Colds and flu in children: How to diagnose and treat them properly!Cold and flu symptoms
Cold symptoms:
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Stuffy nose
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Runny nose
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Sneezing
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Sore throat
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Cough
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Slight fever (38.5°C or lower)
Flu symptoms:
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Extreme fatigue
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Runny nose
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Red eyes
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Headache
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Chest pain
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Dry cough and sore throat
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Chills and shivers
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Muscle pain, sometimes acute
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Sudden fever (over 38.5°C)
Your child may also vomit and have diarrhea.
Consult a doctor urgently or go to the emergency room if your child has the following symptoms:
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Wheezing (high-pitched whistling sound)
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Difficulty breathing and coughing
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Drinking and urinating very little
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Earache or pus draining from the ears
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Vomiting for several hours and diarrhea
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Chest or rib pain
Seek emergency medical help (call 911) if your child has the following symptoms:
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Signs of respiratory distress (difficulty breathing, blue lips, etc.)
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Drowsiness and difficulty waking up or disorientation
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Abnormal stiffness in the neck area
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Refusal to eat or drink for more than 12 hours
If you have any doubts or concerns, don’t hesitate to call the Info-Santé line (811).
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.
Age: Children under 5 are particularly vulnerable to URTIs as their immune systems are not yet fully formed. The frequency of colds is also high in this age group because children under 5 tend to transmit and catch infections more easily than older children. In fact, children who attend daycare centres with more than 3 or 4 toddlers may be in almost constant contact with someone who has a cold. Babies can contract up to 10 colds a year before the age of 2. But this frequency decreases over time, with school-aged children catch colds around 6 times a year. Duration: A cold lasts 3 to 5 days, while the flu lasts 1 to 2 weeks. Infectious period: The infectious period begins 1 or 2 days before the onset of symptoms and lasts as long as the respiratory tract produces secretions (coughing, sneezing, runny nose). How it spreads: Colds and flu are spread by direct or indirect contact with the secretions from an infected person (coughing, sneezing, contaminated hands or objects, etc.). Isolation period: A child with a cold can continue to attend daycare or school if they feel well enough to participate in activities. However, if they have the flu or a very bad cold, they may not feel up to it. In this case, it’s best to keep them at home for as long as they have a fever and feel bad. |
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.
Are humidifiers a good idea? Humidifiers used to be recommended to help kids with breathing problems, but many health experts now advise against them. If not cleaned properly, the water left standing at room temperature for long periods provides an ideal environment for bacteria and mould to grow. What’s more, very few users follow the maintenance routine recommended by manufacturers. Humidifiers are also believed to be ineffective in relieving respiratory problems in children. It’s only for the common cold that some pediatricians continue to recommend the use of cool mist humidifiers to make children more comfortable. That said, the Canadian Pediatric Society and the publication From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two suggest avoiding humidifiers. For more information, see our article on humidifiers. |
Nose care
When your baby isn’t sick, clean their nose twice a day from October to May and once a day the rest of the year.
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.
Recipe for homemade saline solutionDissolve 10 ml (2 tsp) of non-iodized salt (sea salt or kosher salt) and 2.5 ml (1/2 tsp) of baking soda in 1 L (4 cups) of water that has been boiled and cooled. Be sure to use exact measurements. You can make half the recipe if you want, as long as the proportions stay the same. Store the solution in a clean, closed glass container in the fridge for up to 7 days. To avoid putting cold water up your child’s nose, keep some of the solution in a small bottle at room temperature. Discard any solution that has been left unrefrigerated for more than 24 hours. Before filling the small bottle, shake the container to dissolve any salt that has collected at the bottom. |
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
To learn more about cleaning a baby’s or child’s nose, consult CHU Sainte-Justine’s nasal hygiene videos (in French) at
chusj.org.
- 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.
Rinsing the nose with devices like Sinus Rinse® or NetiRinse®, available in pharmacies, has the advantage of cleaning secretions from the back of the nasal passages.
- 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.
Games to teach kids how to blow their nose (starting at 2½ years old)During a bath, let your toddler blow bubbles in the water with their nose. Ask them to move a cotton ball across a table by blowing through their nose (keep their mouth closed with your hand). Stand in front of a mirror with your child and put one hand in front of their mouth. Ask them to blow through their nose at the mirror then use their finger to draw a picture in the mist that forms on the mirror. |
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).
Is the flu vaccine safe?Today’s flu vaccine is made from an inactivated (killed) influenza virus, so it can’t cause the flu. Side effects are generally mild and limited to minor pain at the injection site, a slight fever, and minor muscle or joint pain on the first or second day after vaccination, especially after the first dose. Symptoms may be treated with acetaminophen. In rare cases, a child’s eyes may become red or itchy, they may start coughing, or their face may swell. These symptoms appear a few hours after vaccination and usually disappear within 48 hours. For more information, consult our fact sheet on vaccination. |
| Scientific review: Dr. Anne-Claude Bernard-Bonnin, pediatrician Research and copywriting:The Naître et grandir team Updated: July 2024
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Photo: iStock.com/killerb10
Sources and references
Note: The links to other websites are not updated regularly, and some URLs may have changed since publication. If a link is no longer active, please use search engines to find the relevant information.
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Blais-Poulin, Charles-Éric. “La ‘méthode Sainte-Justine’ revue et corrigée.” La Presse, October 25, 2023. lapresse.ca
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CHU Sainte-Justine. Nasal hygiene: Information brochure for parents. 2024. chusj.org
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CHU Sainte-Justine. “L’hygiène nasale” (videos). CHU Sainte-Justine, 2024, chusj.org
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DeGeorge, Katharine C., et al. “Treatment of the Common Cold,” American Family Physician, vol. 100, no. 5, 2019, pp. 281–289. pubmed.ncbi.nlm.nih.gov
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Doré, Nicole, and Danielle Le Hénaff. From Tiny Tot to Toddler: A practical guide for parents from pregnancy to age two. Institut national de santé publique du Québec, Québec. inspq.qc.ca
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Gouvernement du Québec. “Flu vaccination program.” 2022. quebec.ca
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Montreal Children’s Hospital. “Colds and flu.” montrealchildrenshospital.com
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Labbé, Jean. Bulletins pédiatriques : votre enfant de la naissance à 5 ans. 8th ed., Faculty of Medicine, Université Laval, Québec, 2022. fmed.ulaval.ca
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Ministère de la Famille. Les infections en milieu de garde. 2019. mfa.gouv.qc.ca
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Rennard, Barbara O., et al. “Chicken Soup Inhibits Neutrophil Chemotaxis In Vitro,” Chest, vol. 118, no. 4, 2000, pp. 1150–1157. yorku.ca
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Canadian Paediatric Society. “Influenza in children.” Caring for Kids. 2021. caringforkids.cps.ca
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Canadian Paediatric Society. “Children’s colds.” Caring for Kids. 2021. caringforkids.cps.ca
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Canadian Paediatric Society. “The flu vaccine.” Caring for Kids. 2021. caringforkids.cps.ca
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Canadian Paediatric Society. “Recommendations for influenza vaccines for children and adolescents for the 2022-2023 season.” 2022. cps.ca
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