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It’s really hard sometimes to tell when your child has just a cold or if it’s something more, and it’s something I see all the time in my clinic. My baby just had her first cold, and we were lucky to dodge that bullet for 8.5 months (thank you breastfeeding and grandma for taking care of her during the day!) but inevitably, it happened. It was alarming when she woke up screaming one morning, which was out of character for her, and was inconsolable for a few minutes. Then “poof”, the runny nose and sneezing/coughing started, and fevers around 102*. It was a rough couple of days and nights, with Juliette coughing, uncomfortable, and very congested, but we got through it with tylenol and humidifiers thankfully.
So the question is, when do you worry? I can’t give you the answer for every situation, but I can give you an idea of red flags we look for and when you need to seek the care of a health care professional. This by no means replaces seeking care for your child from your physician but may help give you some of the criteria we look for when evaluating sick children, and what is urgent versus what can wait.
- Is your child active and taking fluids? Something we look for is a “toxic” appearance. If your child is playing with us on the exam table, it’s reassuring that there isn’t something more dangerous going on. If they are laying in your arms, not making eye contact or responding and not moving around a lot, we worry more about this as it could be something much more serious and should be evaluated ASAP. We don’t care if they don’t want to eat when they are sick, most adults don’t really want to eat when they don’t feel good! As long as they’re drinking plenty of fluids we are happy, and you don’t need to worry too much about no food for a few days.
- Are they spiking very high, prolonged fevers? No one likes to see their child with a fever, but this is really just the way the body fights infections and is a totally natural response, however there are times when it is more serious and needs to be evaluated. This depends on your child’s age and the degree of the temperature. For babies under 3 months old, a fever of 100.4 should always be evaluated right away, just because of how susceptible they are to serious infections, and ESPECIALLY in babies under 30 days. In children older than 3 months, we are more concerned with temps over 103.6* that are persistent despite supportive measures like Tylenol (and/or Motrin if they are over 6 months).
- Are they tugging at their ears? This can be a sign of an ear infection and should be evaluated
- Are they having difficulty breathing? Things we look for are flaring of their nostrils, skin tugging in at the base of their neck (called tracheal tugging) or the muscles between/under their ribs tugging in when they breathe, making their ribs more visible. These can be signs of a more serious infection and should be evaluated by a healthcare provider right away as well
It is pretty much unavoidable that your child will have colds throughout their life, even with the best hand washing and hygiene efforts, because children are little germ farms, and it’s just the way it is! So try not to worry too much, daycare and school aged children typically get on average a viral infection per month, especially in the peak cold/flu season. A little chicken noodle soup and a cool mist humidifier go a long way!
