In this blog, TINYHOOD expert Dr. Chase Parsons discusses what to look for symptom-wise when your baby is sick, how to ease their symptoms, and when to call their pediatrician or seek medical care.
Illnesses like colds (and sometimes the flu) are a part of childhood. In fact, on average, kids can go through 6 respiratory illnesses a year. While these infections actually work to build strong immune systems that will help prevent frequent infections as babies get older, that doesn't make them any easier for parents to witness.
Sometimes, it can be hard to tell the difference between a classic childhood cold and the flu. So, what are the key differences between these illnesses? And, what can you do to comfort your baby when they're feverish, stuffy, coughing, and just overall uncomfortable?
I'm going to walk you through all that and more so you're prepared for the next illness that comes your way.
What are the most common symptoms of cold & flu in babies, and how can parents differentiate between them?
While both the common cold and the flu are respiratory illnesses, there are some key differences in their symptom onset and the symptoms themselves.
First, let's talk about symptom onset, or how quickly symptoms begin. Cold symptoms tend to develop gradually over a few days, while flu symptoms tend to come on suddenly and strongly. So, if your baby has been slowly getting stuffier or coughing more over the course of a few days, it's more likely that they have a cold than the flu.
Another way to tell the difference is by taking a look at your child's actual symptoms. Colds generally cause just a mild fever or none at all, while the flu is often associated with a high fever, sometimes lasting several days.
Colds typically result in mild to moderate coughs while the cough associated with the flu tends to be more persistent and severe. And, colds tend to have more stuffy & runny noses than the flu. The flu also has some other telltale symptoms like muscle aches, fatigue, red eyes, headaches, vomiting & diarrhea.
When should parents seek medical attention if their baby is showing symptoms of a cold or flu?
If your baby has symptoms of a cold or the flu, there are times to reach out to your pediatrician or to seek emergency medical care.
Call your doctor if:
• Your child is under 4 months old and has a fever of 100.4ºF or higher
• Your child is over 4 months old and has a fever of 100.4ºF or higher for more than 48 hours
• Your child has nasal congestion that has lasted more than 10 days
• Your child has ear pain. Infants may communicate this by pulling on their ear, or with constant fussiness, especially at night
• Remember, if you are ever concerned about your child's health, even if they aren't exhibiting any of the above symptoms, reach out to their pediatrician
You should always go to the emergency department or call 911 if your child is experiencing any of the following symptoms:
• Difficulty breathing
• A high-pitched sound when they breathe
• Refusing to eat or drink for a long time
• Or, changes in behavior like decreased responsiveness. You know your child best, so this may look like them not responding to you as they typically would, for example, not smiling or becoming lethargic or completely limp
How can parents keep their baby comfortable at night when they're congested or have a cough?
While coughs are the body's way of keeping unwanted things — like mucus — out of your child's lungs, they can still be uncomfortable for your child. To help relieve coughs:
• Use a cool mist humidifier. Adding moisture to the air can help to ease congestion
• If your child is over one year, you can offer them a small amount of honey to ease their cough and soothe their sore throat. Start with half a teaspoon and offer more if necessary. If your child is under 1, do NOT give them honey
• Avoid chest rubs if your child is under 2 years old as there is an ingestion risk when rubs are placed on their body. Instead, offer your child soothing vapors by applying chest rub to a warm towel and keeping it just outside your child's reach
*Do NOT use over-the-counter cough medicines if your child is under 5. They are neither safe nor effective.
To help relieve nasal congestion, try using a nasal aspirator. This can help clear the snot and make your child more comfortable, especially right before eating or sleeping. Make sure to use one in conjunction with some nasal saline. Nasal saline will help to thin the mucus so you can more effectively suck it away. A cool-mist humidifier or taking baby into a steamy shower while you hold them for a few minutes can also help.
What are the best ways to keep a baby hydrated during an illness?
One of the most important things to do when your baby is sick is to keep them hydrated. You'll know your baby is hydrated if they continue to wet their diapers as normal. To keep them hydrated, offer smaller, more frequent feedings (remember, clear any congestion before feedings with the help of a nasal aspirator).
For babies over six months old, it can also be helpful to mix what they typically drink — be it breast milk, formula, or water — with a rehydration solution like Pedialyte.
Can you recommend any specific baby products or tools that can help ease cold and flu symptoms?
There are some products and tools that can be helpful to have on hand to ease cold and flu symptoms. These include:
• Baby thermometer
• Medicine syringe or medicine spoon
• Saline nasal drops
• Tissues or wipes
• Bulb syringe or nasal aspirator
• Cool mist humidifier
• Infant acetaminophen (safe for use once baby is over 4 months old)
• Infant ibuprofen (safe to use once baby is over 6 months old, unless otherwise directed by your doctor)
What should parents know about giving medication to babies for cold and flu symptoms?
How you treat cold and flu symptoms for babies depends on their age.
An important note before we get into the specifics of medication: If your child is younger than 4 months, the presence of any fever is serious and you need to call your pediatrician right away. If unavailable and there's no after-hours line, go to the emergency department. They will provide you with next steps.
Once your baby is older than 4 months, you can give them acetaminophen, or Tylenol, every four hours as needed without having to call the doctor to let them know. Check the packaging for dosing guidelines, and don't exceed 5 doses in a 24-hour period. Once your baby is older than 6 months, you can give them ibuprofen, or Motrin, every six hours as needed. Again, check the packaging for dosing guidelines, and don't exceed 4 doses in a 24-hour period.
Parents often ask me about alternating medications to help manage their child's symptoms. It is possible to alternate between acetaminophen and ibuprofen safely, but you should consult your doctor before doing so. If your doctor feels alternating medications is appropriate given your child's symptoms, you can switch every three hours instead of every four to six with a single medication.
Know that when alternating medication, it can be hard to keep track of what medication was last given and when which leaves room for mistakes and accidental overdoses. It can be helpful to use a medication tracker in these situations.
What steps can parents take to help prevent their baby from catching a cold or the flu during peak season?
While illnesses are just a part of childhood, there are things you can do to help prevent your child from catching a cold or the flu.
Vaccination options are available for the flu for babies over 6 months of age. These are given annually to help prevent infection. The type of shot and dosage your child receives depends on their age and previous vaccination status. It's recommended that everyone in the household (including you!) be vaccinated for the flu annually. A new vaccine is also available for RSV (another common childhood virus) for infants younger than 8 months of age born during RSV season or entering the RSV season. Any questions or concerns about the vaccination are best handled by your child's pediatrician.
Washing hands frequently using soap and water is important. You can use hand sanitizer when hand washing is not available. Make sure anyone who is holding your baby washes their hands first.
Avoid interacting with sick people. So, if someone in your household is sick, try to have them avoid interacting with the baby as much as possible.
And as always, eating well and getting enough sleep can also help keep immunity up.
About Dr. Chase Parsons
Dr. Chase Parsons, DO, MBI, is a Med-Peds trained Pediatric-Hospitalist in Boston and Tinyhood Expert. He cares for children admitted to the hospital and supports their families upon discharge. He's also an instructor in Pediatrics at Harvard Medical School (HMS). Chase attended medical school at Philadelphia College of Osteopathic Medicine and earned a Master's in Biomedical Informatics from HMS.
