How to tell if baby has allergies or cold?

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Does Your Child Have a Cold, or Is It Allergies?

You figured your child’s sneezing, sniffling, stuffy nose, cough and sore throat were yet another cold. But as the days turn into weeks and there’s no sign that his symptoms are getting better, now you’re not so sure. Is it really a cold, or could it be allergies?

What causes colds and allergies?

It’s no surprise that you can’t tell one from the other, since colds and allergies look a lot alike. But they’re actually very different conditions:

  • Colds. The common cold is caused by a virus. Though it can spread like wildfire during cooler months when everyone is trapped inside in close confines, babies and toddlers can catch colds year-round. No matter the season, little ones swap loads of germs because — let’s be real — it isn’t easy to train 1-year-olds to sneeze into their elbows or to stop drooling on their toys before they share them with their playmates. Once your baby or toddler is exposed to someone else who’s infected (or if your little one touches something that an infected person has touched), it’s just a matter of time before he’s infected, too.
  • Allergies. Allergies happen when your child’s immune system overreacts to a normally innocuous substance. Common allergenic substances include mold, dust mites, pet dander and pollen. Translation: If he’s allergic to something, his body will treat that substance like an invader. In an effort to fend off that intruder, his immune system will churn out antibodies that trigger the release of a protein called histamine into the bloodstream. The histamine is what causes allergy symptoms such as watery eyes, sneezing and coughing.

How can you tell whether it’s an allergy or a cold?

Congestion, sneezing and coughing are all normal symptoms associated with both colds and allergies. So how do you distinguish one from the other? Take this quick test:

More About Toddler Colds

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  • How would you describe the consistency and color of your little one’s mucus?
    1. Watery and clear
    2. Thick, cloudy and discolored
  • How would you characterize the cough?
    1. Dry
    2. Wet
  • How do your child’s eyes look?
    1. Itchy and/or watery
    2. Just fine
  • Does your child have a fever?
    1. No
    2. Yes

If you answered mostly “2,” your child likely has a cold or other respiratory infection. If most of your answers were “1,” you might be dealing with an allergy.

Other ways to tell a cold from an allergy

There are a few other telltale signs that help you to differentiate whether your little one has a cold or allergies:

  • Your child’s age. Seasonal allergies are very rare in kids under 1, who are more likely to suffer from eczema or food allergies if anything. Although most cases of seasonal allergies crop up once kids start school, some little ones begin to suffer from seasonal allergies as young as age 2.
  • The duration of symptoms. With colds, symptoms are the worst for the first few days after onset and gradually ease up, going away within a couple of weeks. However if symptoms last for several weeks or even months, it’s more likely an allergy.
  • Family history of allergies. If one parent has allergies, your child has a 25 percent chance of having them. If both parents have allergies, those odds jumps to 60 or 70 percent. To find out if your little one truly has allergies (and to determine what he’s allergic to), consider heading to an allergist to get him tested.
  • There’s a bug going around your family or playgroup. If his symptoms are similar to his playmates’, there’s a good chance he’s been hit by the same virus.

No matter what, don’t try figuring out what’s plaguing him at home on your own, especially if his symptoms have been going on for a while, are getting more severe (or at least aren’t getting milder) and/or are causing other things like moodiness, fatigue, headaches and general discomfort. Make an appointment with the pediatrician just to be sure you get a proper diagnosis and recommendations for kid-safe medications or treatments. This way, you can set about making your little one feel better as soon as possible.

Health Tips for Baby’s Visitors

How to Tell If Your Child Has Allergies … or a Cold

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A child with a runny nose, congestion, and coughing: It’s a cold, right? Maybe not. Symptoms of respiratory allergies can look a lot like a cold, making it difficult for parents — and sometimes even doctors — to tell the difference.

“We see kids coming in with the diagnosis of recurrent infections and sometimes what they actually have is allergies,” says Nicholas Bennett, MD, PhD, assistant professor of pediatrics and adjunct assistant professor of pharmacy at the University of Connecticut School of Medicine and medical director of the department of infectious diseases and immunology at Connecticut Children’s Medical Center in Hartford.

This is a common occurrence because there’s an overlap between allergy symptoms and the symptoms of an infection. Distinguishing between the two is particularly hard when spring approaches because winter respiratory viruses are still circulating while trees are producing pollen, Dr. Bennett says.

But there are some signs you can look for to determine what’s behind your child’s symptoms. Here’s what to do:

Take an inventory of your child’s symptoms. Respiratory allergies, whether seasonal or year-round, can cause sneezing, a runny or stuffy nose, and watery or puffy eyes. Postnasal drip can cause a sore throat. But there’s one more symptom to look for that will clue you in that your child may have allergies: itching of the eyes, nose, or roof of the mouth. “If things are really itchy, it tends to suggest allergies,” Bennett says.

There’s a caveat, however. Itchy eyes can also be a sign of pink eye, he says. If itchy eyes are also pink or red with a discharge that forms a crust, take your child to the doctor to be checked for pink eye.

Some people recommend looking at your child’s nasal mucus as a clue to whether he or she has allergies or a cold, but Bennett says this usually isn’t helpful because both a cold and allergies can cause a clear and runny discharge that may become thick and green over time.

Check your child’s temperature. If your child has a fever, it points to an infection rather than allergies, Bennett says.

Track the length of your child’s symptoms. A cold typically lasts a few days to a week, Bennett says. Respiratory allergies, on the other hand, can cause symptoms for weeks at a time.

