“What helps a toddler with a cough and cold?”
My toddler son has a cough and cold. What helps a toddler with a cough and cold?
4 Answers
Plenty of warm liquid. Normal saline nose drops and Zarbees or Hyland syrup.
Hello,
If your toddler is happy, playful, eating, drinking and sleeping well (especially sleeping well), he or she does not need any help at all. The child’s immune system is working well and doing its thing. If your child is a little under-the-weather, energy wise, but otherwise well, eating, drinking and still sleeping normally, again no special help is needed.
Now, if the cough and cold (runny or congested nose) is associated with fever (>100.4 rectally or 99.4 by armpit or forehead scanner or ear thermometer), there is no need for fever medication (Tylenol or Advil) unless your child feels badly with fever. And you are the best judge of that. Feeling badly is more than just a little bit tired. Think irritable, grouchy, short-tempered, inconsolably crying.
For the last decade or more, informed pediatricians have concluded that fever in a comfortable child is the immune system at work killing viruses. But no doctor or parent wants a child to feel badly with fever. So that’s when fever meds are needed. When nasal breathing is obstructed by nasal discharge or congestion, we recommend nasal saline washes or nasal saline gel used when needed followed by nasal aspiration with a nasal bulb aspiration. There are many varieties of nasal suction devices on the market. Think cheap and effective. You don’t want the treatment to be worse than the problem. Most toddlers won’t say thank you when the aspiration is used. It’s also okay to simply use nasal saline often without suctioning to moisten and remove nasal mucus. Saline used often even without suctioning can lessen mucus. Remember the Colorado River, given enough time, created the Grand Canyon and no suctioning was ever used.
Similarly, a cool mist humidifier used when the child sleeps (nap or bedtime) can loosed nasal mucus. This should be an inexpensive cool mist humidifier, NOT a steam vaporizer which could introduce a risk of scalding the child if running too close to the child’s skin. Avoid the expensive ultrasonic humidifier! It makes water particles too small which can irritate a child’s airway in the lungs. The inexpensive cool mist humidifier makes larger water particles that moisten the upper airway only. Air below the vocal cords is already 100% humidified in all of us. No sense irritating a child’s lungs further with unneeded ultrasonic water particles. Be sure not to run the humidifier 24 hours a day to avoid mold build-up and clean it properly according to its instructions.
Remember the above advice is for significant nasal obstruction. If your child is sleeping well and not snoring loudly and has no noticeable long pauses in breathing due to the cold, it may be wiser to limit your effort to improve nasal symptoms. There is a pattern to a normal toddler cold. There can be fever the first few days, but rarely more than 3-5 days and if your child is comfortable, fever meds are not needed. If your toddler starts the cold with an abrupt high fever (103-104), you may need to call the doctor to discuss the possibility of another problem, e.g., a sinus infection or ear infection, otherwise you can give it a few days for comfortable mild fever to subside. Runny or congested nose symptoms associated with cough usually peaks by day 5-6, then subside over the next 7-14 days. It is uncommon for uncomplicated colds to last beyond two to three weeks. Colds that increase in intensity after the first week into the second week should be evaluated by a doctor for some complication of a cold like a sinus infection or a secondary problem in the lungs or ears. The typical pattern is for the cold to subside into and through the 2nd and 3rd weeks of illness.
A few words about a cough that intrudes on the child’s comfort and disturbs sleep - the child’s sleep, not the parents. You may have noticed that over the last decade cough meds for kids under 6 years of age have disappeared from the pharmacy shelves. That’s because of a few deaths that have resulted from inaccurate dosing in young children. There is no evidence and there has never been evidence of benefit from these over-the-counter (OTC) cough meds, so the FDA pulled them from the commercial marketplace. It is unlikely that the pharmaceutical industry will go through the expense of proving them effective for FDA approval. There is some evidence that once a child is over one year of age, dark honey can soothe a disrupting cough allowing the child to sleep. The study was done with Buckwheat dark honey, although it is presumed that any organic dark honey would similarly work_and we don’t really know why. We speculate that the goo of the honey given undiluted 1/2-1 tsp before bedtime might soothe the throat reducing the cough “tickle” or perhaps it’s the rich antioxidant content that improves the cough. No one knows, but undiluted dark honey has been observed to offer some cough relief in kids over one year of age. Under age one, it is not recommended. Your doctor can explain why. OTC meds that contain honey as an ingredient is NOT the same thing. That honey is diluted and no evidence exists that honey as an
ingredient in OTC cough meds is effective.
