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Baby's First Cold & Flu Season

baby girl in jacket with eyes closed

The dreaded first cold hits just as your baby adopts a routine sleeping and feeding schedule. There's no avoiding it. Although babies are born with some of their mothers' immunity to illness -- which is enhanced by breastfeeding -- they're not completely protected against the ever-changing collection of viruses that cause upper respiratory infections. This means that most healthy babies will get six to eight colds before their first birthday. On a positive note, they will help your child begin to build up immunity of his own.

For many new parents, the real concern is deciding if their baby has just a cold -- or something more serious. Take a deep breath and face this challenge. You'll see it's easy to figure out once you know the signs.

Life Cycle of a Cold

The common cold comes on slowly and lasts about nine days. I find it helpful to break the cycle down into three days coming, three days here, and three days going.

  • Three Days Coming. During the first three days, when your child is contagious, she may seem fussier than usual, have a slight decrease in appetite, and even have a fever. If she is less than 3 months old and her rectal temperature is above 100.4 degrees F., call your pediatrician's office right away for advice and instructions. (Some good news: Once your child is a preschooler, a cold causes only a slight increase in temperature.) On the second or third day, you'll spot a runny nose, signaling that your child's immune system is fighting back. During this stage, the mucus is clear and thin, and runs constantly. I know it's difficult, but try not to be on tissue patrol; multiple attempts to get your kid to blow will bother her more than the runny nose.
  • Three Days Here. During the middle phase of a cold, the fever has usually gone away, and your baby might be less fussy and eating better. The mucus will thicken a bit and may turn light yellow. Your child will now have the classic "stuffy and runny nose." This is also when he could develop a cough; when a baby lies on his back, mucus drips down the nasal passages to the back of the throat and sets off a cough response to keep the fluid out of the lungs. Inevitably, your child will have a hard time sleeping.
  • Three Days Going. Like a houseguest who stays too long, colds can linger. In the final three days, the mucus thickens even more and becomes crusty. Your baby will act normal in most ways, eating well and resuming activity.

Baby Care Basics: What are the Signs of Flu?
Baby Care Basics: What are the Signs of Flu?

Now that you know what the typical cold looks like, let's talk about the flu. It usually peaks from November through March, often for a few weeks at a time. Children can be contagious a day before symptoms start and for as long as they show them, which can be for up to two weeks.

Flu symptoms in older kids and adults are very specific and include:

  • sudden onset of high fever (102 degrees or higher)
  • aching muscles
  • weakness
  • headache
  • pain behind the eyes
  • a sore throat
  • a hacking cough

Preschoolers can say when their arms and legs hurt, and it's clear that your normally active child doesn't feel well when he won't get off the couch. However, these symptoms are harder to detect in babies and toddlers. Here are some guidelines: A cold comes on slowly over a few days, but the flu hits fast, sometimes within a few hours. The fever will last more than one or two days, and your child might not look much better after it breaks. You'll also see a big decrease in his activity level and appetite, and coughing will be worse than with colds. Babies and toddlers can also experience diarrhea and vomiting. If you think your kid has the flu, call his doctor.

The simple truth: There is no quick fix for a cold or the flu. Antibiotics aren't effective against viruses, and antiviral drugs for some influenza strains aren't approved for babies. Plus, a growing body of research suggests that decongestants and combination decongestant-antihistamine products are not very effective in children, who can also experience side effects, such as jitteriness or difficulty sleeping. Most pediatricians don't recommend these medications for babies, and many are now advising parents to use them minimally for all kids. Nonprescription cough suppressants and expectorants have also been shown to have little effect on coughs linked to colds in kids, and experts advise against their use in children under age 14.

Doctors' Recommendations

To prevent influenza, babies should receive a flu shot at 6 months, then a booster four weeks later and an annual shot until age 5. And whether your child has a cold or the flu, she still needs to feel comfortable.

  • Keep infant or children's acetaminophen or ibuprofen on hand for fevers, and make sure you know the correct dosage for baby's age and weight.
  • As soon as the runny nose starts, put a vaporizer or cool-mist humidifier in your kid's bedroom to help keep nasal passages moist, which prevents mucus from drying out and thickening.
  • Also use a saline nasal wash; it's available at pharmacies as a spray or drops and has no side effects besides making babies sneeze, which will also help unplug noses. (If you choose to use a nasal aspirator, gently do so after administering the saline solution.)