Pay attention to the time of year. Spring and fall tend to be when allergy symptoms come on and are at their worst, although it can depend on what your child is allergic to, Bennett says.

Note activities that bring on your child’s symptoms. If you notice that your child is fine inside the house but starts sneezing after playing outside, it could point to allergies, Bennett says. That’s a good clue, particularly if your child is playing near plants or trees that could be causing the allergy. The same concept applies to a pet allergy: If you don’t have pets at home but your child sneezes at Grandma’s house where there’s a cat, an allergy could be to blame.

And timing is important: Pollen counts are highest around midday, which could trigger symptoms that may not be present in the morning, according to the American College of Allergy, Asthma & Immunology (ACAAI).

Check under your child’s eyes. Some kids with allergies have allergic shiners, or chronic dark circles under the eyes, along with puffy eyelids and a sensitivity to light, the ACAAI states. It can be subtle, but this is a physical sign that doctors look for to diagnose allergies, Bennett says.

Look for a wrinkle in your child’s nose. Another physical sign that doctors check for is a wrinkle halfway up the nose. It comes from someone with chronic allergies rubbing, itching, and pushing up on the nose. Doctors will typically see it in older kids and adults, and it’s usually a sign that the person has had allergies for a long time, Bennett says.

Respiratory allergies affect more than 10 percent of children in the U.S., according to the ACAAI. If you think allergies are the culprit behind your child’s symptoms, a skin test or a blood test can tell you for sure. Bennett suggests keeping a diary of your child’s symptoms not only to share with your child’s doctor, but also for your own understanding of what triggers his or her symptoms so you can help your child avoid an allergen whenever possible.

Allergies vs. colds in children

If your child seems to constantly have a runny nose, cough or congestion, you are not alone.

“It’s not unusual for kids to get six to eight colds per year, lasting from 10-14 days,” explains Michael Lee, M.D., a pediatrician with Children’s Health℠. “Additionally, seasonal allergies have become more prevalent. After the first year of life, about 15-20 percent of children suffer from allergy symptoms.”

So how can parents tell if it’s a cold or allergies? Dr. Lee explains the difference between causes and symptoms in kids.

What’s the difference between a cold and allergies?

When exposed to certain particles – such as animal dander, pollen, trees and grasses – children may have an allergic response. This occurs when the immune system overreacts to allergens, triggering the release of histamine and other chemicals into the bloodstream.

This response causes common allergy symptoms, including:

  • Itchy, watery eyes
  • Runny nose
  • Cough and congestion
  • Sneezing
  • Sometimes a sore throat

The common cold, on the other hand, is a contagious viral infection. Children pick up cold viruses through direct person-to-person contact, contact with airborne respiratory droplets or by touching viruses on surfaces.

Common cold symptoms can include:

  • Runny nose
  • Cough and congestion
  • Sneezing
  • Sore throat
  • Fatigue
  • Slight body aches
  • Fever, in some cases

Does my child have allergies or a cold?

While many allergy and cold symptoms are similar, parents can look for certain clues to help tell the difference between a cold vs. allergy.

1. If your child is under age 1, it’s likely a cold

It is unusual for a child under 1 year old to be diagnosed with seasonal allergies. “With allergies, you typically must be exposed to things a number of times to get an allergic response,” explains Dr. Lee. “It’s not that a baby can’t have an allergic reaction to something during the first year of life, but typical seasonal allergies usually involve older kids.”

2. Fever usually signals a cold or viral infection, not allergies

If your child has a fever, it’s likely that they have a cold or another type of viral illness, and not an allergy. “Fever is one of my big tiebreakers. Allergies do not cause fevers in children,” explains Dr. Lee.

3. Fatigue and exhaustion usually indicate cold or viral illness

If your child has cold symptoms and feels wiped out and exhausted, it’s probably a cold or viral illness. “Children who suffer from seasonal allergies don’t feel well, but usually they can still function and attend school,” explains Dr Lee.

4. Check your child’s eyes for allergy symptoms

Itchy, watery eyes more commonly indicate allergies, not a cold. Also, look for a purple and red discoloration under your child’s lower eyelid – called an “allergic shiner.” Some shiners indicate swelling and congestion caused by allergies. Others are genetic.

5. Notice your child’s nasal discharge

A clear, thin nasal discharge – along with itchy, watery eyes – suggests that your child may be dealing with allergies. Of course, children with a common cold may also have clear secretions. A thick nasal discharge, regardless of color, suggests a cold or other infectious process.

6. Duration of symptoms

Common cold symptoms rarely last longer than two weeks. Allergy symptoms will linger as long as the child is exposed to the allergen. With seasonal allergies, your child may have symptoms for many weeks at a time during pollen seasons in the spring, summer or fall.

7. Horizontal nasal line indicates possible allergy

When children rub their nostrils up and down and wiggle their nose side to side, the movement creates a wrinkle or crease on top of their nose. Often, the line or crease is white or reddish in color. “If a child has been dealing with an itchy, sneezy, runny nose for weeks, and we see a horizontal line on the nose, we suspect allergies,” explains Dr. Lee. “That crease is pretty much exclusive to allergy sufferers who rub their nose.”

8. If antihistamines work, it’s probably an allergy

For children over age 1 year, you can use an antihistamine to help determine whether they have colds or allergies. “Try a non-sedating antihistamine. If your child gets no relief within the next day or two, it’s probably a cold virus,” explains Dr. Lee. “However, if symptoms clear up quickly with the antihistamine, your child probably suffers from seasonal allergy symptoms.”

