When is a Cold More Than a Cold?

When is a Cold More Than a Cold?

All kids get colds.  In fact, it’s not uncommon for kids to get up to ten colds per year. If you have more than one child, and one child’s cold comes after the others, as is usually the case, it is very likely that you are dealing with someone’s cold for half of the year.  And that doesn’t include the colds that the adults in the house get, which are usually worse and longer lasting than those of our robust little Petri dishes. We all know that a child with a cold can be pretty miserable—stuffy nose, runny nose, cough, fever, and of course an extra helping of crankiness. But when is a cold more than a cold?  And what else can it be?  Do you really need to bring your children to the doctor’s office ten times per year? And how often should you be using that ’emergency phone line’? You know, the one they give out, and hope you don’t use?  Read on…

The short answer to ‘when is a cold more than a cold’ is a parental gut feeling that ‘something is not right’.  You may not know exactly what that ‘something’ is, but the fact that you have that feeling that this time is different is reason enough to at least give your doctor a call.   Even if it is just to be reassured that your child has ‘that bug’ that’s going around (almost 99% of the time, there is a ‘bug’ going around), reviewing the exact nature of your child’s symptoms will help you and your doctor figure out whether or not your child needs to be seen.   From a practical standpoint, ‘different’ does have some cut and dry meaning, and can include any or all of the following:

  1. * Fever greater than 102 F for more than one day
  2. * Fever greater than 101 F for more than three days
  3. * Few or no wet diapers for one day (or minimal urination if your child is potty trained)
  4. * Ear pain
  5. * Red eyes or eye discharge
  6. * Cough for one week
  7. * Green or yellow nasal discharge for more than two weeks
  8. * Just doesn’t seem ‘right’
  9. * Extreme lethargy, uncontrollable vomiting, fever that wont come down with fever medications, drastic behavior change, seizure, loss of consciousness, dusky skill color, trouble breathing (NOW IS THE TIME TO USE THAT EMERGENCY PHONE LINE, OR CALL 911)


Many of these signs can be indication of a ‘secondary’ infection, meaning, what was a ‘primary’ viral cold is now a ‘secondary’ bacterial infection—either an ear infection, a sinus infection, an eye infection, a throat infection, or a lung infection.  Your child may or may not need antibiotics, but he does need to be evaluated by his doctor.  If your child is seen, and your doctor still does not think antibiotics are needed, do not be disappointed! It still may be a viral infection, whereby antibiotics will do no good, and may actually do some harm.

As far as what your child’s ‘more than a cold’ may be, the most common infections are ear infections and sinus infections.  Ear infections are so common that they are actually the most common reason a child is brought to a doctor’s office.  Ear infections can often (although not always) begin with cold symptoms, and progress to ear pain, fever, irritability, poor sleep, temporary hearing loss, and overall misery.  Thankfully, ear infections are pretty easy to diagnose.  Your doctor is likely very experienced in looking at ears, and can tell a ‘hot’ eardrum from a normal one.  However, diagnosis of an ear infection, even a nasty one, does not necessarily mean that antibiotics are in the plans.  In fact, most ear infections are caused by viruses, and the American Academy of Pediatrics (AAP) recommends ‘watchful waiting’, with a day of pain and fever control before going straight to antibiotics.  The worldwide overuse of antibiotics has led to the need for stronger and stronger antibiotics and higher and higher doses of antibiotics to treat the run-of-the-mill ear infections, as, over time, the stronger bacteria have survived the run-of-the-mill antibiotics.

A prolonged or ‘nasty’ cold may also be a sign of a sinus infection.  These, however, are not so easy to diagnose.  First of all, the sinuses in most children under age 12 years old are barely developed, and each one is the size of a lima bean, or smaller.  A sinus X-ray, or even a sinus CT scan will show sinuses filled with fluid, in a child with a cold or a full-blown sinus infection. In fact, studies have shown that children undergoing head CT scans for reasons unrelated to a sinus infection will have sinuses filled with fluid, without any other signs of sinusitis or even a cold.  Sinus infections in children are diagnosed by a combination of symptoms, and possibly X-rays.   Symptoms of a child with a sinus infection can include:

  1. * Fever
  2. * Green or yellow runny nose for more than two weeks
  3. * Cough for more than two weeks
  4. * Facial pressure, headache, pain, irritability
  5. * Foul-smelling breath
  6. * Puffiness around the eyes
  7. * Sticky drainage from the corners of the eyes
  8. * X-ray evidence of sinusitis with all or some of the above symptoms


A visit to the doctor will be needed to determine whether or not your child needs antibiotics for a sinus infection.

Whether your child has a cold or ‘something more’, it’s good to keep on top of his symptoms with some home remedies.  These include:

  1. * Nasal saline—the best stuff on earth.  Spray this into your child as often as he will humanly tolerate.  It’s really worth the battle on this one.
  2. * Stay on top of fever control.  Make sure you have at least one thermometer in the house!  Keep notes on the time of your child’s fever, whether you gave acetaminophen or ibuprofen, and whether or not the fever broke with the medicine.
  3. * Keep your child hydrated. Drinks with electrolytes work well—diluted apple or white grape juice, Pedialylte®, or even diluted sports drinks will help your child feel better.
  4. * A humidifier, cool-mist is best, in your child’s room at night will prevent dry mouth in the morning if he goes to sleep with a stuffy nose.
  5. * Ask your doctor about over-the-counter cold and cough medicines.  Most are now approved in children over age four years, but check with your doctor first, especially if it’s a new medication for your child.


Most of these remedies are all you need when your child has a cold—plus of course a little extra TLC and attention. These tried and true remedies may also prevent that run-of-the-mill cold from turning into ‘something more’.



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