Colds and flu in children

Cold and flu symptoms

Cold symptoms:

• Stuffy nose
• Runny nose
• Sneezing
• Sore throat
• Cough
• Slight fever (38.5°C or lower)

Flu symptoms:

• Extreme fatigue
• Runny nose
• Red eyes
• Headache
• Chest pain
• Dry cough and sore throat
• Chills and shivers
• Muscle pain, sometimes acute
• Sudden fever (over 38.5°C)

Your child may also vomit and have diarrhea.

• Wheezing (high-pitched whistling sound)
• Difficulty breathing and coughing
• Drinking and urinating very little
• Earache or pus draining from the ears
• Vomiting for several hours and diarrhea
• Chest or rib pain

• Signs of respiratory distress (difficulty breathing, blue lips, etc.)
• Drowsiness and difficulty waking up or disorientation
• Abnormal stiffness in the neck area
• Refusal to eat or drink for more than 12 hours

What are colds and the flu?

Colds and the flu are highly contagious infections of the upper respiratory tract (nose, mouth, pharynx, larynx). They are also known as URTIs (upper respiratory tract infections).

While symptoms of these two illnesses may be similar, the flu is more serious, especially in children under 2 years of age. It’s caused by the influenza virus, which usually circulates between November and April.

In contrast, a cold can be caused by over 200 different viruses. The most common of these are called rhinoviruses. In fact, it’s not uncommon for a child to catch a second cold immediately after the first, which can sometimes make the cold seem to last a very long time.

URTIs sometimes lead to complications, such as otitis, bronchiolitis, conjunctivitis, pneumonia, and sinusitis. However, children under 5 are rarely affected by sinusitis. Dehydration can also occur if a child has difficulty eating or drinking.

Treatment

Because colds and the flu are caused by viruses, antibiotics are not effective in treating them. They must simply run their course. Unless complications arise, the care and practical advice below are usually sufficient, and both illnesses will resolve on their own.

If your child feels unwell due to a fever or complains of pain (sore throat, headache, muscle aches, etc.), you can give them acetaminophen (e.g., Tylenol^®, Tempra^®) or ibuprofen (e.g., Advil^®, Motrin^®) as indicated and in the doses recommended for your child’s age and weight. Don’t give ibuprofen to babies under 6 months, and never give aspirin (acetylsalicylic acid, or ASA) to a child or teen.

Care and practical advice

• Clean your child’s nose with saline water as often as possible when they have a cold or flu.
• Dress your child in light clothing, especially if they have a fever, and keep the room temperature around 20°C.
• Encourage quiet activities. Your child doesn’t have to stay in bed all day, but they do need to rest.
• Give your child plenty to drink (e.g., water, milk, soup). Chicken broth is another tried-and-true option. Because it’s rich in cysteine, it helps reduce nasal discharge.
• If your child has a poor appetite, give them smaller portions five or six times a day. Choose familiar foods that are soft and easy to swallow.
• You can also give your child a spoonful of honey before bedtime. Some studies suggest that honey may help sooth a sore throat. However, you should never give honey to children under 1 year old, as there is a risk of infantile botulism, a rare but potentially serious illness.
• If your child is 4 or older, you can give them sugar-free hard candies and lozenges containing honey, medicinal herbs (e.g., peppermint, lemon balm, thyme, sage, linden, hyssop), or pectin to relieve a sore throat.

Cough and cold medicines

Children under 6 should not be given over-the-counter cough and cold medicines (syrups, decongestants, expectorants, or others) unless a doctor advises otherwise. These drugs can cause side effects. For example, suppressing a cough can cause secretions to build up in the bronchi and lungs and aggravate respiratory problems.

What’s more, they have a very low efficacy rate. Overuse of these medications can also disrupt the nervous system and heart, causing convulsions, drowsiness, rapid heart rate, and hypertension.

Nose care

Babies can’t blow their noses on their own, so clean their noses regularly with a saline solution made at home or purchased from a pharmacy (about four times a day or as often as necessary). This solution will soften secretions and help them drain.

Ideally, clean your baby’s nose before drinking, eating, napping, and going to bed at night to help them nurse, sleep, and feel better.

Remove your baby’s secretions with a nasal aspirator only if necessary, preferably about 20 minutes before nursing or eating. This will make feeding easier for your baby (better sucking when feeding and less choking).

Your child’s nose is delicate, so take care not to irritate it when using a nasal aspirator. Also, avoid suctioning secretions too vigorously when their nose is completely blocked. In this case, clear the nose with saline solution.

How to clean and blow your child’s nose

Always wash your hands before cleaning your child’s nose. Wash them again when you’re done.

If your child has a cold, remove most of the secretions before starting to clean their nose with a nasal aspirator. If your child is older, ask them to blow their nose. This will require less saline solution.

Avoid forcefully injecting large quantities of saline solution into your child’s nostrils as this can impair hearing and cause ear infections.

