4 Month Old Baby Has Cold and Cough
Am Fam Physician. 2012 Jul xv;86(two):153-159.
Patient information: Meet related handouts on treating the mutual cold in adults and in children, written by the authors of this article.
Related letter: Homeopathic Remedies for Treatment of the Mutual Cold
Article Sections
- Abstract
- Children
- Adults
- References
The common cold, or upper respiratory tract infection, is one of the leading reasons for medico visits. Generally caused by viruses, the mutual cold is treated symptomatically. Antibiotics are not effective in children or adults. In children, at that place is a potential for harm and no benefits with over-the-counter cough and common cold medications; therefore, they should not be used in children younger than iv years. Other commonly used medications, such equally inhaled corticosteroids, oral prednisolone, and Echinacea, as well are ineffective in children. Products that meliorate symptoms in children include vapor rub, zinc sulfate, Pelargonium sidoides (geranium) extract, and buckwheat beloved. Safety probiotics, zinc sulfate, nasal saline irrigation, and the herbal training Chizukit reduce the incidence of colds in children. For adults, antihistamines, intranasal corticosteroids, codeine, nasal saline irrigation, Echinacea angustifolia preparations, and steam inhalation are ineffective at relieving cold symptoms. Pseudoephedrine, phenylephrine, inhaled ipratropium, and zinc (acetate or gluconate) modestly reduce the severity and duration of symptoms for adults. Nonsteroidal anti-inflammatory drugs and some herbal preparations, including Echinacea purpurea, improve symptoms in adults. Rubber use of garlic may subtract the frequency of colds in adults, just has no effect on elapsing of symptoms. Hand hygiene reduces the spread of viruses that cause cold illnesses. Condom vitamin C modestly reduces cold symptom duration in adults and children.
The common common cold, or upper respiratory tract infection, commonly is acquired by i of several respiratory viruses, most commonly rhinovirus. These viruses, which concentrate in nasal secretions, are easily transmitted through sneezing, coughing, or nose bravado. Signs and symptoms of the common cold include fever, cough, rhinorrhea, nasal congestion, sore throat, headache, and myalgias.
SORT: Fundamental RECOMMENDATIONS FOR Practise
| Clinical recommendation | Testify rating | References |
|---|---|---|
| Antibiotics should not exist used for the treatment of cold symptoms in children or adults. | A | 7 |
| Over-the-counter coughing and cold medications should not be used in children younger than four years considering of potential harms and lack of benefit. | B | 4, half dozen, 11 |
| Handling with buckwheat dear, Pelargonium sidoides (geranium) excerpt (Umcka Coldcare), nasal saline irrigation, vapor rub, or zinc sulfate may subtract cold symptoms in children. | B | 16–20 |
| Codeine is non effective for coughing in adults. | A | 11, 24 |
| Antihistamine monotherapy (sedating and nonsedating) does not improve cold symptoms in adults. | A | 11, 23, 29 |
| Decongestants, antihistamine/decongestant combinations, and intranasal ipratropium (Atrovent) may improve cold symptoms in adults. | B | 11, 23, 32, 33 |
| Nonsteroidal anti-inflammatory drugs reduce pain secondary to upper respiratory tract infection in adults. | A | 34 |
| Andrographis paniculata (Kalmcold) and P. sidoides may reduce severity and duration of common cold symptoms in adults. | B | 35–37 |
Patients seek care for cold symptoms during all seasons of the year, with cough being the third most common and nasal congestion the 15th well-nigh common presenting symptom amongst all part visits.1 The common cold is the third most mutual primary diagnosis in office visits.1 Colds are cocky-limited, usually lasting upwardly to 10 days; therefore, management is directed at symptom relief rather than treating the infection. Multiple remedies, including complementary and alternative medicine products, over-the-counter products, and prescription drugs, have been used to forbid and treat cold symptoms.
When medications are requested, physicians play an important role in educating patients about the handling choices. Many familiar prescription cough and cold medications were removed from the market in early 2011 because the U.S. Nutrient and Drug Administration had non evaluated them for safety, effectiveness, or quality.2 Physicians should circumspection patients about over-the-counter and complementary and alternative medicine products because manufacturers are not required to prove claims of therapeutic benefit.
