The Common Cold and Decongestant Therapy

Abstract

1. Diane E. Pappas, MD, JD* 2. J. Owen Hendley, MD* 1. *Department of Pediatrics, University of Virginia, Charlottesville, VA. After completing this article, readers should be able to: 1. Discuss the clinical presentation, diagnosis, and complications of the common cold in children. 2. Describe the viral causes and pathogenesis of the common cold. 3. Describe transmission of the common cold. 4. Explain the systemic effects of oral decongestants and antihistamines in infants and young children. 5. Recognize that over-the-counter cough and cold preparations have not been adequately studied in children younger than 6 years of age and are not recommended. 6. List the active ingredients and potential toxicities of over-the-counter cough and cold medications. The common cold heralds the beginning of the fall and winter seasons for pediatricians. Almost every ill patient presents with the runny nose, cough, and congestion that are the hallmarks of the common cold. Although colds are self-limited, most patients (and their parents) are tired and uncomfortable as a result of these symptoms. No effective treatments can be prescribed or recommended beyond ordinary supportive care. Children typically present with cough, sneezing, nasal congestion, and runny nose. Nasal discharge may be clear initially but often turns yellow-green within a few days. Fever may be present initially in preschool-age patients, but vomiting and diarrhea are uncommon. Parents also may report sleep disturbance and increased fatigue. Symptoms persist for at least 10 days in most children but should begin to lessen by this time. This clinical picture differs substantially from colds in adults, which present with the typical nasal discharge, cough, and congestion but no fever and a usual duration of only 5 to 7 days. Sore throat or hoarseness also may be present in children and adults. (1) Common cold is a clinical …