How to treat allergies and colds in children

Once you’ve determined if your child has a cold or allergy, you can take steps to provide relief.

Treating seasonal allergies in children

  • Minimize symptoms at home by washing clothes after being outside, vacuuming often and using air filters and purifiers.
  • Try a non sedating oral antihistamine, such as Zyrtec or Claritin. Your child should get relief within a day or two.
  • If the antihistamine helps, but not much, add a nasal steroid such as over-the-counter Flonase which you spray into the nose. Sometimes you need both antihistamine and nasal spray to control allergies.
  • You can also try nasal spray only. If your child gets relief, skip the oral antihistamine.

Treating common colds in children

  • Use saline solution in the nose to loosen congestion and help children blow their noses. Or, suck out the congestion with a bulb syringe.
  • Try certain home remedies to help relieve your child’s symptoms. For children over age 1 year, a spoonful of honey by mouth may help soothe a sore throat. (Do NOT give honey to babies under the age of 1 year.)
  • Use acetaminophen or ibuprofen, as prescribed by your doctor, to treat aches, pain and fever.
  • For children over age 2 years, you can use mentholated ointments, such as Vicks VapoRub, on top of the chest to soothe and calm coughs, especially nighttime coughs.
  • For children over age 6 years, you can use a topical decongestant, such as Afrin nasal spray, to help relieve nasal congestion. If used, use at night for no more than 3 days in a row.
  • Learn when to consult your physician if your young baby has common cold symptoms.

Keep in mind that oral cough and cold medications are not recommended for children under the age of 6 years. “Typically, I try to avoid oral cough and cold medications for children of any age,” says Dr. Lee. “They are not effective and can have potential side effects, such as elevated blood pressure.”

If your child’s cold and allergy symptoms last more than two weeks, consult your doctor.

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Help for a Child with a Cold

It starts with a sneeze and a runny nose. From your child’s symptoms, you suspect you’re dealing with a cold. You want to help your child feel better, but over-the-counter (OTC) cold and cough medicines may not be the answer. The American Academy of Pediatrics strongly recommends against using them for children younger than 4 years. From age 4 to 6, these medicines should only be used if advised by your child’s doctor. Several studies show that cold and cough products don’t work in young children and can have potentially serious side effects.

In addition, a lot of products contain a mix of ingredients meant to treat more than one symptom, including symptoms your child may not have. This also increases the risk that your child may overdose on one ingredient if you are giving your child more than one medication.

Ask your doctor what he or she recommends for different symptoms, and do it before your child gets a cold.

Here are some common cold symptoms and what ingredients to look for on labels if your pediatrician recommends medication.

Fever and pain

Typical colds do not cause more than a slight fever in kids. It’s OK to let a slight fever run its course if your child is taking liquids and acting well. In fact, fever may help your child’s natural immune system fight off the infection sooner. Only 2 fever or pain medications are available for children: acetaminophen and ibuprofen; others are available by prescription. Both help aches and ease fevers. Some multi-ingredient cold medicines contain one or the other of these ingredients, so read labels carefully to avoid giving extra medication that may not be needed.

Don’t ever give aspirin to infants, children or teens because of the risk for Reye’s syndrome, a rare but potentially fatal disease that can cause liver and brain damage.

Call your doctor right away if your child is less than 3 months of age and has a fever over 100.4°F (38°C).

Stuffy nose and sneezing

If your child has a runny nose, it is enough to either use a bulb syringe to gently suction out the mucus or to have your child blow his or her nose. Antihistamines are only effective if the runny nose is caused by allergies. Antihistamines are not an effective treatment for the common cold.

For a blocked nose, saline spray or drops may be useful. They dilute the mucous, which then makes it easier for the child to blow it out or for you to suction it out. There are no medicines that can remove mucus from the nose. Saline drops and spray are available at the pharmacy, or you may make your own by mixing ½ teaspoon of salt in 8 ounces of warm tap water. For small babies, use the drops before feeding. Older babies and children may have the drops or spray whenever their nose is blocked.

Coughing

For babies under 1, it is enough to keep them well hydrated and comfortable. Ask your child’s doctor if extra water or warm fluids are safe to use. For children over 1 year, honey has been shown to be more helpful than any over-the-counter cough medicine and is much safer. Give your child ½ to 1 teaspoon as needed. Do NOT give honey to babies under 1 year of age because they are at risk of catching a disease known as infantile botulism.

To make your child less susceptible to colds, make sure he stays active, eats nutritious foods, and has ways to deal with stress Those steps can help boost the immune system.

Your child can help prevent colds with good hand-washing techniques, by not touching his nose or eyes and by avoiding people with colds or upper respiratory infections. Alcohol-based hand gels can help prevent spreading a cold or other viral infection.

Feeling better without medicine

There isn’t enough scientific proof to back claims of cold-symptom relief for some alternative treatments, such as vitamin C, echinacea, and zinc. But the following nonmedicinal suggestions may make your child more comfy:

  • Liquids. Give your child plenty of water or other liquids to drink.

  • Cough drops. Lemon and peppermint drops can help a scratchy throat. Cough drops should only be given to older children who can handle hard candies without choking risk.

  • Bed rest. If your child seems tired, let him relax.

