The Common Cold In Pediatric Practice

The common cold is a viral infection with prominent symptoms of rhinorrhea and nasal obstruction, absent or mild fever and lacking systemic manifestations.

Etiology
The viruses primarily involved with colds are rhinoviruses and less commonly coronaviruses. Other viruses that cause common cold symptoms as part of broader clinical syndromes include respiratory syncytial virus and less commonly influenza viruses, parainfluenza viruses and adenoviruses.

Pathophysiology
Viral infection of the nasal epithelium causes an acute inflammatory response with mucosal infiltration by inflammatory cells and release of inflammatory cytokines. The inflammatory response is partly responsible for many of the symptoms.

Clinical FeaturesCommon cold symptoms typically develop 1 to 3 days after viral infection and include nasal obstruction, rhinorrhea, sore or scratchy throat and occasional non productive cough. Colds usually persist about 1 week although 10% lasts 2 weeks. there is often a change in color or consistency of nasal secretions, which is not indicative of sinusitis or bacterial superinfection.

Examination of the nasal mucosa may reveal swollen, erythematous nasal turbinates.

Diagnosis
Diagnosis is made clinically and laboratory studies are often not helpful.

Treatment

• There is no specific therapy for the common cold. Antibacterial therapy is not beneficial and the management only consists of symptomatic therapies.
• Fever is infrequently associated with common cold and antipyretic treatment is usually unnecessary, although acetaminophen may reduce symptoms of sore throat.
• Cough suppressants and expectorants are usually unnecessary and have not been shown to be beneficial.
• Either topical or oral adrenergic agents may be used as nasal decongestants but are not approved for use in children < 2 years.
• First generation antihistamines reduce the symptom of runny nose but the adverse effect is sedation.
• Vitamin C, guaifenesin, and inhalation of warm, humidified air are no more effective than placebo.
• The benefit of zinc lozenges or sprays has been inconsistent.

Complications

• Otitis Media (5-20% of children with cold)
• Bacterial sinusitis
• Exacerbation of asthma.