Moreover, these surefire strategies will help you bottle- and breastfeed more smoothly because baby will be able to breathe better and will be less likely to fuss. And when you want to help your child sleep soundly when he's sick, raise the head of the crib (by placing a rolled towel or books under the mattress), or prop toddlers and preschoolers up in bed with extra pillows. This helps mucus drain more freely away from the lungs.

In the end, it's the simple things, such as lots of fluids, that can make kids feel better. And don't forget chicken soup -- there is actually some research that suggests this time-honored remedy may help to reduce inflammation and thin mucus during a cold. But, of course, moms don't need scientific proof of that.

  • Take your child to the doctor for a flu shot. Although you can't always prevent your baby from getting a cold, you can help prevent the flu by having your baby vaccinated. The American Academy of Pediatrics and the CDC recommend that all infants 6 months of age to 5 years be vaccinated against the flu during the fall months. Every year the CDC creates a vaccine with the "best guess" of which strains of influenza will be present during the next flu season. Although not 100 percent protective, having your baby vaccinated will greatly reduce his or her chances of contracting the flu. Older children with chronic medical conditions and their siblings should also receive the influenza vaccine.
  • Keep sick friends and relatives away. This will not always be possible, but keeping your children away from other children or adults who are obviously sick will cut down on the number of infections. This is especially important during influenza outbreaks.
  • Teach children to wash hands. Washing hands is probably the best way to keep germs from spreading. Teach your child to wash both hands with soap and water for as long as the tune of "Happy Birthday." Many experts suggest this as long enough to kill most germs. Make sure all the adults in the house do the same.
  • Keep kids at arm's length when you're sick. Let another adult in the household who isn't ill care for the children in the first few days of the cold or flu. If you are breastfeeding, try not to breathe, cough, or sneeze directly onto your baby's face. Wash your hands frequently.

Why the Flu Matters
Why the Flu Matters
Telling the Difference Between Cold and Flu

Here are some clues:

  • Season: Although colds occur all year round, the influenza virus usually affects a community during the winter months between November and March, and usually for only a few weeks. Knowing if the flu has hit your neighborhood can be helpful.
  • Speed: The main difference between a cold and the flu is speed of onset. A cold comes on slowly over a few days, the flu comes on very rapidly, sometimes over a few hours. In small infants and toddlers, you will see a rapid and dramatic decrease in your baby's activity level and appetite. Your infant will "just not look right" or will appear very sick.
  • Symptoms: Both colds and flu cause high fevers in babies and toddlers, but with the flu, the fever will last more than one or two days, and your baby might not look much better after you treat the fever. Although both affect the upper respiratory system, the cough will be worse in flu, and there will be less of a congested nose. The flu can also cause diarrhea and vomiting in infants and toddlers.

  • If your baby is listless, not reacting to you, has poor color, or if you just feel something isn't right.
  • If the cough is worsening or your child is having difficulty breathing.
  • If your baby is crying much more than usual, patting or pulling on the ear, or refusing nursing or drinking from a bottle.
  • If you suspect your infant has the flu, especially if he or she has a high fever and cough which persists for more than three days. NOTE: Any infant under 3 months with a fever (rectal temperature of 100.8 or greater) must be seen.
  • If your older child has a high fever for more than five days, a worsening cough (with or without chest pain), a headache for more than five days, or a headache that is getting worse or is accompanied by a stiff neck.

Q. My toddler is miserable when sick. Is there an antidote to this?

A. If only such an elixir existed, but the notion that echinacea, vitamin C, or zinc can wipe away the sniffles is no truer than the bedtime stories you read to your kids. In fact, studies of adults and children have found that vitamin C doesn't prevent or treat the common cold even when taken at the onset of symptoms. Nor does echinacea lessen the duration or severity of a cold. Even the claim that zinc can reduce cold symptoms doesn't stand up in controlled studies.

So when a friend says that she swears by one of these alternative remedies, trust that scientific research has so far shown otherwise. And if you're still contemplating giving your child these supplements and wonder what harm can they do, think again. Possible adverse side effects: nasal applications of zinc might affect one's sense of smell; concentrated vitamin C can upset the stomach and lead to diarrhea; and echinacea causes rashes in some kids.

Mary Ann LoFrumento, MD, is an attending physician at Goryeb Children's Hospital, in Morristown, New Jersey, and is the founder of simplyparenting.com.

Originally published in American Baby magazine.

The information is designed for educational purposes only. It is not intended to be a substitute for informed medical advice or care. You should not use this information to diagnose or treat any health problems or illnesses without consulting your pediatrician or family doctor. Please consult a doctor with any questions or concerns you might have regarding your or your child's condition.