  • Steam. Steam treatment can be helpful. Parents can use cool mist humidifiers at night; warm humidifiers are not recommended because they can burn a child. Any humidifier can harbor mold, so be sure to clean the equipment thoroughly between uses. Running a warm shower in the same room as your child may also ease symptoms if a humidifier isn’t available.

Is your child suddenly sneezy? Cleveland Clinic Children’s pediatric allergist Brian Schroer, MD, provides a tutorial on spring allergies in kids.

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Lesson #1: Know your opponent

Is that “achoo” seasonal allergies or a cold? Sneezing, nose and throat itchiness, and eye itchiness plus redness usually signal allergies. Like a cold, allergies produce nasal drainage, but it looks clear and watery. With a cold, mucus drainage is thicker and yellow or green.

Lesson #2: Age matters

Kids as young as 3 to 5 years old can have seasonal allergies. Indoor allergens, such as dust mites and pet dander, can affect kids as young as 1 or 2 years old. Adults can outgrow childhood allergies in their 40s or 50s, or they may persist throughout their lifetime.

Lesson #3: Parents pass it on

Kids often inherit allergies from Mom or Dad. The catch: They aren’t always allergic to the same things. You inherit the ability to become allergic, not the specific allergen sensitivity.

Lesson #4: OTC medication overview

Over-the-counter medications manage symptoms well for most children. Long-acting, non-sedating antihistamines like loratadine, fexofenadine and celtirizine (sold under brand names Claritin®, Allegra® and Zyrtec®) come in children’s formulations. They work well for sneezing and itching but do not adequately address stuffiness and drainage. A nasal spray newly available over the counter this season, Nasacort®, handles all four symptoms well. Dr. Schroer typically advises against decongestants. Antihistamine eye drops help with itchiness, but avoid those with redness reducers.

Lesson #5: Hone your delivery technique

Continue giving medication throughout the pollen season, even if your child feels better. Give medication, especially nasal spray, at bedtime, not morning. Dr. Schroer offers a few nose spray tips: Tilt the head forward. Insert the applicator in right nostril, not too far. Aim out toward the right eye and spray. Advise kids to sniff, not snort. Repeat on the left side. Proper spraying can make the medicine work better and decrease nose bleeds, a possible side effect.

Lesson #6: Pollen avoidance

Avoidance is the best treatment for allergies – tricky when the trigger wafts in the air. But, you can minimize exposure. Grass and weed pollen tend to peak in the morning, so plan outdoor play toward evening when possible. Wearing tight-fitting sunglasses can protect the eyes from pollen. Create a pollen-free zone in your child’s bedroom. Keep the windows shut, shower and wash hair before going to bed after outdoor play. Consider a HEPA filter on central air conditioner units or a personal air filter to cut indoor pollen.

Lesson #7: When to consider allergy shots

If avoidance and medications don’t adequately manage symptoms, ask your pediatrician or allergist about allergy immunotherapy. A series of weekly injections over the course of months, followed by maintenance injections for several years, reduces symptom severity. Kids 7 to 9 years old typically understand the process and recognize the benefit.

Lesson #8: Dangers of untreated allergies

Many kids with seasonal allergies also have asthma. Uncontrolled allergies can cause asthma flare-ups, with coughing, wheezing and difficulty breathing. Also, kids distracted by constant nose blowing can have trouble focusing in school.

Nose Allergy (Hay Fever)

