In recent weeks, I have received calls, texts, and WhatsApp messages from several understandably concerned parents about their children experiencing coughs, fevers, runny noses, and loss of appetite.
Some parents have mentioned that their children have “red eyes” and want to know whether this indicates “Apollo.” Others report that their children have been vomiting and passing watery stools. Aside from seeking solutions to these issues, many parents are also concerned about the possibility of an “epidemic” or outbreak.
A number of them worry whether Covid-19 has made a resurgence.
These parents are not alone; many others have been visiting the consulting rooms with similar concerns for their children.
So, today, I would like to address these concerns.
I can confidently say that, yes, these concerns are valid. Currently, there appears to be an upsurge in cases of upper respiratory tract infections (URTIs), commonly known as the “common cold” (CC), “catarrh,” or simply “colds.”
However, there is no evidence to suggest that this upsurge is any different from what is typically seen at this time of year; therefore, it cannot be considered an outbreak.
What is the common cold?
The common cold is an acute upper airway infection caused by over 200 different viruses. The upper airways include the nostrils, sinuses, nasopharynx, tonsils, epiglottis, and windpipe.
The most common viruses responsible for the common cold are rhinovirus, coronavirus, parainfluenza, respiratory syncytial virus (RSV), adenovirus, human metapneumovirus, and influenza. In temperate countries, these viruses tend to occur seasonally.
In Ghana, however, there is limited information on seasonality. Research conducted in Kumasi has shown that RSV infections occur year-round, with peak infection rates around the minor rainy season in October. Adenovirus infections, on the other hand, peak in April and October.
Who is more likely to contract these viruses?
Both children and adults are affected by these viruses, but infants who are not exclusively breastfed and children attending daycare centres are more likely to experience frequent infections.
How common is the common cold in children?
The common cold is arguably the most common reason for children, particularly those under five, to be seen by a healthcare professional, such as a paediatrician.
In high-income countries where data is available, it is reported that adults experience two to four colds per year, while children may experience six to eight colds annually due to their limited immunity. Unfortunately, data on this subject is sparse in developing countries like Ghana.
However, a study conducted in Uganda found that the prevalence of the common cold in children was about 38%. Children under five who attend preschools or daycare centres are more likely to acquire a cold than those cared for at home.
However, they tend to become less susceptible to frequent colds as they spend more time in these settings.
How is the cold transmitted?
The common cold is most often transmitted when a child’s hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the child touches their nose or eyes, the viruses enter their system, resulting in an infection.
The cold can also spread when children inhale droplets that have been coughed or sneezed out by an infected person, or when they come into contact with contaminated surfaces.
For various reasons, nasal or respiratory secretions from children with URTIs contain more viruses than those from infected adults.
This increased viral production, combined with the difficulty children have in maintaining proper hygiene, makes them more likely to spread the infection to others. The possibility of transmission is further increased in environments where many children are gathered together, such as daycare centres and schools.
It is therefore common for children to bring colds home from school and transmit them to their parents.
Some of the factors influencing the occurrence of colds include crowding, sociability (school, parties, church gatherings, public transport, etc.), stress, exposure to secondhand smoke, low immunity, poor nutrition, and inadequate sleep.
Contrary to popular belief, factors such as becoming chilled, drinking cold water, getting wet, or becoming tired do not have strong scientific support as causes of colds.
How can you tell if your child has a cold?
Most children with colds will experience symptoms such as coughs, sneezing, a stuffy or runny nose, and a sore throat. Nasal congestion and a runny nose occur due to inflammation of the airways, which results in the production of mucus (phlegm).
Other symptoms may include fever (a body temperature above 37.5°C or 99.9°F), fatigue, decreased appetite, and body aches. Infants and young children may be unable to express their symptoms and will often become cranky, irritable, and uncomfortable.
As infants primarily breathe through their nostrils, those with stuffy noses may have difficulty breastfeeding and breathing at the same time, which can lead to dehydration.
Additionally, children affected by certain viruses, such as adenovirus, may also experience red eyes, diarrhoea, and vomiting. Children with more severe flu-like symptoms may exhibit systemic signs such as fever, muscle aches, pains, and general malaise.
What will a doctor do if my child has a cold, especially when I can purchase medications from a drugstore?
When you visit a doctor or clinician, they will ask when the cold symptoms began. They will also ask whether your child has any complications or other co-occurring conditions.
The doctor will examine your child to determine if there are other issues, such as a middle ear infection, tonsillitis, or pneumonia. Additionally, if your child is very ill and refuses to breastfeed, drink, or eat, they may become dehydrated, and a healthcare professional is in the best position to identify and address this.
Therefore, doctors are well-placed to assess your child’s condition and provide appropriate treatment.
How long does a cold take to resolve?
