Colds and Flu

It’s definitely cold and flu season!  The most important thing to know about colds and the flu is that they are viral illnesses.  Antibiotics will not have any effect on viruses because they kill bacteria, and viruses are not bacteria.  That being said, sometimes colds and flu may linger on long enough that a secondary bacterial infection develops, in which case antibiotics would help.  You can’t prevent a secondary bacterial infection from developing by putting a child on antibiotics are the start of a cold, though, and in fact, if a secondary bacterial infection were to develop, it would be resistant to that antibiotic.  With an infection caused by the influenza virus (i.e., the flu) if you get a case confirmed within the first 48 hours of onset of symptoms, there is an option to treat with oseltamivir (Tamiflu) or baloxavir (Xofluza) to short the duration of the illness.  Tamiflu and Xofluza need to be started within the first 48 hrs of symptom onset in order to be effective, and only work on the influenza virus.  Since colds are caused by different viruses, and not just a “weaker case” of an influenza virus infection, Tamiflu and Xofluza will not work on colds.

How do you prevent from getting colds and the flu?  The best way to protect against the flu is to get an annual flu immunization.  For both colds and the flu, you will want to wash your hands a lot, especially before eating, and try not to touch your face.  Babies and kids will touch their faces (mouths, noses, etc) a lot, no matter what, so it is a good idea to teach them as soon as you can, the importance of washing their hands.

So what do you do to help you feel better from your symptoms?  First of all, realize that the symptoms that make us feel miserable are our body’s response to the virus to try to get rid of it.  Your body creates a fever to make its immune system work better and keep the viruses from replicating as well (see fever post from earlier).  Unfortunately, body aches often come as a side effect of the chemicals your body makes to cause the fever.  The runny nose is your body making mucus to try to flush out the virus, and the cough is your body trying to get rid of mucus that may have dripped down from your nose or virus that actually made it down into the lower airways.   Most over-the-counter cold medications are designed to “treat” these annoying symptoms, but in doing so, you’re actually blocking your body’s own response to try to get rid of the virus.  There are some medications, though, that are actually helpful. 

Saline nasal spray and drops are great for any type of nasal congestion.  With no active ingredient to worry about, they work by loosening up the mucus to make it easier to run out/sneeze out/blow out.  You can truly use them an unlimited number of times a day, though if you are using a bulb suction to extract  boogers after loosening them, limit the suctioning to when you can actually see mucus right at the entrance of the nostrils, so you don’t cause more inflammation trying to get boogers you can hear but can’t see.  Guaifenesin , the active ingredient in Mucinex and Robitussin,  also helps to loosen mucus that saline spray/drops can’t reach, like in the chest, so that it can be more easily coughed up.  This is in contrast to dextromethorphan (the “DM” varieties of Mucinex and Robitussin, available over-the-counter) or codeine (only available through prescription) that suppress the actual cough reflex, which, seems like it would be desirable, but if you think about it … if you don’t cough up the germs, they’re only going to sit in your airways and more easily lead to a secondary infection.  If your child is coughing so much that they’re not sleeping, it is okay to try a cough suppressant at bedtime, but it’s safer to try a honey-based cough suppressant or straight honey (in older than one year olds) because they don’t have the possible side effects of dextromethorphan or codeine, which are chemical derivatives of opioids.

Sometimes, the mucus is as thin as it can be, but if the air passages of the nostrils are swollen, your child will still be congested.  Systemic decongestants such as pseudoephedrine or phenylephrine can hype you up, as well as raise your blood pressure, so aren’t considered safe in young children, but decongestant nasal drops or sprays (Afrin for older kids, Little Noses Decongestant Drops for infants and younger kids) don’t have the systemic side effects.  The drops/sprays, in fact, are so effective that if used longer than three days per month can lead to your nose “thinking” it needs the spray/drops to stay decongested.  This won’t happen if the drops/spray are used for up to three days, and this happens to coincide with when the congestion from a cold usually is the worst.  See the post about fevers to decide how and when to treat fevers, and always call your pediatrician’s office to get the right dose of the various medications that ARE helpful, for your child’s specific age and weight.

Colds usually ramp up in symptom severity in the first 3-5 days, then usually plateau around days 5-7, then usually start to improve around days 7-10.  When does a child with a cold need to be seen by their pediatrician?  If the fever lasts more than 3-4 days, if there is any difficulty breathing (as assessed by labored effort, not necessarily just noisy breathing), if there is still worsening after day 5 of symptoms, if there is no improvement by day 10 of symptoms, if you’re worried about dehydration (because a child with cold symptoms may feel so miserable they are not drinking very well) or if your child has another medical condition that may allow a cold to develop complications quickly (like prematurity or asthma).  Of note, a child who is not eating because of their cold/flu is okay for several days, as long as they are drinking fluids that have a sugar source in them (milk, pedialyte, juice).  If your child is not eating anything, not even crackers, then just plain water is not going to provide any sugar source to be an energy source for their brains and blood cells, so they are going to seem very sluggish.

Whew!  What a long post to read!  I apologize for that, but there is actually a lot to read about for colds and the flu to understand why in general, they just have to run their course, with just a little bit of help from the pharmacy.