Care Advice for Nose Allergies or Hay Fever

  1. What You Should Know About Nose Allergies or Hay Fever:
    • Hay fever is very common. It happens in about 15% of children.
    • Nose and eye symptoms can be controlled by giving allergy medicines.
    • Pollens are in the air every day during pollen season. So, allergy meds must be given daily. They need to be used for 2 months or longer during pollen season.
    • Here is some care advice that should help.
  2. Allergy Medicines:
    • Allergy medicines are called antihistamines. They are the drug of choice for nasal allergies.
    • They will help control the symptoms. These include a runny nose, nasal itching and sneezing.
    • You can give a short-acting allergy medicine (such as Benadryl). No prescription is needed. It needs to be given every 6 to 8 hours.
    • The bedtime dosage is especially important for healing the lining of the nose.
    • The key to control is to give allergy meds every day during pollen season.
  3. Long-Acting Allergy Medicines:
    • You can also use a long-acting allergy medicine (such as Zyrtec). No prescription is needed.
    • Advantage: Causes less sedation than older allergy meds such as Benadryl. It is long-acting and last up to 24 hours.
    • Dose:
    • Age 2-5 years old, discuss with your child’s doctor. If approved, give 2.5 mg (2.5 mL or ½ teaspoon) of liquid syrup. Use once daily in the morning.
    • Age 6-11 years old, give 5 mg chewable tablet once daily in morning.
    • Age 12 years and older, give 10 mg tablet once daily in morning.
    • Downside: Doesn’t control hay fever symptoms as well as older allergy medicines. Also, sometimes will have breakthrough symptoms before 24 hours. If that happens, you can give a single dose of Benadryl.
    • Cost: ask the pharmacist for a store brand. Reason: Costs less than the brand name products.
  4. Nasal Saline to Wash Out Pollen:
    • Use saline (salt water) nose drops or spray (such as store brand). This helps to wash out pollen or to loosen up dried mucus. If you don’t have saline, you can use a few drops of water. Use bottled water, distilled water or boiled tap water. Teens can just splash a little water in the nose and then blow.
    • Step 1: Put 3 drops in each nostril.
    • Step 2: Blow each nostril out while closing off the other nostril. Then, do the other side.
    • Step 3: Repeat nose drops and blowing until the discharge is clear.
    • How often: Do nasal saline rinses when your child can’t breathe through the nose. Also, do them if the nose is very itchy.
    • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
    • Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
    • Other option: Use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
  5. Eye Allergy Treatment:
    • For eye symptoms, wash off the face and eyelids. This will remove pollen or any other allergic substances.
    • Then put a cold wet washcloth on the eyes.
    • Most often, an allergy medicine given by mouth will help the eye symptoms. Sometimes, eye drops are also needed. (See below # 6 and #7)
  6. Antihistamine Eye Drops – Ketotifen (1st Choice) for Eye Allergy Symptoms:
    • Ketotifen eye drops (such as Zaditor) are a safe and effective product. No prescription is needed.
    • Dose: 1 drop every 12 hours.
    • For severe allergies, use ketotifen eyedrops every day during pollen season. This will give the best control.
  7. Antihistamine/Vasoconstrictive Eye Drops (2nd Choice) for Eye Allergy Symptoms:
    • Ask your pharmacist to suggest a brand (such as Visine-A). The A stands for antihistamine. No prescription is needed.
    • Dose: 1 drop every 8 hours
    • Do not use for over 5 days. Reason: Will cause red eyes from rebound effect.
    • Downside: Doesn’t work as well as Ketotifen eye drops.
  8. Wash Pollen Off Body:
    • Remove pollen from the hair and skin with shampoo and a shower. This is especially important before bedtime.
  9. What to Expect:
    • Since pollen allergies recur each year, learn to control the symptoms.
  10. Pollen – How to Reduce the Pollen Your Child Breathes:
    • Pollen is carried in the air.
    • Keep windows closed in the home, at least in your child’s bedroom.
    • Keep windows closed in car. Turn the air conditioner on recirculate.
    • Avoid window fans or attic fans. They pull in pollen.
    • Try to stay indoors on windy days. Reason: The pollen count is much higher when it’s dry and windy.
    • Avoid playing with the outdoor dog. Reason: Pollen collects in the fur.
    • Pollen Count: You can get your daily pollen count from Pollen.com. Just type in your zip code.
  11. Call Your Doctor If:
    • Symptoms are not better in 2 days after starting allergy medicine
    • You think your child needs to be seen
    • Your child becomes worse

Hay Fever

Is this your child’s symptom?

  • An allergic reaction of the nose, usually from pollen
  • An itchy nose, clear discharge and sneezing is common

Triggers of Nasal Allergies

  • Cause. An allergic reaction of the nose and sinuses to an inhaled substance. The medical name for this is allergic rhinitis. The allergic substance is called an allergen.
  • Most allergens float in the air. That’s how they get in the nose. Here are the common ones:
  • Pollens. Trees, grass, weeds and molds are the most common pollens. Tree pollens come in the spring. Grass pollens come in the summer. Weed pollens come in the fall. Pollens cause seasonal allergies. You can’t avoid pollens because they are in the air. Most nasal allergies continue through the pollen season. They can last 4 to 8 weeks. Pollens cause seasonal allergic rhinitis. This is also called hay fever.
  • Pets. Allergens can also be from cats, dogs, horses, rabbits and other animals. Most people don’t keep a pet that they are allergic to. They only have sporadic allergy symptoms when they are exposed to that specific animal. These symptoms will usually last a few hours. If someone with a cat visits you, they will bring cat dander with them. This will cause brief symptoms. If you own the pet, though, your child will have symptoms all the time.
  • House Dust. House dust contains many allergens. It always contains dust mites. If your humidity is high, it will contain mold. House dust causes year round, daily symptoms. The medical name for this is perennial allergic rhinitis.

Symptoms of Nasal Allergies

  • Clear nasal discharge with sneezing, sniffing, and itching of nose (100%)
  • Eye allergies (itchy, red, watery and puffy) also can occur (70%)
  • Ear and sinus congestion or fullness can occur
  • Throat can also feel scratchy or have a tickly feeling at times
  • Itchy ear canals, itchy skin or hoarse voice sometimes also occur
  • Symptoms happen during pollen season
  • Same symptoms during the same month of the last year
  • Past diagnosis by a doctor is helpful
  • No fever

How to Tell Seasonal Nasal Allergies from the Common Cold

  • Symptoms happen during pollen season
  • Had the same symptoms during the same month last year
  • Hay fever symptoms last 6-8 weeks for each pollen. (Colds last 1-3 weeks).
  • Allergies: itchy eyes and nose. Not seen with colds.
  • Colds: fever and/or sore throat. Not seen with allergies
  • Both: runny nose and watery eyes. Can also have a cough with both, but less common with allergies.

Nose and Eye Allergies: Age of Onset

  • Seasonal pollen allergies usually begin at age 2 to 5 years.
  • The symptoms peak in school age children, teens and young adults.
  • Pollen symptoms are rare in children under age 2. They require at least 2 seasons of exposure to the pollen.
  • Children under age 2 who have chronic nasal symptoms have other causes. Examples are recurrent colds, large adenoids or cow’s milk allergy.
  • Food allergies can start during the first year of life, but not pollen allergies.

When to Call for Hay Fever

Call Doctor Within 24 Hours

  • You think your child needs to be seen
  • Lots of coughing
  • Sinus pain (not just congestion) does not go away with allergy medicines. Note: sinus pain is around the cheekbone or eyes.

