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Children’s colds and throats

By: Dr Maria Alice

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TREATING THE colds and throats of children is part of the Family Physician’s job. Parents are very confused about what to do, with good reason, as they get lost in a foggy winter wonderland of coughs, runny noses, fever and vanished appetite. “Please doctor, what should I do, my child is not eating?” No vitamins will make them eat until they get over the infection.

What is a common cold?

It is a relatively harmless infection of the upper respiratory tract, although it does not usually feel that way. If it is not a runny nose, sore throat and cough, it is watery eyes, sneezing and congestion … or maybe all of the above. Symptoms tend to vary greatly, as any of more than 200 viruses can cause a common cold.

Most adults are likely to have a cold virus two to four times a year but, unfortunately, children, especially pre-schoolers, may have one as many as eight to 10 times.

A cold virus is highly contagious and enters your body through the mouth or nose, through droplets thrown in the air when someone, who is sick coughs, sneezes or talks. It also spreads by hand-to-hand contact or through using shared objects, such as utensils, towels, toys or telephones. Touch your eyes, nose or mouth after such contact or exposure and you’re likely to catch a cold.

What makes a cold different from other viral infections is that it is unlikely to cause significant fatigue or high fever.

Children are especially vulnerable to common colds because they have not yet developed resistance to most of the viruses that cause them. Besides their immature immune system, they also tend to spend lots of time with other children and are not always careful about washing their hands and covering their face when they cough or sneeze. This is why we have mothers complaining all the time that “since my child started to go to school he/she is always ill ….”

Like adults, children are more susceptible to colds in fall and winter, when they are in school and spending a lot of time indoors. Some researchers theorise that cold winter temperatures constrict blood vessels in the nose, slowing the white cells that fight infection and disrupting the first-line defence against germs.

Flu viruses are transmitted in the same way as common cold ones. Initially, flu may seem like a common cold, with a runny nose, sneezing and sore throat, but colds usually develop slowly, whereas the flu tends to come on suddenly.

When is the doctor needed?

Children do not need to see the doctor for a common cold, but it is necessary to seek medical attention right away if a child has any of the following signs or symptoms:

• Fever of 38ºC or higher that lasts more than 72 hours, chills or sweating.

• Vomiting or abdominal pain.

• Unusual sleepiness.

• Severe headache.

• Difficult breathing.

• Persistent crying.

• Persistent cough with coloured phlegm.

• Ear pain.

Do not forget that a cold can trigger wheezing in children with asthma.

If symptoms of a common cold get worse instead of better see the doctor to make sure your child does not have a bacterial infection in the lungs, sinuses or ears. When a child is fighting a viral infection, all defences are weakened. Other infectious agents, like bacteria, “step in” without finding the usual defensive obstacles and cause secondary infections, like strep throat (streptococcal pharyngitis), pneumonia, bronchiolitis and croup. These need to be treated by a doctor.

Treatment and prevention

There is no “cure” for the common cold. Antibiotics are of no use against cold viruses. Most over-the-counter cold medications have side effects and will not cure a common cold or make it go away any sooner. People turn to Paracetamol (acetaminophen) for almost everything, but keep in mind that it can cause liver damage if taken too frequently or in larger-than-recommended doses. Children should only use decongestant nasal sprays when prescribed by a doctor. Use saline sprays instead. They are effective, safe and non-irritating.

In the winter, non-prescription cough syrups practically fly off pharmacy shelves, but some ingredients may be harmful for children, especially if younger than 14. Coughs, associated with a cold, usually last less than two to three weeks so, if a cough lingers longer than that (or is turning your life into hell), see your doctor.

For the flu, the first line of defence is an annual flu shot, that although not offering 100 per cent protection, can reduce the chance of infection and help prevent serious complications.

Because so many different viruses can cause a common cold, no effective vaccine has been developed.

What about sore throats?

Viruses, the same type of germs that cause colds and flu, cause most sore throats. A much smaller number are due to bacterial infections.

Most often, doctors will diagnose the cause of a sore throat based on a physical examination and throat culture. Although redness, swelling and white streaks or puss on the tonsils indicate an infection, there is no accurate way to tell only by looking if it is viral or bacterial. That is why doctors sometimes perform a rapid “strep test”. Even if it is not 100 per cent accurate, it can be done there and then and is a good guideline if combined with observation.

In some cases, a blood sample might be necessary to discover if there are any alterations to the white cells’ count that will help in making the decision of whether to prescribe an antibiotic or not.


Although most bacterial throat infections are not dangerous, they can lead to serious complications. Strep throat in particular can cause other infections, such as tonsillitis, sinusitis, ear infections and scarlet fever. Two of the most serious sore throat complications are kidney damage (glomerulonephritis) and rheumatic fever that can permanently damage the heart valves. Strep throat occurs most commonly in children between the ages of five and 15.

Most sore throats go away without treatment, often within a week or so. Increasing your fluid intake and getting extra sleep can help speed up your recovery, as always.

Follow the same guidelines as above on when to see a doctor.

Misuse of antibiotics

At one time, doctors automatically treated all sore throats with antibiotics, both to cure the infection and to prevent the dangerous complications. The overuse of antibiotics has led to an alarming increase in antibiotic-resistant strains of bacteria and doctors are now much less likely to prescribe them.

If the doctor prescribes antibiotics, use the entire course of medication, even if all seems fine. This helps to prevent the infection from coming back and bacteria from becoming resistant to the medication.

Common sense general hygiene precautions must be taken to slow the spreading of any viruses and bacteria. The most important of these is washing your hands.

Best health wishes,

Drª Maria Alice