Advice for surviving stuffy noses, coughs, and crankiness.

By Aviva Patz
October 03, 2005


I thought my 5-week-old daughter was going to die. She was clearly struggling to breathe, and she looked pale and limp. I rushed her to the emergency room at 11 p.m., fretting all the way. The diagnosis? Sadie had a virus and she was very congested, but she wasn't dying. The doctor calmly explained that it takes infants a while to learn that they can breathe through their mouth, and until they do, a stuffed-up nose can make them extremely uncomfortable. Sadie's "common cold" lasted four miserable days and four nerve-racking, sleepless nights.

If you're a new parent, your child's first cold can be pretty scary. "The only way your baby has to communicate is by crying," says Debby Clarke, a mother of two from Colorado Springs. "It's terrifying to look at the person you love more than anything and not know what's wrong or how to help."

Although babies can seem miserable, they actually tolerate colds far better than their parents do, says Charles Shubin, MD, director of the Children's Health Center at Mercy Family Care in Baltimore. "The vast majority of respiratory infections are brief and inconvenient, but not serious."

That's good news because babies can contract a lot of colds -- about six to eight a year -- due to their immature immune systems. There's no cure for a cold, which is caused by a virus that results in five to six days of upper respiratory symptoms such as runny nose, sneezing, congestion, and coughing. Colds are usually transmitted by touch, not from someone's sneezing in your baby's direction, as you might think. "Typically, a sick person will touch your child's hand or a shared toy and get nasal drippings on it. When your child touches that toy and then her own nose, she catches the germs," explains Dr. Shubin.

The flu is also caused by a virus, but it often lasts longer, about seven to 10 days, and in children it can cause vomiting and diarrhea as well as upper respiratory symptoms, such as congestion and sneezing, and muscle aches. It's not easy to tell the difference between

a cold and the flu in babies since they don't experience the dramatic onset that screams "flu" to an adult. Instead, your child may simply appear fussier and more irritable, and may run a higher fever for longer.

Although colds and flu can lead to a secondary infection, such as an ear or sinus infection, this happens in only a quarter to a third of cases, says Christopher White, MD, a pediatric infectious disease specialist at the Medical College of Georgia in Augusta. The odds of a cold's turning into pneumonia are fewer than 1 in 20.

So when your child gets sick, your biggest challenge is to help him muddle through the cranky, stuffy days and sleepless nights. The following advice from pediatricians and moms can make the experience a lot less miserable for everyone.

The Right Medicine

Medication won't make a cold or flu go away any faster, but it can relieve some of baby's symptoms. Still, most doctors agree that for infants, less is best. In fact, the only medicine pediatricians generally recommend for children younger than 6 months is acetaminophen (Tylenol) or ibuprofen (Motrin), which treat both fever and pain. Why not cold medicine? "Infants are more susceptible to its side effects, and that often outweighs the benefit," says Dr. White. Cold medicines can act like caffeine, he explains, increasing heart rate and blood pressure, making babies more irritable and even jittery. "So you have a child who's a little less stuffy but so hyped up that he can't sleep," Dr. White says. The side effects can also mask a child's real symptoms that your doctor needs to consider when making a diagnosis.

The rules are more flexible for children older than 6 months. Keep in mind, however, that sneezing and coughing are all part of the body's defense against a virus. These actions help your child clear mucus and germs from the respiratory tract and move the illness along.

"So if your child is running around, and isn't terribly bothered by a cold, I'd hold off on medicine," says Yvonne Hung, MD, a pediatrician in Montclair, New Jersey. "But if your baby is miserable -- very congested and coughing a lot -- or he can't sleep, then you can use an over-the-counter cough suppressant or decongestant."