Call Doctor During Office Hours

  • Hay fever symptoms make it hard to go to school or do normal activities. Note: taking allergy medicine for 2 days has not helped.
  • Diagnosis of hay fever has never been made by a doctor
  • Year-round symptoms of nasal allergies
  • Snoring is a frequent problem
  • You have other questions or concerns

Self Care at Home

  • Nasal allergy symptoms or hay fever

Seattle Children’s Urgent Care Locations

If your child’s illness or injury is life-threatening, call 911.

Is it a cold or allergies?

Ask the doctors

Published: March, 2018

Q. I feel like I have a perpetual cold all winter, every winter. I’m stuffy and sneezy and it never seems to get better. Do you think it could be allergies? How can I tell the difference?

A. Colds and allergies produce many of the same symptoms: a runny nose, tiredness, and sometimes a sore throat. But they have different causes — a virus causes colds, while allergies are an immune system response to trigger substances, known as allergens. There are ways to distinguish one from the other. Colds sometimes produce a fever, but allergies never do. In addition, if you are suffering from allergies, you may also have itchy, watery eyes, symptoms that won’t typically accompany a cold. But perhaps the biggest clue that can help you distinguish between a cold and allergies is the duration of symptoms. Cold symptoms rarely last more than two weeks, but allergies can last as long as you are exposed to the substance that is triggering the reaction. So, if your “cold symptoms” appear at the same time every year and last for an extended period of time, the cause may very well be allergies. Many people with seasonal allergies will experience symptoms for six weeks at a time. If you are allergic to something in your home, such as dust mites, mold, or pet dander, your symptoms could get worse during the winter months, because the house is sealed up and fresh air isn’t getting in. In addition, your heating system may be recirculating the allergen. Because your symptoms last for an extended period of time, it may be worth a visit to the allergist.

— by Hope Ricciotti, M.D., and Hye-Chun Hur, M.D., M.P.H.
Editors in Chief, Harvard Women’s Health Watch

Disclaimer:
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Colds

  • Runny nose and sore throat caused by a virus
  • You think your child has a cold. Reason: Other family members, friends or classmates have same symptoms.
  • Also called an Upper Respiratory Infection (URI)

Symptoms of a Cold

  • Runny or stuffy nose
  • The nasal discharge starts clear but changes to grey. It can also be yellow or green.
  • Most children have a fever at the start.
  • A sore throat can be the first sign
  • At times, the child may also have a cough and hoarse voice. Sometimes, watery eyes and swollen lymph nodes in the neck also occur.

Cause of Colds

  • Colds are caused by many respiratory viruses. Healthy children get about 6 colds a year.
  • Influenza virus causes a bad cold with more fever and muscle aches.
  • Colds are not serious. With a cold, about 5 and 10% of children develop another health problem. Most often, this is an ear or sinus infection. These are caused by a bacteria.

Colds: Normal Viral Symptoms

  • Colds can cause a runny nose, sore throat, hoarse voice, a cough or croup. They can also cause stuffiness of the nose, sinus or ear. Red watery eyes can also occur. Colds are the most common reason for calls to the doctor. This is because of all the symptoms that occur with colds.
  • Cold symptoms are also the number one reason for office and ER visits. Hopefully, this information will save you time and money. It can help you to avoid some needless trips to the doctor. The cold symptoms listed below are normal. These children don’t need to be seen:
    • Fever up to 3 days (unless it goes above 104° F or 40° C)
    • Sore throat up to 5 days (with other cold symptoms)
    • Nasal discharge and congestion up to 2 weeks
    • Coughs up to 3 weeks

Colds: Symptoms of Secondary Bacterial Infections (other health problems)

Using this guide, you can decide if your child has developed another health problem. This happens in about 5 to 10% of children who have a cold. Many will have an ear infection or sinus infection. Look for these symptoms:

  • Earache or ear discharge
  • Sinus pain not relieved by nasal washes
  • Lots of pus in the eyes (Eyelids stuck together after naps)
  • Trouble breathing or rapid breathing (could have pneumonia)
  • Fever lasts over 3 days
  • Fever that goes away for 24 hours and then returns
  • Sore throat lasts over 5 days (may have Strep throat)
  • Nasal discharge lasts over 2 weeks
  • Cough lasts over 3 weeks

Trouble Breathing: How to Tell

Trouble breathing is a reason to see a doctor right away. Respiratory distress is the medical name for trouble breathing. Here are symptoms to worry about:

  • Struggling for each breath or shortness of breath
  • Tight breathing so that your child can barely speak or cry
  • Ribs are pulling in with each breath (called retractions)
  • Breathing has become noisy (such as wheezes)
  • Breathing is much faster than normal
  • Lips or face turn a blue color

When to Call for Colds

Call 911 Now

  • Severe trouble breathing (struggling for each breath, can barely speak or cry)
  • You think your child has a life-threatening emergency

Call Doctor or Seek Care Now

  • Not alert when awake (“out of it”)
  • Trouble breathing not gone after cleaning out the nose
  • Wheezing (high-pitched purring or whistling sound when breathing out)
  • Breathing is much faster than normal
  • Trouble swallowing and new onset drooling
  • Ribs are pulling in with each breath (retractions)
  • High-risk child (such as cystic fibrosis or other chronic lung disease)
  • Weak immune system. Examples are: sickle cell disease, HIV, cancer, organ transplant, taking oral steroids.
  • Fever over 104° F (40° C)
  • Age less than 12 weeks old with fever. Caution: do NOT give your baby any fever medicine before being seen.
  • Your child looks or acts very sick
  • You think your child needs to be seen, and the problem is urgent