My hope for parents reading this answer will recognize that their toddler with a runny/congested nose and a cough who is otherwise well, playful, eating and sleeping well, needs no intervention at all; that low grade fever in a comfortable child with a cold can be normal the first few days of a cold; that all normal colds peak in intensity by days 5-7, then subside in intensity and are gone by 2-3 weeks; and that colds are not normal if they start with a very high fever or symptoms increase in intensity in the 2nd week of illness. Lastly, a few words about contagion. Colds mild or otherwise are contagious to others. Good hand washing by toddler caregivers is essential. Colds spread by droplets coughed through the air and by cough/nasal discharge on hands or home surfaces. Just think what does the family, not just the toddler, touch? Although Lysol and Clorox wipes work, that’s too much effort. I recommend Lysol spray multiple times a day on all the common touchy places: stairwell banisters, TV controls and remotes, keyboards, refrigerator handles, door knobs, toilet bowel levers, etc. No wiping needed. Just frequent walk-by spraying and air drying. Does this sound like a good chore for an older sib who won’t spray his/her own face? Parents already have much to do. Use Kleenex for your toddler when needed. Wash your hands after parenting care of your toddler with a cold. Try not to let your toddler cough into your face. Good luck with that! You might even consider wearing a face mask covering when working with your toddler.
There is one terrible “cold” you can prevent and that’s influenza by getting a flu shot for you and your toddler. In fact, all persons 6 months of age and older without a medical contraindication should get a flu shot before the end of October. The flu is not really a cold; it’s more like a train wreck, compared to a cold which is like running into a cotton ball. Help your toddler immune system and your’s recognize the flu virus and be prepared to fight it off by getting a flu shot. And then there’s COVID-19, which can be asymptomatic in some and not in others, can cause a cold in some or a terrible respiratory illness in others and we can’t predict in whom COVID will cause what. As you know, children 12 and older can get a COVID-19 vaccine. We are hopeful that by the end of November or December, children 5 and older will be able to get a COVID vaccine as well, then later as further evidence of safety and benefit come in, even kids 2 and older, perhaps 6 months and older.
Just like you put your kids in federally approved car seats and buckle yourselves up a car to reduce the chance of serious injury in a motor vehicle accident, and you don’t text while driving because you know it’s in your best interest and that of your passengers in your car, it’s time to be proactive for your kids to get a flu shot and a COVID-19 if eligible. You don’t need a law or mandate to use common sense. You can get additional information about colds, cough and fever, as well as current COVID-19 guidelines as well as immunization information at the American Academy of Pediatrics family website www.healthy children.org. It has a great search window.
Have a good Autumn and Winter,
Dr. T
If your toddler is happy, playful, eating, drinking and sleeping well (especially sleeping well), he or she does not need any help at all. The child’s immune system is working well and doing its thing. If your child is a little under-the-weather, energy wise, but otherwise well, eating, drinking and still sleeping normally, again no special help is needed.
Now, if the cough and cold (runny or congested nose) is associated with fever (>100.4 rectally or 99.4 by armpit or forehead scanner or ear thermometer), there is no need for fever medication (Tylenol or Advil) unless your child feels badly with fever. And you are the best judge of that. Feeling badly is more than just a little bit tired. Think irritable, grouchy, short-tempered, inconsolably crying.
For the last decade or more, informed pediatricians have concluded that fever in a comfortable child is the immune system at work killing viruses. But no doctor or parent wants a child to feel badly with fever. So that’s when fever meds are needed. When nasal breathing is obstructed by nasal discharge or congestion, we recommend nasal saline washes or nasal saline gel used when needed followed by nasal aspiration with a nasal bulb aspiration. There are many varieties of nasal suction devices on the market. Think cheap and effective. You don’t want the treatment to be worse than the problem. Most toddlers won’t say thank you when the aspiration is used. It’s also okay to simply use nasal saline often without suctioning to moisten and remove nasal mucus. Saline used often even without suctioning can lessen mucus. Remember the Colorado River, given enough time, created the Grand Canyon and no suctioning was ever used.
Similarly, a cool mist humidifier used when the child sleeps (nap or bedtime) can loosed nasal mucus. This should be an inexpensive cool mist humidifier, NOT a steam vaporizer which could introduce a risk of scalding the child if running too close to the child’s skin. Avoid the expensive ultrasonic humidifier! It makes water particles too small which can irritate a child’s airway in the lungs. The inexpensive cool mist humidifier makes larger water particles that moisten the upper airway only. Air below the vocal cords is already 100% humidified in all of us. No sense irritating a child’s lungs further with unneeded ultrasonic water particles. Be sure not to run the humidifier 24 hours a day to avoid mold build-up and clean it properly according to its instructions.
Remember the above advice is for significant nasal obstruction. If your child is sleeping well and not snoring loudly and has no noticeable long pauses in breathing due to the cold, it may be wiser to limit your effort to improve nasal symptoms. There is a pattern to a normal toddler cold. There can be fever the first few days, but rarely more than 3-5 days and if your child is comfortable, fever meds are not needed. If your toddler starts the cold with an abrupt high fever (103-104), you may need to call the doctor to discuss the possibility of another problem, e.g., a sinus infection or ear infection, otherwise you can give it a few days for comfortable mild fever to subside. Runny or congested nose symptoms associated with cough usually peaks by day 5-6, then subside over the next 7-14 days. It is uncommon for uncomplicated colds to last beyond two to three weeks. Colds that increase in intensity after the first week into the second week should be evaluated by a doctor for some complication of a cold like a sinus infection or a secondary problem in the lungs or ears. The typical pattern is for the cold to subside into and through the 2nd and 3rd weeks of illness.
