Too many colds

The Pediatric Insider

© 2010 Roy Benaroch, MD

Claire wanted to know why her kids get sick so much. So many colds, so much snot. Is there any way to stop this?

Colds are called “upper respiratory infections” in doctor-talk. They’re caused by one of hundreds of viruses that invade the tissues of your nose, sinuses, and throat. Typically symptoms begin with a sore throat, move into a stuffy nose, and then cause a lingering cough as a good-bye present.

Normal kids get a lot of upper respiratory infections, about twelve per year for pre-schoolers and nine per year for kindergarteners. They tend to occur more frequently once school starts in the fall, and last all through the winter. So from September through March you can expect what will seem like at least one cold a month. Since ordinary colds last at least 10 days, for the winter it seems like many kids are sick more days than they’re well.

What about those kids who really do get more than their share of colds, or the kids whose colds linger for weeks and turn into sinus infections or other problems? Think about these kids in three groups:

  1. Otherwise completely healthy kids who just get a lot of colds. They get better on their own, but seem to get “frequent colds” one after another in a string of isolated episodes. There’s no history of other infections, unusual infections, or anything else about these children that seems unhealthy.  They’re often in day care or school, and sometimes get extra exposures to cold viruses from helpful siblings. This is the largest of the three groups.
  1. Kids who “keep a cold.” These children get many colds, but don’t get better on their own. The cold symptoms linger and last “forever.” Often their colds will turn into ear infections or sinus infections, and won’t get better until an antibiotic is prescribed. Other than the lingering colds, these kids are not otherwise unwell. They don’t get lots of infections other than these respiratory problems, they’re growing well, they’re doing fine. They just have persistent snotty noses.
  1. Kids who are genuinely unwell. By far, this is the smallest of the three groups. These are children who are often not growing well, and suffer from many other frequent infections including chronic diarrhea, thrush, and other unusual or chronic, hard-to-treat infections. Kids in this group should be aggressively evaluated for an immune deficiency, and should be seen by a specialist in pediatric immunology.

Kids in group 3 are rare, but characteristic, and it’s easy to tell that these children are different. It’s sometimes tricky to separate group 1 from group 2, especially if the group 1 kids get so many colds that one just immediately follows another. The best “test” to tell if your child is in group 1 or group 2 is for parents to keep a “snot calendar.” Group 1 children, the “frequent colds,” really should get completely better, at least briefly, in between individual cold episodes. Group 2 kids, the “keep a colds,” have symptoms that get better and worse, but are never completely free of cold symptoms.

“Frequent colds” versus “keep a cold” kids are different. Though they might both benefit from strategies to prevent colds in the first place (more about that later), the children who “keep a cold” very often develop complications of viral respiratory infections: bacterial sinusitis or ear infections. Snot that stays in one place for too long is very inviting to bacteria– like a sticky, inviting swimming pool– and eventually, kids who “keep a cold” are going to be infected with bacteria. To help avoid these secondary infections, families with “keep a cold” kids need to get very aggressive about clearing out mucus. Use a humidifier, long steamy showers, and saline nose drops. Anything that physically clears out mucus will make secondary infections less likely. The children will feel better, and will need fewer antibiotics. Families who get good at mucus control might even be able to avoid a trip to the ENT for sinus surgery or ear tubes.

“Keep a cold” kids tend to run in families, probably because their parents share their same small sinuses and ear anatomy that makes clearance of mucus difficult. Some of these kids might also have allergies that trigger very similar symptoms. If your child who keeps a cold has symptoms of allergy (itchy nose, itchy eyes, sneezing) or a strong family history of allergy, further testing or treatment of possible allergies might be worthwhile.

Whether your child is in the “frequent colds” of group 1 or the “keep a cold” of group two, strategies to avoid infections are a good idea. Many, many respiratory virus exposures occur in day care. Can you move your child out of group care, at least for the winter? Children can be taught not to rub or touch their own face, which prevents viruses on their hands from invading their usual ports of entry, the nose, eyes, and mouth. Avoid playing with toys in common areas like doctor waiting rooms, and stay out of little gym classes and fast food play areas. Get into the habit of washing hands frequently or using an alcohol-based hand sanitizer to prevent not only upper respiratory infections, but common “tummy bugs” as well.