Children
- Abstract
- Children
- Adults
- References
Common cold and cough medications are amongst the top 20 substances leading to death in children younger than five years.iii In 2008, the U.South. Food and Drug Administration recommended that over-the-counter cough and cold medications be avoided in children younger than 2 years.4 After the removal of over-the-counter infant cough and common cold medications from chemist's shop shelves, the estimated number of emergency department visits for adverse events involving these medications was cut in one-half for children younger than two years.5 Manufacturers of these medications have voluntarily modified the product labels to land that they should not be used in children younger than four years.six
INEFFECTIVE INTERVENTIONS
Prescription and Over-the-Counter Products. Considering viruses crusade most colds, antibiotics are ineffective.seven Low-dose inhaled corticosteroids8 and oral prednisolone9 practice non improve outcomes in children without asthma. Echinacea products also are ineffective for treating cold symptoms in children.x There is no prove to support the employ of most over-the-counter cough remedies in children.11,12 Table one summarizes findings of studies on these medications.7–14
Table i.
Therapies Not Constructive for the Mutual Cold in Children
| Therapy | Evidence | Findings |
|---|---|---|
| Antibiotics | Cochrane review of four studies7 | No difference in persistence of symptoms for the common common cold or astute purulent rhinitis compared with placebo |
| Carbocysteine | Cochrane review of three RCTs13 | No pregnant difference in cough, dyspnea, or overall general health compared with placebo |
| Dextromethorphan | One cohort study12 | Non superior to placebo in nocturnal cough or sleep quality in the child or parents |
| Diphenhydramine (Benadryl) | One accomplice study12 | Not superior to placebo in nocturnal cough or sleep quality in the child or parents |
| Echinacea purpurea | Cochrane review of two RCTs10 | No deviation in severity of symptoms, tiptop of symptom severity, number of days of fever, or parental report of severity score compared with placebo |
| Low-dose inhaled corticosteroids | Cochrane review of two studies8 | No decrease in the number of episodes requiring oral corticosteroids, emergency department visits, hospital admissions, the frequency of wheezing, or elapsing of episodes |
| Oral prednisolone | One RCT of a five-mean solar day course9 | No meaning divergence in duration of hospitalization, interval betwixt admission and discharge, mean vii-twenty-four hour period symptom score reported by a parent, or hospital readmission for wheezing within one month compared with placebo |
| OTC antihistamines | Cochrane review of two studies11 | No more constructive than placebo for cough |
| OTC antihistamine with decongestant | Cochrane review of two studies11 | No more constructive than placebo for cough |
| OTC antitussives | Cochrane review of iii studies11 | No more than constructive than placebo for coughing |
| OTC antitussive and bronchodilator | Cochrane review of one study11 | No more effective than placebo for cough |
| Vitamin C | Not studied in children14 | — |
Fluids. Caregivers are often advised to increase a kid's fluid intake. However, in two example series and a prevalence written report, some children with respiratory infections but no signs of aridity developed hyponatremia with increased fluids.15 Therefore, actress fluid intake is not advised in children because of potential harm.
EFFECTIVE INTERVENTIONS
Tabular array 2 summarizes therapies that may exist effective in children with the mutual cold.8,13,xvi–20
Tabular array 2.
