My goal with this post is to give some guidelines to help you figure out when a trip to the doctor's office is indicated. Many times, there is nothing to do but wait it out, so I am including some tips to help you and your child get through the illness as comfortably as possible. I have included standard treatments along with plenty of alternative options. I am comfortable trying some of the more natural approaches AS LONG AS you or your child are dealing with something mild. At the end I add some prevention tips.
If you are a new parent, buckle your seat belt. Studies say that most children will have an average of EIGHT colds within the first 18 months of life. Even if we don't have young children, colds and coughs can nail any of us. Most of the time the congestion is caused by a viral syndrome. Allergies and teething* can also be the underlying culprits.
{*Medical literature often disputes whether or not teething is connected to any symptoms, but I still maintain that at times it feels like it is an x in the equation.}
All that mucus is the perfect breeding ground for bacteria, which is why something that starts as a virus can turn into a bacterial infection. I have seen ear infections come on in a flash.
What symptoms do you need to pay attention to?
If you are dealing with a congested family member, here are the questions to consider:
Is there any labored breathing?
I listed this first, because I don’t care what else is going on! If there is any labored breathing or wheezing the patient usually needs to be seen. Noisy breathing isn’t always something to worry about, but it can be a clue. Grunting during an exhale or wheezy whistling sounds can indicate trouble.
When someone is working hard to breathe, respirations are faster and actually look different. You might see retractions, where it looks like the areas at the base of the throat, the sternum and between the ribs are actually sucking in. The nose might be flaring. The patients color might be pale or bluish around the mouth. With young babies you might see their little tummies going in and out more than usual.
These kids are rarely the ones happily running around and playing. They are low energy.
Sometimes a big mucus plug may be momentarily blocking an airway, causing a minute of distress that clears with a big cough. If coughing and steam are able to clear things up, it is more likely that it is upper airway congestion which is not as much of a concern.
If you find that you are having a hard time assessing the respirations, try sticking your ear up to their lungs and see if you can hear anything. If you can hear nice clear air noises, that is great. If you hear whistles or squeaky noises, that may mean the congestion has spread down to the lungs. Using your ear as a stethoscope doesn’t always work; more than half the time you won't be able to hear anything, but once in a while parents are able to get some important clues from the "ear to chest" evaluation.
If your child is old enough to cooperate, have them take a great big deep breath, in and out.
If they are wheezy or have any inflammation in their lungs, that deep breath will often trigger a bit of a coughing fit.
It is not a bad idea to get an idea of what “normal” looks like. If you are lucky enough to be reading this when your child is healthy, lift up their shirt and watch them breathe for a minute or two. How fast are their normal breaths?
Check out the Tik Tok that Dr. Ted and I did. Seeing what labored breathing actually looks like is worth 1000 words
(if someone had told me a few years ago that I would be doing TikToks, I would not have believed them.)
There are also oximeters available that can measure the oxygen status. A good number above 98% is always going to be reassuring. A low number might be garbage, so please don’t freak out. The oximeters that you can get from Amazon might not work well on kids. With a little one, you might do better putting this on a toe instead of the finger.
How is their mood?
Anyone is going to be grumpier than usual if they have a cough or cold, but if your little one is really fussy and doesn’t have the language to tell you what’s wrong, I might suggest getting their ears checked to rule out an ear infection. (Not all ear infections need to be treated, but it is worth seeing what’s going on in there.)
Do they have a fever?
Plenty of colds come with fevers. A fever that doesn’t go below 102 after the proper dose of medication, or a fever that is lasting more than 3 days should be checked.
How is the appetite?
If your baby is nursing well, that is very reassuring. I don’t get too worried if your child isn’t too interested in solid foods for a couple of days, as long as they are drinking.
Are they sleeping well at night?
The congestion and coughing alone can be a reason that it is hard to sleep, but ear pain is worse when your little one is in a flat position, so I want to rule out an infection if you have more than one completely miserable night
What color is the mucous?
I am more interested in mucus that is getting thicker and greener. Green mucus does not automatically signal a problem. It is just one more clue. It is common for mucus to have more color when they first wake up and then to clear throughout the day
How long has this been going on?
Many colds and coughs can last between 1 and 2 weeks. It is common for coughs to linger for another couple of weeks before they are completely gone.
It is okay to play the wait and see game if your little one is:
- Reasonably consolable
- Mucus is mostly clear (greenish in the morning that clears throughout the day is fine)
- Staying hydrated
- Sleeping isn’t horrid
- No breathing concerns
- Fever controllable and lasting less than 3-4 days
If your baby is less than 3 months I am often quicker to get them checked out.