  • Age less than 6 months old
  • Earache or ear drainage
  • Yellow or green eye discharge
  • Sinus pain around cheekbone or eyes (not just congestion)
  • Fever lasts more than 3 days
  • Fever returns after being gone more than 24 hours
  • You think your child needs to be seen, but the problem is not urgent
  • Blocked nose wakes up from sleep
  • Yellow scabs around the nasal openings. (Use an antibiotic ointment)
  • Sore throat lasts more than 5 days
  • Sinus congestion (fullness) lasts more than 14 days
  • Nasal discharge lasts more than 2 weeks
  • You have other questions or concerns
  • Mild cold with no other problems

If your child’s illness or injury is life-threatening, call 911.

Care Advice for Colds

  1. What You Should Know About Colds:
    • It’s normal for healthy children to get at least 6 colds a year. This is because there are so many viruses that cause colds. With each new cold, your child’s body builds up immunity to that virus.
    • Most parents know when their child has a cold. Sometimes, they have it too or other children in school have it. Most often, you don’t need to call or see your child’s doctor. You do need to call your child’s doctor if your child develops a complication. Examples are an earache or if the symptoms last too long.
    • The normal cold lasts about 2 weeks. There are no drugs to make it go away sooner.
    • But, there are good ways to help many of the symptoms. With most colds, the starting symptom is a runny nose. This is followed in 3 or 4 days by a stuffy nose. The treatment for each symptom is different.
    • Here is some care advice that should help.
  2. For a Runny Nose with Lots of Discharge: Blow or Suction the Nose
    • The nasal mucus and discharge is washing germs out of the nose and sinuses.
    • Blowing the nose is all that’s needed. Teach your child how to blow the nose at age 2 or 3.
    • For younger children, gently suction the nose with a suction bulb.
    • Put petroleum jelly on the skin under the nose. Wash the skin first with warm water. This will help to protect the nostrils from any redness.
  3. Nasal Saline to Open a Blocked Nose:
    • Use saline (salt water) nose spray to loosen up the dried mucus. If you don’t have saline, you can use a few drops of water. Use distilled water, bottled water or boiled tap water.
    • Step 1. Put 3 drops in each nostril. If under 1 year old, use 1 drop.
    • Step 2. Blow (or suction) each nostril out while closing off the other nostril. Then, do the other side.
    • Step 3. Repeat nose drops and blowing (or suctioning) until the discharge is clear.
    • How Often. Do nasal saline rinses when your child can’t breathe through the nose.
    • Limit. If under 1 year old, no more than 4 times per day or before every feeding.
    • Saline nose drops or spray can be bought in any drugstore. No prescription is needed.
    • Saline nose drops can also be made at home. Use ½ teaspoon (2 mL) of table salt. Stir the salt into 1 cup (8 ounces or 240 mL) of warm water. Use bottled water or boiled water to make saline nose drops.
    • Reason for nose drops: Suction or blowing alone can’t remove dried or sticky mucus. Also, babies can’t nurse or drink from a bottle unless the nose is open.
    • Other option: use a warm shower to loosen mucus. Breathe in the moist air, then blow each nostril.
    • For young children, can also use a wet cotton swab to remove sticky mucus.
  4. Fluids – Offer More:
    • Try to get your child to drink lots of fluids.
    • Goal: Keep your child well hydrated.
    • It also will thin out the mucus discharge from the nose.
    • It also loosens up any phlegm in the lungs. Then it’s easier to cough up.
  5. Humidifier:
    • If the air in your home is dry, use a humidifier.
    • Reason: Dry air makes nasal mucus thicker.
  6. Medicines for Colds:
    • Cold Medicines. Don’t give any drugstore cold or cough medicines to young children. They are not approved by the FDA under 6 years. Reasons: not safe and can cause serious side effects. Also, they are not helpful. They can’t remove dried mucus from the nose. Nasal saline works best.
    • Allergy Medicines. They are not helpful, unless your child also has nasal allergies. They can also help an allergic cough.
    • No Antibiotics. Antibiotics are not helpful for colds. Antibiotics may be used if your child gets an ear or sinus infection.
  7. Other Symptoms of Colds – Treatment:
    • Pain or Fever. Use acetaminophen (such as Tylenol) to treat muscle aches, sore throat or headaches. Another choice is an ibuprofen product (such as Advil). You can also use these medicines for fever above 102° F (39° C).
    • Sore Throat. If over 6 years of age, your child can also suck on hard candy. For children over 1 year old, sip warm chicken broth. Some children prefer cold foods, such as popsicles or ice cream.
    • Cough. For children over 1 year old, give honey ½ to 1 teaspoon (2 to 5 mL). Caution: Do not use honey until 1 year old. If over 6 years of age, you can also use cough drops. Avoid cough drops before 6 years. Reason: risk of choking.
    • Red Eyes. Rinse eyelids often with wet cotton balls.
  8. Return to School:
    • Your child can go back to school after the fever is gone. Your child should also feel well enough to join in normal activities.
    • For practical purposes, the spread of colds can’t be prevented.
  9. What to Expect:
    • Fever can last 2-3 days
    • Nasal drainage can last 7-14 days
    • Cough can last 2-3 weeks
  10. Call Your Doctor If:
    • Trouble breathing occurs
    • Earache occurs
    • Fever lasts more than 3 days or goes above 104° F (40° C)
    • Any fever if under 12 weeks old
    • Nasal discharge lasts more than 14 days
    • Cough lasts more than 3 weeks
    • You think your child needs to be seen
    • Your child becomes worse
  11. Extra Advice – Air Travel with Colds:
    • It’s safe to fly when your child has a cold.
    • He could get some mild ear congestion or even a brief earache while flying. Most often, that can be prevented. (See # 12).
    • Flying will not cause an ear infection.
  12. Extra Advice – Prevent Ear Congestion During Air Travel:
    • Most symptoms happen when the airplane is coming down in altitude. This is the descent of the plane during the 15 minutes before landing.
    • Keep your child awake during takeoff and descent.
    • Swallow during descent using fluids or a pacifier.
    • Children over age 4 can chew gum during descent.
    • Yawning during descent also can open the middle ear.
    • Drink lots of fluids throughout the flight. This will prevent the nasal secretions from drying out.