The symptoms of a cold typically worsen by days 2-3 and then begin to improve by days 7-10. However, the cough can last for up to 3 weeks.
The fever may subside in one day or last longer, depending on the type of virus causing the infection. If the fever persists for an unusually long time, it may indicate a co-infection (e.g., a bacterial infection or even malaria) or a complication (e.g., acute middle ear infection, sinusitis, or pneumonia).
Are there any complications?
Although the common cold is a viral infection and is generally self-limiting, some children may develop complications, such as middle ear infections or sinus infections.
Children with asthma—particularly those not taking their preventive medication—are at increased risk of asthma attacks. Some children may also develop lower respiratory tract infections like pneumonia.
Are there any laboratory investigations to determine the cause?
Most viral infections, including the common cold, affect many people simultaneously, and there is often a seasonality to these infections. Because the illness is short-lived, most healthcare professionals do not conduct laboratory investigations and instead rely on their knowledge and experience to diagnose and treat the condition.
However, in some cases, tests such as a Full/Complete Blood Count (FBC or CBC) may be performed to help differentiate between viral and bacterial infections. In the early days of an epidemic, healthcare professionals may also conduct studies to identify the viruses causing the illness.
During the Covid-19 pandemic, for example, authorities had to isolate the virus and compare it to others to understand its behaviour. Based on these early investigations, they provided guidance on managing Covid-19 cases.
What is the treatment for a child with a cold?
As colds are typically caused by viruses, and most viruses cannot be treated directly with medication, the main focus of treatment is supportive. Most children recover from colds on their own, and the role of a healthcare professional is to reassure parents, provide education, and help manage symptoms at home.
Managing fever
Many parents fear fever, which is often the primary reason for seeking medical attention. Fever can be managed with paracetamol and/or ibuprofen. Paracetamol helps reduce fever and alleviate pain and can be administered orally or rectally every 4-8 hours.
Ibuprofen is taken orally every 8 hours and helps reduce fever, pain, and inflammation. Although ibuprofen has been shown to reduce fever more effectively than paracetamol in some cases, it should be used with caution, as it can cause stomach irritation and impact kidney function if the child is not adequately hydrated.
Managing cough
Coughing is an important defensive mechanism that helps clear secretions and particles from the airways. Several medications are available to manage coughs, including cough suppressants (e.g., dextromethorphan), expectorants (e.g., guaifenesin), and decongestants (e.g., pseudoephedrine).
Some of these medications are combined with other treatments, such as antihistamines or pain relievers. However, these over-the-counter medications should be used cautiously in children, particularly those under 5 years old, as they can have serious side effects.
Managing nasal congestion and runny nose
Salt-water solutions (physiological saline) or seawater-based preparations for nasal drops, sprays, or irrigation are beneficial for alleviating nasal congestion and helping with mucus clearance.
These solutions can reduce the duration of cold symptoms, particularly when used early in the illness. Your doctor may also recommend intranasal steroids for more severe congestion.
Are antibiotics needed for treating colds?
Antibiotics are ineffective against viral infections and should not be prescribed for the common cold. Over-prescribing antibiotics contributes to antibiotic resistance, which is a significant concern in the community. Antibiotics are only required in cases of co-infection, such as a middle ear or sinus infection.
Are there complementary and alternative medicines (CAM) for treating colds?
Herbal remedies and complementary treatments have been used traditionally to manage colds, but their effectiveness is inconclusive. Honey, for example, has been shown to be effective in relieving a child’s nighttime cough and improving sleep. However, it should not be given to children under 12 months due to the risk of botulism.
Does daily vitamin C prevent colds?
Although vitamin C has been promoted as a cold preventive for many years, research suggests that daily vitamin C intake does not reduce the likelihood of catching a cold. However, it may help shorten the duration and severity of symptoms. It is more effective in those with severe symptoms or those engaged in intense physical activity, such as athletes or military personnel.
When should I be concerned about my child’s cold?
You should seek medical advice if your child is under 3 months old, if the fever lasts for more than three days, if your child refuses to eat or drink, or if they are having difficulty breathing, with blue lips, or if the cough persists beyond two weeks.
Conclusion
The common cold is a leading reason for parents to consult a paediatrician. It is caused primarily by viral infections and can lead to symptoms such as coughs, runny or stuffy noses, sneezing, and sore throats.
Although the common cold is typically self-limiting, it can occasionally lead to complications such as middle ear or sinus infections. Supportive treatment aims to alleviate symptoms such as fever, nasal congestion, and cough.
Vaccination, proper hygiene, and good nutrition can help prevent colds in children. However, most colds resolve within 7 to 10 days with appropriate care and attention.
I declare no competing financial interest.
The author, Dr Kojo Ahor-Essel is a Consultant Paediatrician, at The Bank Hospital, Cantonments, Accra, and a member of the Paediatric Society of Ghana.
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