Therapies That May Be Constructive for the Mutual Common cold in Children
| Therapy | Historic period of children studied | Dosing | Duration of handling |
|---|---|---|---|
| Acetylcysteine13 | 0 to xviii years | Variable | Variable, up to 28 days |
| High-dose inhaled corticosteroids in children who are wheezing8 | 1 to five years | Budesonide (Pulmicort), 1,600 mcg by MDI with nebuhaler or 3,200 mcg past MDI with nebuhaler and face mask, if needed | Until asymptomatic for 24 hours |
| One to 5 years | Beclomethasone, two,250 mcg daily past MDI | 5 days | |
| 1 to three years | Budesonide 1,600 mcg past MDI with nebuhaler and confront mask for first three days, then 800 mcg for another seven days | Total of 10 days | |
| Honey (buckwheat)16 | Ii to five years | 2.5 mL | One time |
| Vi to xi years | 5 mL | Once | |
| 12 to 18 years | x mL | Once | |
| Nasal irrigation with saline17 | Half dozen to 10 years | 3 to 9 mL per nostril | Upwardly to 3 weeks |
| Pelargonium sidoides (geranium) extract (Umcka Coldcare)18 | One to eighteen years | 10 to 30 drops (depending on age) | 7 days |
| Vapor rub19 | Two to five years | 5 mL | Once |
| Six to 11 years | x mL | Once | |
| Zinc sulfate20 | Ane to 10 years | Syrup, 15 mg per five mL | 10 days |
Complementary and Culling Medicine Products. Several of these therapies provide relief from cold symptoms. Vapor rub applied to the chest and neck has been shown to improve cough severity and quality of sleep for the kid and parents, but information technology has a strong smell that children may not tolerate.19 Studies regarding therapeutic use of zinc sulfate show a trend toward decreased duration of cold symptoms when it is taken within the first 24 hours of symptom onset.20 Adverse effects, such every bit bad gustation and nausea, are more common with zinc lozenges than with syrup or tablets.20 Pelargonium sidoides (geranium) extract (Umcka Coldcare) may help resolve cough and sputum production in children with the cold.eighteen Buckwheat honey is superior to placebo for reducing frequency of cough, reducing bothersome cough, and improving quality of slumber for the child.16 Honey should not be used in children younger than one year because of the adventure of botulism.
Nasal Irrigation and Acetylcysteine. During acute illness, nasal irrigation with saline tin can help alleviate sore throat, thin nasal secretions, and ameliorate nasal breathing and tin reduce the demand for nasal decongestants and mucolytics.17 A systematic review of six trials published in the 1990s constitute that acetylcysteine (commonly used in Europe, but not in the Us, as a mucolytic) may decrease coughing after half-dozen to seven days of therapy in children older than two years.13 The main agin consequence of acetylcysteine is vomiting.
Inhaled Corticosteroids. Some children with viral common cold symptoms likewise develop wheezing. Although low-dose corticosteroids are ineffective in these children, ane review of loftier-dose inhaled corticosteroids institute a trend toward decreased frequency of wheezing episodes that require oral corticosteroids, the duration of episodes, and the number of physician visits.8
PROPHYLAXIS
Tabular array 3 summarizes therapies that may be effective for cold prophylaxis in children.14,17,20–22
Tabular array 3.
Therapies That May Be Constructive for Common Cold Prophylaxis in Children
| Therapy | Age of children studied | Dosing | Elapsing of handling |
|---|---|---|---|
| Chizukit21 | One to 3 years | 5 mL twice daily | 12 weeks |
| Four to 5 years | vii.5 mL twice daily | 12 weeks | |
| Nasal irrigation with saline17 | Six to ten years | iii to 9 mL per nostril 3 times daily | Nine weeks |
| Probiotics*22 | Three to five years | 1 g (1 × 10x colony-forming units) mixed with 120 mL of i% milk twice daily | Half dozen months |
| Vitamin C14 | < 12 years | 0.2 to 2 1000 daily | Two weeks to nine months |
| Zinc sulfate20 | One to 10 years | Syrup, xv mg per five mL daily | Seven months |
| half dozen.5 to 16 years | Tablet, ten mg daily | Six days per week for five months |
Complementary and Culling Medicine Products. Some of these products may assist forbid colds if taken regularly. Probiotics, such as Lactobacillus acidophilus NCFM, alone or combined with Bifidobacterium animalis, taken by good for you children during the winter may reduce day care absences; the incidence of fever, cough, and rhinorrhea; and the use of antibiotics.22
A Cochrane review showed a 13 percent decrease in common cold symptoms in children who took 1 g of vitamin C daily before illness, although optimal duration of handling to attain these benefits is unknown.14 Zinc sulfate used prophylactically for at least five months reduces the incidence of viral colds, absences from school, and antibiotic use in children.20
The herbal grooming Chizukit contains l mg per mL of Echinacea, 50 mg per mL of propolis, and 10 mg per mL of vitamin C.21 In a randomized, placebo-controlled trial of 430 children one to five years of age, Chizukit decreased the number of common cold episodes, the number of days the child was ill, and the number of days the child missed school. It also decreased the need for antipyretics and antibiotics; physician visits; and episodes of otitis media, pneumonia, and tonsillitis. Nevertheless, children may not comply with taking the production because of its unpleasant taste.21
Nasal Saline Irrigation. Nasal irrigation with saline as a preventive measure in children is ameliorate than standard treatment for multiple common cold symptoms. Overall, the treatment decreases disease and nasal secretions, improving nasal breathing. These children also use fewer antipyretics, nasal decongestants, and mucolytics and accept fewer school absences.17
Adults
- Abstruse
- Children
- Adults
- References
INEFFECTIVE INTERVENTIONS
Table 4 summarizes studies of medications that are ineffective for the cold in adults.7,11,14,23–28
Table four.