And remember, contact your doctor if your child develops any of the ‘Call Your Doctor’ symptoms.

Disclaimer: this health information is for educational purposes only. You, the reader, assume full responsibility for how you choose to use it.

Last Reviewed: 02/01/2020

Last Revised: 11/13/2019

Copyright 2000-2019 Schmitt Pediatric Guidelines LLC.

By Fionna Lam and Tran Nguyen, clinical pharmacists at CHOC Children’s and Dr. Jonathan Auth, CHOC Children’s pediatrician

With the winter season nearing the end and spring season already here, many of us are experiencing nasal symptoms related to the common cold, a sinus infection, or seasonal allergies. Since all these conditions share overlapping signs such as sneezing, nasal discharge and congestion, distinguishing between them may be the first step to selecting the proper over-the-counter remedy for symptomatic relief.

The common cold usually peaks during cold weather and is caused by a viral infection. While children may feel crummy for a few days, most cold symptoms can be managed with over-the-counter medications. Sinus infections, on the other hand, can bring about headaches and facial pain. It can happen after a prolonged common cold when the body is more vulnerable to bacterial or viral infections. Some children may be more susceptible to sinus infections than others due to structural abnormalities in the nose.

Sneezing, nasal congestion, and/or watery eyes are the hallmark symptoms of seasonal allergies. These are due to the body’s immunologic reaction to irritants in the air. This condition usually peaks during spring time when the highest amount of pollens from trees, grasses or weeds are present in the environment. Other common allergens include dust and mold.

The following table compares some common signs and symptoms of common cold, sinus infections and seasonal allergies:

+ present

+/- may or may not be present

*Fever and/or chills are more common in children than adults

**Cough may present if post nasal drip present

It’s important to be aware of how long each symptom has been present. Cold symptoms usually start to show improvement in most children in 7-10 days. Sinus infections usually have longer lasting symptoms without treatment, around 10-14 days. Allergies are usually present for weeks or more.

When an infection or allergy occurs, the blood vessels in your child’s sinuses dilate and the tissues tend to swell up, which can lead to pain around the eyes, cheeks and forehead. Mucus production increases during an infection and can cause further discomfort. Small microscopic hairs in our nose called cilia help sweep bacteria and particles from our nose, but when dry air enters our nose, it can damage the cilia by drying them out.

Before resorting to medications, non-pharmacological strategies can be tried first such as introducing moist air with a humidifier, taking warm showers or drinking hot fluids like tea and soup. Keeping the air moist will help prevent drying out the nose passage and prevent mucus buildup. Applying a warm compress to the face may also help alleviate congestion pain.

A variety of over-the-counter medications can provide targeted symptomatic relief. See the chart below for active ingredients and their role in cold and sinus infections. Learn what to look for when choosing the right over-the-counter medication for your child. While combination products offer the convenience of addressing many symptoms at once, they often contain more than one ingredient. When multiple over-the-counter remedies are taken together, the risk of toxicity increases due to duplication of active ingredients or doubling up on drugs in the same drug class. For example, acetaminophen (Tylenol) is commonly found in many over-the-counter cold and cough medications. Inadvertent overdoses have occurred when parents gave these medications along with Tylenol. To minimize this risk, single ingredient products are recommended whenever possible. Download this guide to acetaminophen for children.

Remember that over-the counter medications are not completely safe and do come with risk of side effects and toxicity if not taken correctly. Talk to your child’s pediatrician or pharmacist before starting a medication regimen.

Active ingredient Purpose Symptoms Treated
Mucous Cough Pain Fever Runny Nose Stuffy Nose
Acetaminophen Pain reliever + +
Ibuprofen, Naproxen Pain reliever + +
Phenylephrine*, Pseudoephrine* To relieve nasal congestion + +
Dextromethorphan** Cough suppressant +
Guaifenesin To loosen up phlegm + +
Saline spray To relieve nasal congestion + +
Mentholated topical ointment To relieve nasal congestion + +
Fluticasone, Triamcinolone (Nasal Spray) To relieve nasal congestion + +
Oxymetazoline*, Phenylephrine*(Nasal Spray) To relieve nasal congestion + +

+ present

*Do not use decongestant for more than 3 days as it might make you more congested.

**Discretion should be used when using dextromethorphan as a cough suppressant as high doses can cause hallucinogenic effects and be abused.

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