Moms Columns & Blogs

When is a cold serious?

Q. Since October, our 2 year-old daughter has had a constant runny nose. We have been to the pediatrician twice, and she was treated each time with antibiotics for a sinus infection. She was symptom-free for about two days after finishing the antibiotics each time, but then the runny nose started again. How do I know when a runny nose is not just a cold? I would like to avoid unnecessary antibiotics and co-pays.

According to the Centers for Disease Control, children have up to nine viral respiratory illnesses, or colds, per year. Cold viruses are more common during the winter, so it’s no surprise that many toddlers seem to have a constant runny nose then. The challenge becomes distinguishing between a common childhood cold and bacterial sinusitis. By understanding the difference, parents and healthcare workers can decrease antibiotics overuse.

First, it is important to understand the natural progression of a cold. A cold typically includes fever, body aches, sore throat, nasal congestion, sneezing and runny nose. The majority of these symptoms will clear up within the first 4-5 days; however, the nasal drainage may last up to 14 days.

The second thing to clarify is that green nasal mucous does not indicate the presence of bacterial sinusitis. In fact, nasal mucous will often be clear during the first few days of a cold, then progress to thick green or yellow for several days before clearing again at the end.

Nasal mucous will often be thicker and darker in the morning. As hydration status improves through the day, the mucous will become thinner.

Here are the guidelines for diagnosing sinusitis in children: Nasal drainage or persistent daytime cough lasting longer than 10-14 days without improvement or fever with facial pain or swelling.

Occasionally, imaging studies such as CT scans are necessary for the diagnosis and treatment of sinusitis -- particularly recurrent or chronic sinusitis.

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