Therapies Not Effective for the Mutual Cold in Adults
| Therapy | Evidence | Findings |
|---|---|---|
| Antibiotics | Cochrane review of nine RCTs7 | No divergence in symptoms or purulent rhinitis compared with placebo |
| Antihistamine monotherapy (sedating and nonsedating) | Cochrane review of three RCTs11 | No more constructive than placebo |
| Cochrane review of 32 RCTs23 | No more effective than placebo | |
| Codeine | Cochrane review of two RCTs11 | No more constructive than placebo for cough |
| American College of Breast Physicians24 | Not recommended | |
| Echinacea angustifolia | RCT with viral challenge25 | No more effective than placebo for cold symptoms |
| Intranasal corticosteroids | Two RCTs26,27 | No more effective than placebo |
| Nasal irrigation with hypertonic or normal saline | Ane RCT28 | No more constructive than observation |
| Vitamin C | Cochrane review of seven RCTs14 | No more effective than placebo for reducing elapsing or severity of cold symptoms |
Antibiotics and Antihistamines. In adults, as in children, antibiotics do non decrease the duration or severity of illness, fifty-fifty when purulent rhinitis is nowadays.vii Sedating and nonsedating antihistamines are ineffective for cough and other common cold symptoms.11,23,29
Opioids, Intranasal Corticosteroids, and Nasal Saline Irrigation. Despite widespread apply, codeine is no more effective than placebo for reducing coughing.xi,24 The American College of Breast Physicians (ACCP) does not recommend other opioids for the handling of cough.24 Although intranasal corticosteroids reduce swelling and inflammation of the nasal mucosa, they have not been shown to significantly benefit patients with the common common cold.26,27 Nasal irrigation with hypertonic or normal saline does not provide significant relief for cold symptoms in adults.28
Complementary and Alternative Medicine Products. When used solely for treatment of symptoms after they appear, vitamin C does non consistently reduce their duration or severity.fourteen Herbal preparations containing Echinacea angustifolia are not beneficial.25 Many physicians have recommended increased fluid intake and inhalation of heated, humidified air to sparse secretions during a cold. No randomized trials have assessed the effect of increasing fluid intake in adults,30 and a Cochrane review constitute inconsistent study results for steam inhalation.31
EFFECTIVE INTERVENTIONS
Decongestants With or Without Antihistamines. Oral or topical decongestants lonely seem to be somewhat effective for short-term relief of cold symptoms, compared with placebo.32 Pseudoephedrine and phenylephrine decrease nasal edema to ameliorate air intake.32 Although antihistamines do not work as monotherapy, combination medications containing a first-generation antihistamine and decongestant may be slightly beneficial in relieving general symptoms, nasal symptoms,23 and cough.11 Combination medications are recommended by the ACCP to treat acute cough.29
Anticholinergics, Dextromethorphan, Guaifenesin. Ipratropium (Atrovent) is the merely orally inhaled anticholinergic recommended by the ACCP for cough acquired by a common common cold,24 and 1 study showed that the nasal conception decreases rhinorrhea and sneezing.33 Studies of dextromethorphan and guaifenesin for cough are nearly evenly split, with some demonstrating do good and others not.11,24
Nonsteroidal Anti-inflammatory Drugs. These medications finer relieve pain from headache, myalgias, and arthralgias experienced during a cold; however, decreased sneezing is the only effect they have on respiratory symptoms.34 The ACCP has concluded that naproxen (Naprosyn) is beneficial in the handling of acute cough.24
Complementary and Alternative Medicine Products. Table 5 summarizes the herbal preparations that may be constructive in adults.x,14,18,20,35–38 An herbal solution containing P. sidoides was shown to reduce the duration and severity of 10 different cold symptoms in a randomized controlled trial.37 Another randomized controlled trial demonstrated the benefit of Andrographis paniculata (Kalmcold) in improving symptom scores.35 A systematic review likewise indicated that A. paniculata, solitary or in combination with Acanthopanax senticosus, may be more than effective for symptom relief than placebo.36
Table 5.
