How is a cold different from the flu?

A cold and the flu (influenza) are two different illnesses. A cold is relatively harmless and usually clears up by itself after a period of time, although sometimes it may lead to a secondary infection, such as an ear infection. In contrast, the flu can lead to complications, such as pneumonia and even death. What may seem like a cold, could, in fact, be the flu. Be aware of these differences:

Who is at greater risk for catching the common cold?

Children suffer more colds each year than adults, due to their immature immune systems and to the close physical contact with other children at school or in daycare. In fact, the average child will have between six to eight colds a year, while the average adult will get two to four colds a year.

How is the common cold diagnosed?

Most common colds are diagnosed based on reported symptoms. However, cold symptoms may be similar to certain bacterial infections, allergies, and other medical conditions. Always consult your child's physician for a diagnosis.

Treatment for the common cold

There is no cure for the common cold and antibiotics will not help treat a cold. Medications are used to help relieve the symptoms, but will not make the cold go away any faster. Therefore, treatment is based on helping the symptoms and supportive care.

The specific treatment for this condition depends on many factors and is tailored for each child. Please discuss your child's condition, treatment options and your preference with your child's physician or healthcare provider.

Treatment may include the following:

• Increased fluid intake - this will help keep the lining of the nose and throat moist and to prevent dehydration.
• Avoidance of secondhand smoke - keep your child away from passive (secondhand) smoke, as this will increase the irritation in the nose and throat.

To help relieve the congestion and obstruction in the nose for younger children, consider the following:

• Use saline (salt water) nose drops.
• Use a bulb syringe to help remove the mucus.
• Place a cool mist humidifier in the room.
• Analgesics, such as acetaminophen, are sometimes helpful in decreasing the discomfort of colds. Consult your child's physician before giving any medication to your child.

There are other medications for congestion, cough, or runny noses. Discuss your options with your child's physician.

Vitamin C and the common cold

Many people believe taking large amounts of vitamin C will either prevent the common cold or reduce its symptoms. However, to date, studies have not indicated that high amounts of vitamin C affect the onset and symptoms of the common cold. In addition, taking large quantities of vitamin C over a long period of time may, in fact, be harmful, causing diarrhea and distorting urine and blood test results.

Aspirin and the risk of Reye syndrome in children

Do not give aspirin to a child who has fever without first contacting the child's physician. Aspirin, when given as treatment for viral illnesses in children, has been associated with Reye syndrome, a potentially serious or deadly disorder in children. Therefore, pediatricians and other healthcare providers recommend that aspirin (or any medication that contains aspirin) not be used to treat any viral illnesses (such as colds, the flu, and chickenpox) in children.

Can I prevent my child from getting colds?

Taking proper preventive measures can reduce the risk of your child developing a cold. Preventive measures may include the following:

• Keep your child away from a person with a cold.
• Encourage your child to wash his hands frequently and not to touch his mouth, eyes, or nose until his hands are washed.
• Make sure toys and play areas are properly cleaned, especially if multiple children are playing together.

What are the possible complications from having a cold?

The following are some of the complications that might occur if your child gets a cold:

• Ear infections
• Sinus infections
• Pneumonia
• Throat infections

Consult your child's physician for further evaluation.

Cold weather and colds

Contrary to popular belief, cold weather or getting chilled does not cause a cold, according to the National Institute of Allergy and Infectious Diseases (NIAID). However, more colds do occur during the cold season (early fall to late winter), which is probably due to a variety of factors, including the following:

• Schools are in session, increasing the risk for exposure to the virus
• People stay more indoors and are in closer proximity to each other
• Low humidity, causing dry nasal passages which are more susceptible to cold viruses

Antibiotics overuse

Antibiotic overuse in children has become a common problem, aggravated by parental pressure for the medication, according to the American Academy of Pediatrics (AAP). As a result, many bacterial infections in the US and worldwide are becoming resistant to antibiotics, thus creating a lack of effective treatment for bacterial infections.

However, parents and physicians are heeding warnings about antibiotic overuse. In a 2002 study, researchers found that antibiotic prescriptions per 1,000 children and adolescents under the age of 15 dropped by 40 percent from the year 1990 to 2000. Antibiotic prescriptions resulting from physician's visits also dropped by 29 percent. For otitis media, specifically, prescriptions dropped by 47 percent.

Overuse of antibiotics is leading to strains of diseases that are becoming resistant to the medication, making it harder to treat patients. All too often, antibiotics have been prescribed for conditions such as colds, fluid in the middle ear, or bronchitis, which do not respond to antibiotics, according to the Centers for Disease Control and Prevention (CDC). Antibiotics are only effective in treating bacterial infections.

The key to preventing overuse of antibiotics is education of the parents and physicians in the appropriate use of antibiotics, according to the AAP. Some tips to remember when taking antibiotics, according to the American Medical Association (AMA), include the following:

• Take the antibiotics as prescribed.
• Finish the full course of antibiotics, as prescribed.
• Do not save or reuse antibiotics.

Always consult your child's physician for more information.

Reviewed by: Steven D. Handler, MD, MBE
Date: April 2009