Laura J. Martin, MD
For a week, you've wiped your preschooler's runny nose all day long, then listened to her cough in her sleep all night. She's been looking and feeling miserable, and you want to help her get better, but you aren't sure exactly how to categorize her symptoms. Is it a cold, or does she have allergies?
You aren't alone; many parents are confused about the proper way to treat a coughing, sneezing child, because colds and allergies often have overlapping symptoms.
“I think most parents want a checklist, but it's not that easy,” says pediatric allergist Derek K. Johnson, MD, director of the Fairfax Allergy and Sinus Clinic in Fairfax, Va. “However, there are certain things that doctors can teach parents about the differences.”
When in doubt, check with your pediatrician, who will know for sure what's causing your child's symptoms, especially when they persist or worsen over time. If you want to try to solve the mystery on your own, though, time is a good indicator.
“A rule of thumb is that colds last 7 to 10 days and then resolve,” Johnson says. “If you're exposed to allergens, allergic reactions usually persist longer than that.”
Here, experts categorize common symptoms that can indicate colds, environmental allergies, or other problems that are often mistaken for the two.
Common colds are viral infections that affect children much the same way they do adults. Kids may feel achy and have a low-grade fever (100°F or less), then develop a sore throat, runny or stuffy nose, and a cough.
You usually can't diagnose your child's condition by analyzing her cough, says Asriani M. Chiu, MD, associate professor of pediatrics and medicine for allergy and immunology at the Medical College of Wisconsin in Milwaukee. “A cough can be productive [indicating phlegm that needs to be coughed up] with both colds and allergies, since it's typically from nasal and sinus drainage that comes down the back of the throat.”
Nasal secretions, however, can often clue you in to your child's diagnosis.
“A cold has thick, yellowy or green nasal discharge,” says Mike Tringale, spokesman for the Asthma and Allergy Foundation of America. “Watery, clear discharge is most often an allergy. When Mom's wiping noses, she can tell immediately what kind of discharge it is, which indicates whether it's some kind of infection or not.”
Because colds are caused by viruses, they can't be cured with medication. Over-the-counter cold remedies may help ease your child's symptoms and discomfort, but if you're uncomfortable giving drugs to your young child, there are medication-free ways to soothe her.
“Ensure hydration by having your child drink lots of fluids,” Chiu says. “And parents can use saline nasal sprays and suction.”
A recent study of 401 children, published in the Archives of Otolaryngology - Head and Neck Surgery, found that using a saline nasal rinse several times per day helped improve nasal symptoms in the common cold in children and possibly reduced the risk of a relapse.
If your child seems to get a cold every April, when everything in your neighborhood starts blooming, it's likely that he has seasonal allergies.
“A mother can do a pretty good job on her own of making a quick distinction,” Tringale says. “If it happens every spring with clear nasal discharge and no fever, it's most likely allergies.”
There's one time of year when an annual cold may actually be a cold, though, says Chiu: Back-to-school time in September.
“At the start of school season, everyone always seems to get an upper respiratory infection, with all the exposures from classmates,” she says, “so it may be hard to distinguish between viral cold and fall allergy.”
The younger your child, the less likely she is to have a seasonal environmental allergy.
“No one is born with an allergy,” says Johnson, who notes that most children under age 3 don't have allergies yet. “It takes 2 to 3 seasons, even in a highly allergic person, to develop the immunologic response [to pollen, which causes allergic reactions].”
Allergies tend to run in families, so a child with a family history of allergies whose parents notice that she gets sneezy every May can ask the pediatrician to recommend an allergist, Chiu says. “The best, most cost-effective way [to be diagnosed] is to see an allergist for allergy skin testing, [when an allergen is placed onto the child's skin to check for a reaction],” she says.
If your child has allergies, ask the pediatrician whether over-the-counter antihistamines or eyedrops are appropriate for your child, or if she'll need prescription nasal spray. Older children may be cured of their allergies by getting regular allergy shots over the course of several years. Although the occasional 3-year-old with severe allergies does get allergy shots, Johnson says, it's easier for a 7-year-old to rationalize the benefits of getting a painful jab each week.
If your child begins a course of allergy shots but decides to quit before it's finished, the partial treatment may have a protective effect. A recent study published in the Journal of Allergy and Clinical Immunology\ found that children who only received a fraction of an allergy shot regimen needed less allergy medication and visited the doctor less often than they had before.
Sometimes, when a child's so-called cold or allergies endure for weeks or months, the parents bring her to the pediatrician's office and learn that a third, unconsidered condition is to blame.
“If symptoms 'always' persist, especially in preschoolers, that usually means something else is going on, like asthma, sinus infections or reflux,” Johnson says. “These are three things that can cause an ongoing cough that people don't think of. And some kids have non-allergic rhinitis, which is excess mucus production.”
Asthma that isn't diagnosed can be a serious problem for children, so parents should talk to their pediatricians about constant nighttime coughing in children.
“More than half of asthma attacks occur at night when children are sleeping,” Tringale says. “The worst asthma triggers are in the bedroom, and the nature of lying down makes it harder to get air. When parents hear children coughing at night, when there are no nasal symptoms and no fever, it can be an early sign of asthma. These are things that pediatricians and allergists are really skilled at diagnosing."
SOURCES: Derek K. Johnson, MD, pediatric allergist and director, Fairfax Allergy and Sinus Clinic, Fairfax. Va.Asriani M. Chiu, MD, associate professor of pediatrics and medicine for allergy and immunology, and program director of the allergy and immunology fellowship, Medical College of Wisconsin, Milwaukee.Mike Tringale, spokesman, Asthma and Allergy Foundation of America.Hankin C. Journal of Allergy and Clinical Immunology, January 2008; vol 121: pp 227-232.Slapak I. Archives of Otolaryngology - Head and Neck Surgery, January 2008; vol 134: pp 67-74.
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