A child with a cold may also be running a mild fever -- a sign that his body is fighting the illness. If your child is younger than 3 months old, report any fever to your pediatrician; young infants are at greater risk of getting a serious infection, the only sign of which could be a fever. For older babies and toddlers, tell your doctor about a fever if it lasts more than 24 hours, is high (101.5 degrees or more), or your child seems particularly ill. Otherwise you can bring down the fever with acetaminophen or ibuprofen to make your child feel more comfortable.

The gold standard for taking an infant's temperature is a rectal thermometer (it provides the most accurate reading), but using one is a task many parents find intimidating. "My biggest recollection of Haleigh's being sick was taking her rectal temperature," says Jennifer Pine of Glen Ridge, New Jersey. "She was just a few months old and it scared the daylights out of my husband and me. We had the instructions on the floor next to her and must have read them three to four times. You would have thought we were performing brain surgery." If the prospect is too daunting, don't sweat it. Benjamin Kligler, MD, associate medical director of Beth Israel's Center for Health and Healing in New York City, says an ear thermometer is sufficiently precise. What's most important is to get an idea about whether or not your baby has a fever. But let your doctor know you used an ear thermometer when you report the temperature.

If you're cruising the drugstore aisles for an over-the-counter cold remedy, choose only single-purpose medications, such as a fever-reducer or decongestant, but not a preparation that does both or even a few things. According to Dr. White, this is to ensure that you don't accidentally overdose your baby. You might also skip the expectorants, since they're not terribly effective for kids. "Children don't cough up stuff and spit it out the way adults do -- they're more likely to swallow it," says Dr. White. "You're better off trying to keep their nose clear and keep up the fluids."

Clearing a Stuffy Nose

A baby can't blow his nose, and even 3-year-olds, who may able to go through the motions, may not generate enough force to expel the mucus. Clearing a stuffed nose so baby can breathe is often a full-time job for the parent of a sick baby or toddler. William Sears, MD, the author of scores of parenting books, recommends what he calls "the nose hose and steam clean."

Place a few drops of an over-the-counter saline solution in baby's nostrils to loosen up the mucus and then suck it out with a bulb syringe. Then, for the steam clean part, take your child into a closed bathroom and run a hot shower for about 15 minutes. "The high humidity liquifies the nasal secretions," he explains. You can add five to 10 drops of eucalyptus oil (available at natural food stores) to the shower floor before turning on the water, suggests Dr. Kligler. The fumes help open up the nasal passages and sinuses.

Applying a salve with eucalyptus oil directly to baby's chest several times a day can be helpful, too. Johnson's makes such a cream, as well as a soothing herbal vapor bath.

Using a humidifier to keep the air moist is key, especially if your home has central heat, which dries out baby's mucous membranes, leaving them more inflamed and irritated. Dr. Sears recommends a warm-mist vaporizer because it adds heat as well as humidity.

However, warm-air vaporizers are often discouraged because they present a safety hazard. To prevent accidental burns due to your child's pulling down the unit filled with hot water, use the warm-mist version only when your baby is still in the crib.

Dr. Shubin also suggests creating a mini "steam room" over baby's crib. Place a humidifier on a chair next to the crib and spread a bed sheet over both for 15 minutes. The tent of humid air helps the baby breathe, he says. Of course, never leave a child unattended in this setup.

Once your child is crawling and walking, switch to a cool-mist humidifier and rinse it daily to prevent mold, which can make cold symptoms worse.

For an instant humidity fix -- and a nice change of scenery -- bundle up your sick baby and take him outside. Outdoor air is always more humid than the air in a sealed house. "We've taken 1-year-old Jackson on walks in the cool night to relieve pressure in his sinuses," says Nina Marchese of Quincy, Massachusetts. "Being outdoors cleared him right up!"

Keeping a sick baby's airway clear long enough for him to get some quality sleep can be tough. One solution that many moms use is to elevate their child's head. Becky Leibowitz of Scotch Plains, New Jersey, puts a pillow under 6-month-old Jonah's crib mattress. Rolled up towels or even phone books work well, too -- just be sure to place them under the mattress and not in the crib, where they can pose a suffocation hazard.