If your baby is under 6 months old

• Lay your baby on their side or back. Swaddling them can make it easier to clean their nose. You can also place their head on a towel or washcloth to mop up secretions.
• Using a syringe, gently place 1 to 3 ml of salt water into your baby’s nostril (or 1 ml per nostril if they were born prematurely). The flow rate should be around 1 ml/second. If your baby is lying on their side, place the salt water in the upper nostril. Sometimes, secretions may come out of both nostrils and the mouth, but not always. Sometimes, your baby will swallow the secretions.
• Repeat the same technique with the other nostril. If your baby is lying on their side, turn them onto their other side so that the nostril to be cleaned is on top.
• Gently clean the edges of your baby’s nostrils with a wet tissue or washcloth. Use a nasal aspirator if necessary.
• Repeat the above steps until your baby’s nose is clean.

If your child is over 6 months old

• Place your child on your lap with their head upright. Swaddling them in a large towel can help keep them stable. Hold their jaw with one hand and press your cheek against theirs to keep them from moving.
• Hold the syringe in your other hand and place the tip in your child’s nostril. Aim the syringe at the corner of the eye located nearest the nose and above the nostril you’re cleaning.
• Gently empty the saline syringe into your child’s nostril. Use 1 to 3 ml of salt water per nostril for children under 2; 3 ml per nostril for children aged 2 to 5; and 3 to 5 ml per nostril for children over 5. The flow rate should be around 1 ml/second. Secretions may exit through both nostrils and the mouth, but this is not necessary. Sometimes, your child may swallow the secretions.
• Repeat the previous steps with the other nostril.
• Blow your child’s nose, one nostril at a time. If they are unable to blow their nose, gently clean the edge of their nostrils with a wet tissue or washcloth. If necessary, use a nasal aspirator.
• Repeat the steps above until your child’s nose is clean.

If your child is over 2 years old

To clean the nose of a child over the age of 2, you can continue to use the syringe method or try the nasal spray technique.

Nasal spray technique

This technique is good for children who can’t tolerate cleaning their nose with a syringe or whose ears hurt when they use an irrigation (squeeze) bottle.

• Ask your child to sit up and keep their head upright while looking into your eyes so they don’t move.
• Insert half the spray bottle’s tip into the centre of your child’s nostril.
• Spray salt water into one nostril as directed by the manufacturer, pharmacist, or doctor. Do the same in the other nostril.
• Ask your child to blow their nose, one nostril at a time, keeping their mouth closed.

Squeeze bottle technique

Toddlers around 3 or 4 years old can try the squeeze bottle technique. They must, however, be able to control the flow of water from the bottle.

Rinsing your sinuses should never cause ear pain. If your child is in pain, tell them to squeeze the bottle more gently and use less water. If the pain persists, use a syringe or nasal spray.

• Fill the 120 ml (4 oz) nasal irrigation bottle with the salt water recipe. Each nostril should require about half a bottle.
• Place your child in front of a sink. Ask them to tilt their head forward and keep their mouth open.
• Place the tip of the bottle at the entrance to one nostril. The tip of the bottle should completely block the nostril.
• Ask your child to press gently on the bottle until the salt water comes out of their other nostril or mouth.
• Ask your child to blow their nose, one nostril at a time.
• Repeat with the other nostril.

When should you consult a doctor?

There is usually no need to consult a doctor unless a fever lasts for more than 3 days and your child has the symptoms described above in the “Consult a doctor” and “Seek emergency medical help” sections.

Complications (otitis, conjunctivitis, pneumonia, etc.) may, however, require medical attention. These conditions most often manifest 3 to 4 days after the onset of cold or flu symptoms, when a child should normally start to feel better.

How to prevent colds and the flu

Hygiene

Avoiding contact with the viruses that cause colds and the flu is impossible as they are everywhere from October to April. However, you can reduce the risk of infection by following these hygiene rules:

• Wash your hands with soap after coming into contact with an infected person or touching an object they handled. Wash your child’s hands often and teach them how to do it themselves as soon as possible, especially after they cough, sneeze, or blow their nose.
• Teach your child to cough or sneeze into a tissue or, if they don’t have one, into the crook of their elbow rather than into their hand.
• Make sure your toddler doesn’t use someone else’s glass or utensils.
• Clean toys, faucets, and door handles thoroughly, preferably with an alcohol-based cleaner.
• Make sure all family members, including older children with colds, follow these hygiene rules to avoid contaminating babies.

Vaccination

There is no vaccine against the viruses that cause the common cold because there are too many of them, and the disease is generally harmless in most cases.

However, children aged 6 months and over can be vaccinated against the flu, which is more serious than the common cold.

The Canadian Paediatric Society (CPS) encourages influenza vaccination for all children and adolescents, starting at 6 months of age. The CPS indicates that children under 5 years of age are at high risk of flu-related complications and hospitalizations. The same is true for children and teens with chronic illnesses (e.g., diabetes or lung disease).

Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and copywriting:The Naître et grandir team Updated: July 2024

Photo: iStock.com/killerb10