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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Tags: colds, congestion, cough, immune deficiency, uri

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