Colds, Coughs, and Ear Infections
Because their immune systems are still developing, children are especially vulnerable to viruses and bacteria, and they tend to get sick more than grown-ups. Most of the time, all kids need is a little symptom relief and comfort. Here's how you can help yours recover faster from colds, coughs, and earaches, plus how to tell when sickness indicates something more serious.
Babies and kids typically get six to eight colds a year -- just think of all the stuff they're constantly sticking into their mouths and it's easy to understand why. The good news: These infections actually help strengthen their immune systems down the line. Meanwhile, to help her feel better:
- Saline drops in the nose can reduce congestion (follow package directions for dosage). This is especially helpful for babies too young to blow their noses.
- Put a cool-mist vaporizer in her bedroom -- moist air helps alleviate congestion.
- Give infant acetaminophen (babies older than 3 months only) to ease her discomfort. For babies 3 months or younger, don't give any medication without talking to your doctor first (it can mask a fever, which requires immediate medical attention in infants; for more info, see "Fevers", below).
Call the doctor if...
- You suspect the flu in an infant younger than 3 months, go to the doctor right away (symptoms of flu include fever, fatigue, and listlessness); from 3 to 6 months of age, it's less urgent, so call your pediatrician and ask what the best course of action is. (Remember, symptoms of flu come on suddenly -- as opposed to cold symptoms, which come on gradually -- and they're more intense.)
- Your child shows symptoms of sinus inflammation or sinusitis (a bacterial infection of the facial cavities), both of which may cause a wet or phlegmy cough, bad breath, and thick yellow or green mucus. Sinusitis may also bring on a headache and fever. If your doctor diagnoses an infection, he'll likely prescribe antibiotics.
A cough often develops with a cold, and can be persistent. There's usually nothing to worry about, and the best thing to do is let it run its course. To make your child more comfortable:
- Offer liquids to lubricate an irritated, cough-prone throat. For babies, nurse or bottle-feed more frequently. For children, give water, warm tea, or diluted juice (semi-frozen if you want, for its soothing chill).
- At bedtime, elevate your child's head with a wedge underneath his mattress.
- Always ask a pediatrician before giving a child under 3 years of age an over-the-counter cough preparation or decongestant. For all kids, avoid any medication that contains phenylpropanolamine, which may trigger seizures and increase the risk of stroke.
Call the doctor if...
- Your child has a severe cough and a fever of more than 101 degrees Fahrenheit that lasts more than a day; you'll need to have your pediatrician rule out strep. (A rectal temperature is the most accurate reading.)
- Your child is wheezing and coughing to the point that he's having trouble breathing -- or he shows a loss of appetite and unusual lethargy. This could signal a more serious infection such as respiratory syncytial virus (RSV), which can lead to bronchiolitis, an inflammation of the small tubes of the lungs. Bronchiolitis can be life-threatening in some babies under 6 months, and in preemies up to 1 year.
- Your child has a hacking, barking cough -- usually at night -- which means he probably has croup, an infection of the larynx (the voice box). Call the doctor no matter the hour; he'll probably advise you to elevate your child's head and go out into the cool night air with him. If your child is struggling for breath, go to the emergency room. He likely will be given an injection of steroids -- a standard treatment that's safe in kids as young as 3 months -- and perhaps a nebulizer with medication to help open his airways.
- Your child's cough persists for a week or two and then worsens, with severe and prolonged coughing jags punctuated by gags and gasps and, occasionally, vomiting. This could be pertussis (a.k.a. whooping cough). In spite of its name, babies under 1 rarely "whoop." Nor do adults (kids do). Your doctor will probably prescribe antibiotics.
Babies are especially vulnerable until they get the third of four diphtheria-tetanus-pertussis (DtP) vaccinations, usually at 6 months. Those under 3 months are at increased risk for pertussis-related apnea, in which they stop breathing altogether and need emergency help. The best prevention: Stay on schedule with baby shots and remain vigilant for signs of pertussis until full protection kicks in around 6 months. When kids hit 11 or 12, they'll need a booster shot.
A fever indicates that the body is working to fight an infection, and is usually not a cause for concern. How your child is behaving is actually a better way to tell how ill she is. If your baby has a fever but plays normally (rather than being listless and fussy), there's probably nothing to worry about. Same goes for toddlers and older kids. As long as your child acts like she normally does, all you need to do is comfort her by:
- Making sure she gets plenty of rest.