There are plenty of herbal products and supplements that claim to protect your child from colds. They’re quackery. Save your money for something else.

Some vaccines can help prevent at least some respiratory infections, and even some complications. Influenza vaccines should be given to all children each winter. Very recently, the Prevnar (pneumococcal) vaccine was improved to include several more strains of this common bacterial cause of ear infections and sinus infections. These vaccines will not prevent all or even most of these infections, but they can make an important difference.

What about medicines to treat Junior when he has a cold? Though they’re marketed very heavily, they’re not very effective. Your best bets for symptom relief during a cold are acetaminophen or ibuprofen for aches, nasal saline washes for congestion, honey for cough (over age 12 months), throat drops for sore throat, and ice cream for the child and the parents. There. Doesn’t that feel better?

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13 Comments on “Too many colds”

  1. Phil Says:

    Great and very practical advice in here! Thanks for posting.

    We finally had to change doctors because it was always the same basic answer (“write a prescription”). We found that by asking questions and looking for alternatives we felt a lot better about our options.

    Even as it began to look like out daughter would need a procedure for her sinusitis – sinus surgery was the only initial option until we were told of a balloon sinuplasty procedure.

    Anyway, nice to hear such practical advice. Thanks again.


  2. Kathryn Says:

    What a great article! Dr. Roy, you’re the best! Always so sensible and patient! Thank you!


  3. Ray Says:

    Great article!!!! This has been the BEST feedback I have recieved in the last 2 years. Thanks Dr. Roy


  4. Catherine Says:

    This was very helpful. Thank you.


  5. Julie Says:

    Hello. My 16 month old falls in the “keep a cold” category these days and I was wondering if you felt it was ok to vaccinate these kids who are chronically fighting off a cold? It seems I can never get her vaccines because she is always fighting something! Any thought? Thank you!


  6. Dr. Roy Says:

    Julie, vaccines should be held for serious or severe illnesses– but not for ordinary colds in otherwise healthy kids. All winter we’re swamped with kids with colds. Get them vaccinated so they don’t catch anything serious– it’s those same kids who pick up the colds who are at risk for something bad.


  7. Shri Says:

    very good article


  8. HB Says:

    I have bookmarked this article to keep me sane as a worried mama. My toddler is 2 and has been in a large group daycare since 6 months and is definitely a Keeper of colds. Only recently, after a year of so many secondary infections (ear infections or pinkeye), are we understanding the importance of “snot management” using saline drops. I wish we had been more diligent from the get-go instead of ending up taking so many antibiotics.


  9. Gouraja Says:

    This was really helpful. I have alway been worried to hell thinking that my son is the only one to get frequent colds from the time he started daycare. His vaccinations are all up to date and even had flu shots. But he always needed medical intervention whenever he had cold. However, now he is 18 months old and fortunately I guess his bouts would turn less frequent.


  10. Phillip Says:

    Having studied health as much as I did. You must acknowledge the one group you FORGOT. And this one is the MOST important!!! It’s information available in several case studies and college books 📚!
    Ignorant individuals who expose their children and loved ones to second hand smoke double thei chances of that child having upper respiratory issues.
    Usually it’s people who smoke that ignore those FACTS, or just don’t have a heart. Read the facts before posting anything this important or serious!…otherwise it’s a bunch of BS!
    You CAN amend your little write up?


  11. Phillip Says:

    As a health advocate I’d go as far as saying you also listed the 4 GROUPS in the opposite order.
    All accurate information available would list the inconsiderate, selfish, careless, HEARTLESS, F’N a-holes as the number one cause of children health diffencies.
    Not until having a child who has been subjected to such selfishness did I completely understand!
    I smoked from age 7-22,,,that’s 15 years!
    That’s reason enough to arrest my own mother!


  12. Phillip Says:

    The most important thing you can do as a health advocate is stress how important it is to have a voice for the voiceless!


  13. Danny Says:

    Great article.
    Phillip, this article is not about you and your views, it’s a practical article for parents with kids wondering why their kids get so many colds.
    Rambling on about Smokers won’t help the article.
    At most I’d say a comment reminding all that smoking around children will/can increase their likelihood of getting viruses (provided there is evidence that is).
    I’m not or never have been a smoker and avoid anyone who is too, especially if my kids are with me.


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