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 primary care provider visits and absences from school and work than any other illness every year. It is estimated that during a one-year period, people in the U.S. will suffer one billion colds. Caused by a virus that inflames the membranes in the lining of the nose and throat, colds can be the result of more than 200 different viruses. However, among all of the cold viruses, the rhinoviruses cause the majority of colds.

Facts about an URI or cold:

  • Most children will develop at least six to eight colds a year. This number increases for children who attend day care.
  • Colds may occur less frequently after the age of 6.
  • Adults get colds about two to four times a year.

When is "cold season?"

Although upper respiratory infections can occur at any time of year, 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. In fact, over 200 different varieties of viruses can cause the symptoms of a cold. The most common virus is called the rhinovirus. Other viruses include the coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus (RSV).

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 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 someone who is infected. 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 your child's nasal membrane.

  • Direct contact. This means that your child directly touched a person that 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. It is important to know that 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 in each child, and may last even up to two weeks. The following are the most common symptoms of a cold. However, each child may experience symptoms differently. Symptoms may include:

Signs and symptoms of a cold in infants:

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

Signs and symptoms of a cold in older children:

  • Stuffy, runny nose
  • Scratchy, tickly throat
  • Watery 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 primary care provider 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. The flu can also be harmless, but may progress to a more complicated illness, such as pneumonia and even death. What may seem like a cold, could, in fact, be the flu. Be aware of these differences (source: CDC):

Signs and Symptoms Cold Influenza (Flu)
Symptom onset Gradual Abrupt
Fever Rare Common; lasts 3-4 days
Aches Slight Common; often severe
Chills Uncommon Fairly common
Fatigue, weakness Sometimes Usual
Sneezing Common Sometimes
Chest discomfort, cough Mild to moderate; hacking cough Common; can be severe
Stuffy nose Common Sometimes
Sore throat Common Sometimes
Headache Rare Common


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 day care. In fact, the average child will have six to eight colds a year, while the average adult will get two to four colds a year. However, the average number of colds for children and adults will vary.

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 primary care provider for a diagnosis.

Treatment for the common cold

It is important to remember that there is no cure for the common cold and that antibiotics will not help treat a common 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.

Treatment may include the following:

  • Increased fluid intake. This will help keep the lining of the nose and throat moist and help 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:

  • Saline nose drops may be used.
  • Use a bulb syringe to help remove the mucus.
  • Place a cool mist humidifier in the room.

Do not give aspirin to a child who has fever. 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 health care 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.

There are other medications for congestion, cough, or runny noses. In 2008, the FDA recommended a ban on over-the-counter cough and cold medicines for children younger than four years old.

Discuss your options with your child's primary care provider.

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 or her hands frequently and not to touch his or her mouth, eyes, or nose until their 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 primary care provider 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. 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 indoors more and are in closer proximity to each other.
  • Low humidity causes 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 U.S. and worldwide are becoming resistant to antibiotics, thus creating a lack of effective treatment for bacterial infections.

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 CDC. Antibiotics are only effective in treating bacterial infections.

The key to preventing overuse of antibiotics is education of the parents and primary care providers in the appropriate use of antibiotics, according to the AAP. Some tips to remember when taking antibiotics, according to the American Medical Association, 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 primary care provider for more information.

Reviewed by Anthony F. Napoli, MD, Vicky L. Scheid, MD, FAAP

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