- Giving her lots of fluids. Infants and toddlers may be given a commercial rehydrating solution, such as Pedialyte or Rehydralyte.
- Sponging her with tepid water or placing her in a bath of lukewarm water.
- Giving her acetaminophen or ibuprofen to reduce her discomfort, as long as the doctor says it's okay. (Children under 18 should never be given aspirin; it's been linked to Reye's syndrome, a serious disease that affects the brain and liver.)
Call the doctor if...
- An infant 3 months or younger has a temperature over 100.4 degrees Fahrenheit, even if she shows no other signs of illness. (Always use a rectal thermometer for babies this age since it provides the most accurate reading.) And be ready for a trip to the emergency room to rule out a serious infection -- in the early weeks of life, babies have a limited ability to fight illness because their immune systems are not fully developed.
- Your 3- to 6-month-old has a temperature of 101 degrees Fahrenheit or higher, as children this age have a greater (though still small) risk of a serious bacterial infection than older kids do.
- An older child's temperature hasn't improved in three days or reaches 103 degrees Fahrenheit or higher.
- A feverish child of any age develops other symptoms -- a rash, an earache, swollen glands, or trouble breathing. The pediatrician will want to make sure your child doesn't have a serious illness, such as pneumonia or meningitis.
- Your child suffers a febrile convulsion. These seizures are scary but not uncommon, and happen most often in babies between 6 months and 2 years. Have the doctor check your child the first time this happens to make sure it hasn't been caused by an underlying condition. Kids prone to febrile convulsions usually outgrow them by age 6 with no long-term effects.
By age 3, 70 percent of children have had at least one ear infection. The vast majority occur when fluid accumulates in the middle ear and becomes infected (usually a bacterial infection), causing pain, swelling, and redness. If your baby seems uncomfortable and begins pulling on his ears, you may have an ear infection on your hands.
About 80 percent of the time, the infection will clear up on its own in a few days, so you may not need an antibiotic. New evidence shows that antibiotics simply don't help most kids that much -- they end pain at best half a day sooner than if left untreated. Many experts think it's best to wait on antibiotics and manage the discomfort by:
- Giving your child acetaminophen or pain-numbing drops (which your doctor can prescribe)
- Applying mild heat to the ear-try a warm, moist washcloth.
Call the doctor if...
- You suspect an ear infection and your child is 2 or younger.
- Your older child has mild pain in his ears for more than 24 hours; is in great pain; is running a temperature of 102 degrees Fahrenheit or higher; or you notice pus coming out of his ears, or the glands in his neck seem swollen.
- Your child gets one ear infection after another. If this is the case, talk to your pediatrician about whether ear tubes are a good option. These tubes are implanted surgically, and are designed to allow bacteria-friendly fluids to drain from the ear. Tube implantation should be a last resort, but chronic ear infections shouldn't be ignored since they can affect a young child's hearing and delay speech.
Preventing ear infections
To lower your child's odds of getting an ear infection:
Breastfeed. This is associated with a lower risk of ear infections.
Feed upright. In young children, the ear's Eustachian tube goes in a straight line from the mouth to the nose to the ear, so when a child lies flat, formula or milk may drain through the tube into the middle ear and provide a meal for bacteria.
Limit pacifiers. A study found that babies who didn't use pacifiers had one-third fewer middle ear infections. If your baby loves his, try giving it only at naptime and bedtime.
Stop sniffles. Ear infections often follow colds, so cold-prevention tips matter: Remind kids to wash hands with soap and water after they cough or sneeze, and before meals.
Don't smoke. Kids who are exposed to secondhand smoke get more ear infections; it irritates mucous membranes and damages tiny hairs in the middle ear.
Stay up-to-date with vaccines. The pneumococcal vaccine, Prevnar (recommended for all healthy children under 2), mainly prevents bacterial meningitis, but also guards against seven strains of ear infection-causing bacteria. (Babies typically get four shots, between 2 and 15 months.)
Your child is bound to get her share of coughs, colds, and earaches when she's little. They'll become less frequent as her immune system strengthens. Meanwhile, be watchful of symptoms and give her plenty of TLC.