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Tuesday, September 9, 2014

How long will a cough or cold last?

How long will a cough or cold last?

I get this question all the time. Most people want it gone now. Unfortunately despite our medical advancements over the years, we still have no cure for colds and coughs. Viruses do not get killed by antibiotics, and most colds and coughs are caused by viruses.

Unfortunately our area has been hit with Enterovirus D68, which seems to cause prolonged symptoms compared to many respiratory viruses.

I don't hold back on advice when I see kids with disturbing colds and coughs. I sympathize with the child and parents. I've been there: both as a person with a bad cold and as a parent watching my kids struggle with colds. But I still can't make them better faster.

We have our standard instructions:

  • Fluids (water)
  • Rest
  • Saline washes to the nose
  • Blow the mucus out. If a child's too young to blow his nose well, parents can suck the snot right out.
  • Honey for children over 12 months of age
  • Prop the head up during sleep
  • Prevent spread
But then we still have the original question: How long will a cough or cold last?

One of my favorite graphs depicting the timeline of a typical upper respiratory infection is from research done in the 1960's, but since we don't have any better treatment now than we did back then, I find it to hold true to what I experience when I get a cold and what I see in the office.


Notice how the symptoms are most severe during the first 1-5 days, but still persist for at least 14 days. And at 14 days 20% of people still have a cough, 10% still have a runny nose. And the lines aren't going down fast at that point, they both seem to linger. 

A more recent review of medical studies showed that the many symptoms of illness linger for much longer than parents want to accept. From this study:
* Earache range 7-8 days, Sore throat 2-7 days

Bear in mind that children tend to get about 8 colds per year, often in the fall/winter months, so a second virus might start developing symptoms right as the first cold is finally going away. That is an important distinction between back to back illnesses versus a sinus infection requiring antibiotics. This is why doctors and nurses ask (and re-ask) about symptoms. The history and timeline of symptoms are very important in a proper diagnosis. It isn't the color of the mucus (really!) We don't want people to unnecessarily take antibiotics. That leads to bacterial resistance, side effects of medicine, and increased cost to families.

So if you're struggling with cough and cold symptoms in your house, follow these instructions. To help determine when your child needs to be seen:
Urgently or emergently: If your child is breathing more than 60 times in a minute, ribs are going in and out with breaths, or the belly is sucking in and out with each breath, your child needs to be seen in the office, at urgent care or an ER (preferably one that specializes in children), depending on time of day and your location. Another complication that kids must be seen for is dehydration. Dehydration may be present when the child is unable to take in enough fluids to make urine at least 4 times a day for infants, twice a day for older children. 
Routine office visits: If your child has ear pain, trouble sleeping, or general fussiness but is otherwise breathing comfortably and well hydrated, he should be seen during regular office hours. If the cold is worsening after 10-14 days, bring your child in during regular office hours.




More reading:


Clinical Practice Guideline for the Diagnosis and Management of Acute Bacterial Sinusitis in Children Aged 1 to 18 Years