You can also let your child sleep in his stroller, slightly reclined, or in a car seat. "I've actually put the entire car seat in the crib," says Mary Lyon, author of The Frazzled Working Woman's Practical Guide to Motherhood (Starburst, 1997). Of course Mom makes a good bolster, too. "To help my son nap when he's sick, I'll lie down on the couch on my side, then position him so he's almost sitting up against me," says Mary Rose Almasi of Somers, New York, mother of Jack, 2, and Grace, 4. "It's cozy for the baby and helps things drain so he can sleep."

Drink Up

Babies often don't have much of an appetite when they're sick, so while food is optional -- even for several days -- it's essential that they drink enough to prevent dehydration.

If your child is still breast- or bottlefeeding, continue doing so. However, this can be a challenge because a congested infant may stop nursing every few seconds to gulp air. If this is the case, Dr. Kligler suggests asking your doctor if you can give her Pedialyte, an over-the-counter rehydrating solution. "Use an eyedropper so you can keep squirting it in her mouth. Little babies do well with it," he says.

For sick kids 6 months and older, keep in mind that they're also unlikely to guzzle a whole bottle or cup at once. "Offer water, formula, milk, juice -- whatever they normally drink -- in smaller amounts throughout the day," says Dr. Hung. "Every little bit adds up."

If your toddler refuses to drink, try offering him Popsicles. Marguerite Lamb of Yardley, Pennsylvania, mother of Jake, 3, and Sophie, 1, stocks her freezer with Pedialyte pops, which her kids love. If she runs out, she uses regular ice pops. "They're mostly sugar and water, but since sugar is the main ingredient in anti-nausea syrups -- and my kids are often sick with vomiting -- that's probably a good thing."

Signs that your baby is not getting enough fluid include a dry mouth, few or no tears when he's crying, and a failure to wet diapers regularly. If you do offer foods to a toddler who has the flu, follow the BRAT diet, which means bananas, rice, applesauce, and toast -- all easy-to-digest foods.

Tender Loving Care

"A miserable kid makes everyone miserable," says Dr. Shubin, so making a sick baby comfortable is important. For young babies, simply keeping them close to you can work wonders, but it's tough to hold a baby all day. "I'd let my children rest in a baby carrier on my chest, leaving it a little open so they didn't get too hot, and I'd just go about my business at home," says New York City mom Patty Baronwoski. "They felt secure and slept peacefully."

Debby Clarke swears by the old trick of placing a cool washcloth on her daughters' foreheads. "It feels good on their hot head and I think it makes them feel cared for," she says. "And since I feel like I'm helping, I can relax a little bit." Mary Lyon takes the opposite tack, wrapping her baby in a towel fresh from the dryer to re-create the womb experience. "Once we had Elizabeth completely wrapped up, she abruptly stopped crying and fell asleep," Lyon says. "It was weirdly magical."

Dr. Kligler relies on herbal teas, especially chamomile, to calm his kids. "They seem to like it," he says. "I can't say it shortens the duration of the illness, but it seems to make them more comfortable."

Reading to kids, extra hugs and kisses -- anything that makes your child feel cared for -- is the best medicine. Before you know it, your baby will feel like his usual, adorable self.

When to Get Help

These red flags mean your child may have more than just the sniffles.

  • Rapid or labored breathing. The baby is clearly struggling to breathe -- he may flare his nostrils, and the skin between his ribs might suck in with each breath.
  • Increasing sickness. Your baby becomes quieter, limp, or pale, and appears more miserable instead of getting better.
  • A fever of 101 degrees or higher for two days or more. It doesn't guarantee a secondary infection, but you should check it out.
  • Mother's intuition. If your child looks and acts extremely ill and it's making you anxious, call your doctor. "How sick a child looks is more important than how high his fever is," William Sears, MD, says.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

American Baby