A few words about a cough that intrudes on the child’s comfort and disturbs sleep - the child’s sleep, not the parents. You may have noticed that over the last decade cough meds for kids under 6 years of age have disappeared from the pharmacy shelves. That’s because of a few deaths that have resulted from inaccurate dosing in young children. There is no evidence and there has never been evidence of benefit from these over-the-counter (OTC) cough meds, so the FDA pulled them from the commercial marketplace. It is unlikely that the pharmaceutical industry will go through the expense of proving them effective for FDA approval. There is some evidence that once a child is over one year of age, dark honey can soothe a disrupting cough allowing the child to sleep. The study was done with Buckwheat dark honey, although it is presumed that any organic dark honey would similarly work_and we don’t really know why. We speculate that the goo of the honey given undiluted 1/2-1 tsp before bedtime might soothe the throat reducing the cough “tickle” or perhaps it’s the rich antioxidant content that improves the cough. No one knows, but undiluted dark honey has been observed to offer some cough relief in kids over one year of age. Under age one, it is not recommended. Your doctor can explain why. OTC meds that contain honey as an ingredient is NOT the same thing. That honey is diluted and no evidence exists that honey as an
ingredient in OTC cough meds is effective.
My hope for parents reading this answer will recognize that their toddler with a runny/congested nose and a cough who is otherwise well, playful, eating and sleeping well, needs no intervention at all; that low grade fever in a comfortable child with a cold can be normal the first few days of a cold; that all normal colds peak in intensity by days 5-7, then subside in intensity and are gone by 2-3 weeks; and that colds are not normal if they start with a very high fever or symptoms increase in intensity in the 2nd week of illness. Lastly, a few words about contagion. Colds mild or otherwise are contagious to others. Good hand washing by toddler caregivers is essential. Colds spread by droplets coughed through the air and by cough/nasal discharge on hands or home surfaces. Just think what does the family, not just the toddler, touch? Although Lysol and Clorox wipes work, that’s too much effort. I recommend Lysol spray multiple times a day on all the common touchy places: stairwell banisters, TV controls and remotes, keyboards, refrigerator handles, door knobs, toilet bowel levers, etc. No wiping needed. Just frequent walk-by spraying and air drying. Does this sound like a good chore for an older sib who won’t spray his/her own face? Parents already have much to do. Use Kleenex for your toddler when needed. Wash your hands after parenting care of your toddler with a cold. Try not to let your toddler cough into your face. Good luck with that! You might even consider wearing a face mask covering when working with your toddler.
There is one terrible “cold” you can prevent and that’s influenza by getting a flu shot for you and your toddler. In fact, all persons 6 months of age and older without a medical contraindication should get a flu shot before the end of October. The flu is not really a cold; it’s more like a train wreck, compared to a cold which is like running into a cotton ball. Help your toddler immune system and your’s recognize the flu virus and be prepared to fight it off by getting a flu shot. And then there’s COVID-19, which can be asymptomatic in some and not in others, can cause a cold in some or a terrible respiratory illness in others and we can’t predict in whom COVID will cause what. As you know, children 12 and older can get a COVID-19 vaccine. We are hopeful that by the end of November or December, children 5 and older will be able to get a COVID vaccine as well, then later as further evidence of safety and benefit come in, even kids 2 and older, perhaps 6 months and older.
Just like you put your kids in federally approved car seats and buckle yourselves up a car to reduce the chance of serious injury in a motor vehicle accident, and you don’t text while driving because you know it’s in your best interest and that of your passengers in your car, it’s time to be proactive for your kids to get a flu shot and a COVID-19 if eligible. You don’t need a law or mandate to use common sense. You can get additional information about colds, cough and fever, as well as current COVID-19 guidelines as well as immunization information at the American Academy of Pediatrics family website www.healthy children.org. It has a great search window.
Have a good Autumn and Winter,
Dr. T
Over-the-counter oral cough and cold medicines do not help and may have unacceptable side effects. Keeping the child comfortable and well hydrated helps them fight any infection. If the nose is stuffy, then normal saline nose drops may help. If it is a dry, irritated cough and they are over one year old, a teaspoon of honey every few hours will help. Honey is a natural anti-oxidant, which will soothe inflammation in the throat. Vicks vaporub applied to the chest of toddlers over a year old will also help cough and congestion. Under one year, the Vicks can be used in a vaporizer.
Allergy medicine is best for toddlers. Do not give any cough syrup.