Tell your doctor If there has been a recent exposure to Covid or another illness. If family or friends are having similar symptoms, that information will be useful
Management tips
Standard suggestions -
Hydration is key! The best way to manage congestion at home is to make sure your little patient is getting plenty of fluids. This will help to keep the mucus thinner; it will also keep the mucus membranes moist, which in turn makes it easier for them to clear debris.
With some older kids, cow's milk may not be the best choice because it can increase the amount of mucus (it doesn't impact everyone the same way.) I have plenty of patients who love their milk, and taking it away for a couple of days is not a reasonable option. Sometimes thinning it with a bit of extra water is a good compromise. Breast milk is the perfect liquid if you are lucky enough to have it.
Warm tea with honey (for kids over the age of one) can soothe the back of the throat and ease the coughing.
For older kids and adults, don't minimize the value of chicken soup!
Steam is great. Hang out in the bathroom when anyone takes a shower. Running a humidifier or vaporizer at night can be very useful. Turn it off during the day and give the room a chance to dry out so that you don't grow mold. Make sure you change the water daily. As long as you follow those rules, I don't have a preference between warm or cool mist.
Keeping the head elevated makes a huge difference. Some of the younger babies will do best napping someplace where they are on an angle. This is fine as long as they are monitored. For night time, if you want them on a little slant, according to the new AAP guidelines it shouldn’t be any greater than 10%
You can put saline drops or breast milk into the nose (and then suck it out with a nose frida. This is the likely the best way to actually clear the nose. Your baby will no doubt hate this, but if you can manage to do it about ten minutes before a feeding, it may clear the nose up enough to make eating much easier.
It is the rare toddler who is going to cooperate with any drops of any kind in the nose. My grandson Elliot is no exception. If that is the case for you as well, try the AYR saline gel. Lauren got creative and convinced him to ‘see if he could smell it’ and it worked well.
Some of my parents really like the Oogiebear nose and ear cleaners. These are safe, soft little plastic scoops that allow you to remove stubborn little boogies.
Consider acupuncture! One of our neighborhood acupuncturists gets some good results from her treatments for your basic coughs and colds. Her treatment of children often does not use any needles.
Is there something I can give them?
The standard cold and cough meds that many of you grew up with are no longer recommended for children under the age of 6 years. If your kids are utterly miserable and are having an impossible time sleeping due to coughing and congestion, many seasoned pediatricians may recommend a dose of Zyrtec or Benadryl at night to help dry the kids up and give them (and you) a break. Before I would do that, I would want them checked out to make sure the lungs and ears are clear.
Say WHAT??!!
There are some homeopathic remedies. Boiron and Zarbees are two popular brands. They both have products that are safe for infants. Make sure that anyone under a year uses the appropriate formulation.
When I was at Noe Valley Pediatrics, we loved to treat colds with Windbreaker or Pipecleaner. These are Chinese herbs that can dry up congestion. I had hundreds of patients who swore by these.
Still in the realm of Chinese medicine, there is a product on the market that you likely haven't heard of. Dr. Loo, a local physician, has created a patch to treat the symptoms of congestion. These are safe for any age! Several years ago she gave me samples for my patients to try. In some cases, the parents reported that they thought they indeed seemed to help. In any case, they are not terribly expensive and there are no safety concerns.
For night coughs, without taking anything orally, you might try a bit of Vicks Vaporub on the feet! Trust me, I scoffed at that as much as anyone, until I asked my patients to test it out and was shocked at how much it seems to help. A little dab under the nose can also sometimes help clear things up. Do NOT place it inside the nostril.
Prevention
For parents and big kids I really like
I have heard folks consider these to be placebos, but in my case I say " bring it on" because they seem to work.
Remember that I used to work in what could have been considered a veritable germ factory and (knock wood) I usually managed to avoid many of the things I was exposed to. The second I feel that little tickle in my throat or any tell-tale signs of an illness I take a zinc cold therapy lozenge (Walgreens generic tastes better and are cheaper) and a Sambucol lozenge twice a day.
Another very good thing to do for folks who are old enough is to use a Neti Pot or sinus irrigation. Make sure to use distilled water. NeilMed has quite a few excellent products to help clear out the nose. For nursing moms, this is my absolute favorite remedy. If you have a deviated septum, this may not work well for you.
Teach your kids who are old enough how to blow their noses. Lots of kids have ZERO idea how to do this, so they need to be taught. Play games with a tissue. See if they can make it dance by blowing on it. Start with the mouth and then see if they can make it move by blowing it with their nose.
Blowing too hard can hurt the ears. See if they can gently hold one side closed and blow gently, giving each side a turn.
It is also good to teach your kids to cover their sneezes and coughs when possible by coughing into their elbow
Good hand washing is of course essential.
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