Coughs Colds and Congestion

Background:

The mucus production from a respiratory viral infection is one of the ways the body is fighting against the virus. Some viruses, such as RSV, directly cause increased mucus production. All of this increased mucus results in stuffy or runny noses, fluid in the ears, and cough.

 

But most importantly, just like in adults, the symptoms are always worse when lying down which is what we do when we go to sleep. No one sleeps well when they are sick and it's particularly hard with young children who need our help to feel better. When your child is sick, no one sleeps.

 

What To Do:

Whether coughs are wet or dry, and what colour the mucus is, has no bearing on what is causing their illness and none of those symptoms are an indication that your child needs to be seen.

 

For babies who are too young to resist, nasal suctioning as needed can be very helpful. Do not suction them just because you hear stuff rattling around. Only suction them if it is bothering them. For example, if your baby cannot feed from the breast/bottle and has to keep stopping to catch their breath, that is a good reason to suction them.

 

Another would be if they keep trying to breathe through their nose while sleeping and keep waking up because they can't breathe through their nose. No matter how much noise you hear, if it is not bothering your child, don't torture them by trying to suction their nose, it can cause irritation and bleeding. Suction devices such as a NoseFrida or a bulb suction with a pointed tip work well.

 

Children as young as 2 can be taught how to blow their nose. Not all of them will be able to do it at that age but if you don't start working on it they won't learn.

 

Ensure adequate hydration. Most people do not have their normal appetite when they are sick so don't worry about how much your child is eating. Concentrate more on fluid intake. This will help keep the mucus thinner and allow them to clear it more easily.

 

A humidifier near their bed will also help to keep secretions moist and easier to clear. Vicks VapoRub on the upper back also helps. Use baby Vicks for children under one year of age and regular Vicks for children over one. Ensure that the jar is kept out of reach so that children cannot get hold of it as it is toxic if eaten.

 

Do not use over-the-counter homeopathic medications as they are ineffective, and not subject to the quality control regulations that all other drugs are. Thus we do not know what is actually in them, and what you are giving to your children.

 

Cough and cold medications are not to be used in children under the age of 6.

 

For children over one year of age, a teaspoon of honey before bed (and before you brush their teeth) does help to decrease coughing. You may repeat the dose again during the night but be sure to either give your child some water in order to rinse the honey off their teeth or use a wet cloth to wipe their teeth. Once the child is 6 years of age, you may use an over-the-counter cough medication. You need to be careful what product you use as many products are combinations of different ingredients and can have significant side effects or create a risk of overdose. For example, if they contain acetaminophen and you also give your child Tylenol (which is acetaminophen), you could end up overdosing your child. For that reason the ones we recommend are Benylin for kids dry cough (it doesn't matter whether your child's cough is dry or wet, this is the medication that has the single ingredient to help with coughs) or the Buckley's dry cough if your child weighs at least 40 kg.

 

For children over the age of six, you can use Xylometalzoline (brand name Otrivin but buy the generic as it costs much less and is exactly the same) nasal spray 0.05% at bedtime to help unplug their nose. It is very important to use this as minimal as possible as using it too much can cause worsening of their nasal congestion. We recommend not using it for more than five nights per nostril. As we only breathe out of one nostril, at a time, you can use it on one side each night, which will give up to 10 days of use. Most colds should be settling by then. Older children and teens who are at least 45 kg can use the adult 0.1% strength.

 

If you are doing all of the above, and your child still can't sleep (and therefore you can't sleep) then, just as we do for ourselves, sleeping propped up is very helpful. Older children can be propped up on pillows just as adults do. For young infants, you can tilt their bassinet so their head is up about 10°. Do not prop anything under the mattress, prop up the whole bassinet. Ensure that it is stable if you do this.

 

Most other young kids tend to flop around in their bed until about 6 years of age and won't stay on pillows even when they are old enough to use them. For these kids, we recommend having them sleep in a stroller. Once they are asleep, move them into the stroller (bring the stroller inside), strap them in, put the brakes on and tilt them up to the point where they are breathing better. You can do this even with children who sleep on their bellies.

 

For all ages, whether they have fever or not, feel better medicine (ibuprofen or acetaminophen) can also make them feel better and thus sleep better.

 

When To Be Concerned:

All of that congestion can certainly make it difficult to breathe comfortably but that is not the same as trouble breathing. Trouble breathing is when your lungs are actually having difficulty working and providing oxygen to your body. It is very easy to tell if that may be going on in young children.

 

If they are breathing fast consistently and without a fever (children with a fever will breathe fast just like a dog panting in the heat), they should be assessed. Other signs are what we call "work of breathing".

 

See this video: https://www.youtube.com/watch?v=Radr3Fr_Nro

 

This is children using extra muscles such as their belly and ribs in order to breathe. It is important that you help them clear their nose and cough up anything that might be stuck in their throat before you assess work of breathing. If your child does have work of breathing, they should also be seen. If they are otherwise comfortable, able to maintain their hydration and sleeping comfortably, it can wait till the next day. However if they are in a significant amount of distress, that is an emergency room visit.

 

Older children, can tell you if they are having trouble breathing. You would still do the same things such as getting them to clear their nose or any other secretions. If they are still complaining then they should be seen by a doctor.

 

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