CAM Products That May Be Effective for the Common Common cold in Adults
| Training | Dosing | Duration of treatment |
|---|---|---|
| Handling | ||
| Andrographis paniculata (Kalmcold)35,36 | 200 mg daily | Five days |
| Echinacea purpurea (solution of pressed juice of aerial parts and alcohol)x | 4 mL twice daily | 8 weeks |
| 20 drops every 2 hours on day 1, so 20 drops three times daily | 10 days | |
| Pelargonium sidoides (geranium) extract (Umcka Coldcare)eighteen,37 | 30 drops three times daily, alcohol root extract | 10 days |
| Zinc acetate or gluconate20 | Variable (lozenges contain betwixt iv.5 and 23.7 mg of zinc) | As long as symptoms persist |
| Prophylaxis | ||
| Garlic38 | Supplement with 180 mg of allicin | 12 weeks |
| Vitamin C14 | 0.25 to 2 1000 daily | 40 days to 28 weeks (by and large around iii months) |
Early on use of Echinacea purpurea shortens duration and decreases severity of cold symptoms; preparations with the aerial parts versus the flowering parts are virtually effective.ten Although dosages and preparations of zinc are non standardized, a Cochrane review showed that starting zinc lozenges (acetate or gluconate) within the first 24 hours of symptom onset reduces the severity and duration of disease.xx Adverse effects of zinc include bad taste and nausea.20 Intranasal zinc should not exist used because it may event in the permanent loss of smell.39
PROPHYLAXIS
Few medications have been shown to be benign in preventing the common cold in adults (Table 5ten,xiv,18,20,35–38). The prophylactic use of vitamin C does non reduce the incidence of colds, but decreases affliction duration by eight percentage.14 Express, poor-quality studies of garlic evidence a decrease in the number of self-reported colds, just no decrease in days to recovery. Adverse effects from garlic included bad olfactory property and skin rash.38
Frequent hand washing tin reduce the spread of respiratory viruses in all ages and can reduce transmission from children to other household members.40 In a large meta-analysis, the benefits of antibacterial and nonantibacterial soaps were not significantly unlike.41 Benzalkonium chloride–based hand sanitizers that foam and exit a residual have a protective event against colds. Alcohol hand sanitizers are less effective.41
Data Sources: A search of Essential Evidence Plus was completed using the key words cold and respiratory tract infections. This search included InfoPOEMs, Cochrane reviews, and practice guidelines. We besides searched Dynamed and the U.Due south. Food and Drug Administration Web site for specific data regarding changes in recommendations for the use of cough and cold medications in children. Search dates: March 22, 2011, to April 6, 2011.
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REFERENCES
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thirteen. Duijvestijn YC, Mourdi N, Smucny J, Pons G, Chalumeau M. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochrane Database Syst Rev. 2009;(ane):CD003124.
xiv. Douglas RM, Hemilä H, Chalker Due east, Treacy B. Vitamin C for preventing and treating the cold. Cochrane Database Syst Rev. 2007;(3):CD000980.
15. Guppy MP, Mickan SM, Del Mar CB. "Drinkable plenty of fluids": a systematic review of evidence for this recommendation in acute respiratory infections. BMJ. 2004;328(7438):499–500.
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