Here is the next post in the series I did for A Musing Maralee’s blog. I answer some of her reader questions concerning the common cold and influenza infections. You can find the original blog post here.
What is the biggest mistake you see parents making in treating the common cold or flu?
If a child has a cold, when would it be necessary to see a doctor? If they have the flu, when would it be necessary?
What are the pros and cons of cold medicine for children?
The common cold and influenza are both caused by viral infections of the respiratory tract. That’s about where the similarities end. The common cold is caused by over 200 different strains of viruses while influenza only has a couple predominant strains each year. The common cold causes a runny nose, congestion, a sore throat, cough, and often a mild fever. Influenza on the other hand can be devastating. It causes a violent infection of the upper respiratory tract (the nose and throat) as well as usually infecting the lower respiratory tract (the trachea, bronchi, and lungs). Fevers up to 104F are typical. The common cold hits its stride during the fall and winter months but can be a problem all year long. Influenza tends to come in mini-epidemics for individual communities. January through mid February is the peak season for my town.
The biggest mistake I see parents making in treating the common cold or influenza is seeking medical care at the wrong time. For most of the year when a child gets a fever and has a runny nose or sore throat that’s just a symptom of the common cold. A lot of TLC and chicken noodle soup will help them along until the body clears that infection in about 7-10 days. No amount of medication will change that time frame. If the common cold infection causes enough disruption in the body’s normal defenses, bacteria that are always around trying to invade will take the opportunity to set up shop. A new fever, new pain, and focusing of symptoms to the affected spot would be an indication that something different is occurring. This could be fluid build up in the middle ears, the sinuses, and even just the nose. Bacteria grow and cause an ear infection, a sinusitis, or a rhinitis. Medical attention would be a good idea at that time.
During influenza season a new pronounced fever (>102F) especially if there is a known exposure should prompt an evaluation right away. After about 48-72 hours of symptoms antiviral medications that help limit influenza’s spread don’t work. The person just has to ride it out at that point which is often a two week process.
I classify the common cold as a ‘desert island disease’. If you have the common cold and are stuck on a desert island, then you are still stuck on a desert island. No matter what you do or what medicine you take you will get better. That is often not the case for influenza which sadly has claimed the lives of several people in my town already this year.
In choosing medications or therapies to help with the common cold we should pick options with low possibility of side effects. Since the cure will come from ourselves we need to realize that nothing we do is strictly necessary to get better. That will happen anyway.
That being said I like using medications for specific symptoms. If I have a congested cough then I’ll take an expectorant. If I have nasal congestion I’ll take a decongestant. There are many preparations available for multisymptom treatment. I don’t like those as much but that’s just my personal preference. Since these drugs are not curative and can have side effects if used too much, I try to take as little as possible to obtain some relief and for as short a time as possible. Less really is more in these situations.
Generally you should avoid cold medications in children under two years of age. They don’t really work anyway at that age and aren’t necessary for getting better either. We all want to make our kids feel good but we don’t want to put them at unnecessary risk however slight it may be.
Fever and pain treatment are amazingly helpful in keeping kids feeling better while their body does its job. Acetaminophen (Tylenol) and ibuprofen (Advil, Motrin) are useful medications to relieve these aches and pains from infections and are good fever reducers. Remember not to use ibuprofen in children under six months of age.
During this recent cold snap I got to sneak out to Ober Gatlinburg with some of my family – tame skiing for my wife and me, and a little more edgy snowboarding for the kids. The wind chill was pretty impressive and the toes and fingers were getting chilled. My youngest daughter peeled off her boots and socks to reveal some red, numbed toes. It reminded me of a conversation earlier in the week with a boy with Raynaud’s phenomenon.
Raynaud’s shows up in the cold or under stress. The fingers and/or toes, usually in a somewhat symmetrical pattern, show at least two of the colors of the flag. First they become almost white with cold or stress, then dusky blue, and finally flushed red. These color changes can be associated with pain or numbness. The border between the normal part of the hand and the area affected by Raynaud’s is usually a fairly sharp line. Less commonly, Raynaud’s can result in some tissue death and ulcers of the toes or fingers.
What’s going on with Raynaud’s phenomenon? The small arteries of the toes and fingers are going into spasm in response to cold or stress, cutting off circulation to the downstream areas.
Sometimes there is no other disease or problem connected with Raynaud’s; this is called Primary Raynaud’s, or Raynaud’s Disease. But in over half of the cases, some other particular disease or problem is present, or will show up, sometimes as long as 20 years later. Some of these connected problems include rheumatoid arthritis, scleroderma, leukemia, lymphoma, exposure to vibration (such as a jackhammer), hepatitis C, and a long list of other maladies. If you’re playing the odds, young women with Raynaud’s usually will have no connected problem, while older men who develop it usually have something else going on with it. The cause of Primary Raynaud’s is still unknown.
What if while out skiing, sledding, working in the cold or even with lesser cold or stress exposure, you notice these kinds of color changes in your hands or feet? If you can, take a photo with a digital phone or other device so that you can show it to your doctor, since it will probably not be visible when you come in for your appointment. Your doctor will ask questions about possible triggers and probably get some blood work to screen for some of the most common associated diseases.
Can it be treated? Keeping the hands and feet warm is a common sense mainstay of treatment. I’ve had a few patients even move farther south to avoid the problem. Short of that, using good gloves, not putting your hands around a cold drink, and avoiding other inciting activities can help. Nicotine is a definite bad guy if you have Raynaud’s, so this needs to be cut out. Certain other meds, such as beta blockers, can also make the symptoms worse. Your doctor may be able to substitute a more circulation friendly alternative. On the other hand, calcium channel blockers, such as nifedipine, can often reduce the symptoms of Raynaud’s phenomenon.
So if your hands and feet are cold, it’s obvious you need to warm them up. But if your fingers or toes are turning the colors of the flag with sharp lines between normal and abnormal coloring, it’s time to talk to your doctor about what else may be going on. In the meantime, bundle up, it’s freezing out there!
Andrew Smith, MD is board-certified in Family Medicine and practices at 1503 East Lamar Alexander Parkway, Maryville. Contact him at 982-0835