Here are situations that likely do NOT warrant an evaluation by us:
- Newborns or young infants with nasal congestion. Virtually all newborns go through a few months of nasal congestion as their airway adjusts to life. If there is no dripping runny nose or cough, then this is not an illness. Saline drops or breastmilk in the nose can relieve this.
- Anyone with a runny nose and general cough who has no fever or in whom a fever has now resolved, and has no rapid labored breathing, likely has a common cold or mild respiratory illness that will resolve without medical intervention.
- RSV is going around, as it does every late Fall and Winter. Pfizer is in the process of having the FDA approve a new RSV vaccine for pregnant women so newborns will be born with some protection, so RSV is all over the news this year. However, RSV is mild and harmless in most cases. More info below on when to worry.
- Even junky coughs with mucus (bronchitis) likely don’t need to be seen if there is no persistent fever (more than a few days) and no rapid labored breathing as antibiotics are rarely necessary in such circumstances. Normal coughs from cold viruses can normally last from 1 to 4 weeks, then go away.
- Green runny noses generally do not need antibiotics, as most common colds have a “green” phase, and even most sinus infections will go away without antibiotics (see sinus infection below).
- Coughs with some wheezing are usually caused by RSV (a winter-time cold virus). You may notice a tight cough and may be able to hear wheezing when your child breathes deeply. There is generally no medical treatment that helps other than the same measures you would use for a common cold. If your child is having labored, asthmatic breathing, a doctor’s visit is warranted (or the ER if severe).
Common colds and coughs can typically last from 1 to 3 weeks, and likely don’t need to be seen.
Here are scenarios that may require an evaluation by us:
- NOTE: Before you call us, consider taking a short video (about 10 seconds) of your child’s breathing bare-chested so we can see any distress. Then also take a short video of the cough. Send these to us with a message in your Chart Portal.
- CHRONIC COUGHS: If you are bringing your child in for an appointment for chronic coughing fits, please bring some video examples of these, as most kids won’t cough once they are at our office, and seeing the nature of the coughing fits will help in our evaluation. Most chronic coughs do not need antibiotics or prescription medical treatment, and there is often nothing we need to do for your child unless he or she fits one of the severe descriptions below. The most common causes of chronic coughs are RSV (see above), allergies, and residual bronchitis from a cold. These generally don’t need antibiotics or prescription medical treatment. We can see your child for an appointment if you need reassurance.
- RSV. Like most other respiratory viruses like Covid and Flu, most cases of RSV are harmless and don’t require treatment. You likely won’t even know if your newborn, infant, or child even has it, and there’s no reason to test for it unless in an ER. Please do not contact us in a panic because you think your child might have RSV because there’s nothing we’ll need to do (unless severe), and there’s nothing we can do to keep it from being severe if it is going to go that way. Simply treat this like any other cold, and try your best to keep your newborns and infants away from sick older children for the 10-day contagious period.
- RSV: when to be seen. Rarely RSV can cause a more severe infection. If your child has rapid labored breathing or chest retractions (caving in with each breath) that lasts for hours, and doesn’t improve with steaming and suction, then go to an ER if it’s after hours or call our office for an appointment during the day. There isn’t anything we can do over the phone as far as treatment goes. An ER will stabilize the breathing with some inhaled medications and then decide what more needs to be done, if anything.
- Croupy coughs (cough sounds like a seal barking, your child has lost her voice or has a raspy voice or cry): Croup is a viral illness and doesn’t require antibiotics. Most mild cases don’t need to be seen by us. Search croup on our web site AskDrSears.com for more information. If your child has labored breathing and stridor (see our web page on croup) – not just while coughing, but persistently for hours – she should be evaluated by us. 20 minutes of cold, humid night air or in a bathroom with steamy shower running often settles down croupy coughs and stridor. Go to an ER if your child is blue or acting like she isn’t getting enough air.
- Cough and/or runny nose with fever for more than 3 days. Since most Flus and many colds (including RSV) can cause fever for 3 to 5 days, there still may be nothing medical for us to do. But we can generally see you to just make sure if fever lasts more than 72 hours.
- Rapid labored breathing that persists for hours.
- Ear pain with fever and cold/cough symptoms (see Ear Infection section below). Ear pain does NOT simply mean touching or grabbing the ears as an infant, as babies are prone to doing that due to teething or for no reason.
- Wheezing, chest retractions (chest caving in with each breath).
- Any infant 3 months and younger with a fever of 101 or higher should be seen.
- Sinus infection: most of these don’t need antibiotics. If sinus headaches and pain, green nose, and fever persists for 5 or more days, we should see your child to discuss antibiotics.
- Prolonged, severe coughing fits that last 20 or more seconds that make the face turn red, with “whooping” gasps between fits of coughing in which it seems your child has some difficulty inhaling, often ending in gagging or throwing up. This may be whooping cough – search for this on our AskDrSears.com website for more info.
- What about Pneumonia? Kids with pneumonia typically have 3 or more days of fever, severe cough, possible chest pains, and rapid labored breathing even when fever is down. These scenarios are listed above as reasons to be seen. If your child does not fit this scenario, then being seen just to rule out pneumonia is likely not necessary.
OTC medications for treating cold and cough symptoms – Kids 4 and older:
For OTC cough and cold medications, search our “medications to treat coughs and colds” guide on AskDrSears.com for guidelines on this for kids 4 years and older.
Natural remedies for infants and children:
Sinupret – herbal liquid available online or in our office. Helps with the nasal symptoms associated with a cold. Follow dose on bottle for 2 years and older. For infants 6 months to 23 months, can give 1/2 to 3/4 of the 2 year old dose. Three times daily.
Zarbees – this brand makes several different cold and cough remedies. Follow the dose on the bottle.
Use steam (hot shower steam or humidifier), suction out the nose, and sleep a bit upright (with a pillow under the mattress).
Supplements to take that may boost the immune system when sick:
You can also give these to boost the immune system when well to help fight off illness, at about half the dosing indicated below:
Zinc – 5 mg/day for kids 2 to 6; 10 mg/day for kids 7 to 12; 20 to 40 mg/day for teens and adults.
Vitamin D (buy one that also has Vit K in it too) – 2000 IU daily for kids 2 to 6; 5000 IU daily for kids 7 to 12; 10,000 IU daily for teens and adults
Vitamin C (I like the white powder sodium ascorbate type) – 250 mg three times daily for kids 2 to 6; 500 mg three times daily for kids 7 to 12; 1000 to 2000 mg three times daily for teens and adults.
Echinacea – dose the same mg as Vit C
Elderberry extract – follow dosing on the package, twice daily.
For kids under two, you can likely give about half the young child’s doses indicated above, with your doctor’s guidance.
How long are colds contagious? At least as long as there is fever, and a day or 2 after fever is gone. Colds are generally contagious for about 10 days though. They are possibly contagious longer if cough remains moderate to severe and as long as the runny nose persists.
