Cold in Children: Symptoms, Duration & When to See a Doctor

What Is a Cold and Why Do Children Get So Many?

A cold (common cold, upper respiratory tract infection) is a viral infection of the nose and throat caused by one of more than 200 different viruses. Children get colds frequently because their immune systems are still developing and they are exposed to many new viruses in daycare and school settings.

The common cold is the most frequent infectious disease in children and one of the most common reasons parents miss work to care for their sick child. While it may seem concerning that your child catches one cold after another, this is actually a normal part of childhood development. Each cold helps build the immune system's memory, which is why adults typically get fewer colds than children.

The viruses that cause colds spread easily from person to person through respiratory droplets when an infected person coughs, sneezes, or talks. They can also spread when a child touches a contaminated surface and then touches their eyes, nose, or mouth. This is why hand hygiene is so important in preventing cold transmission.

Understanding why children get so many colds can help parents feel less worried. Young children, especially those in daycare or with older siblings, are exposed to numerous viruses they have never encountered before. Their immune systems must learn to recognize and fight each new virus, which takes time. As children grow older and their immune systems mature, they typically get fewer colds each year.

What Viruses Cause Colds?

More than 200 different viruses can cause the common cold, which is why there is no vaccine and why children can get multiple colds each year without becoming immune. The most common culprits include:

• Rhinoviruses: Responsible for up to 50% of colds, with over 100 different types
• Coronaviruses: Cause about 15% of colds (different from SARS-CoV-2)
• Respiratory syncytial virus (RSV): Common in young children, can cause more severe illness in infants
• Parainfluenza viruses: Can also cause croup in young children
• Adenoviruses: Can cause cold symptoms along with other manifestations

Because so many different viruses cause colds, developing immunity to all of them takes many years. This explains why children continue to get colds throughout childhood, though the frequency decreases with age as their immune repertoire expands.

Why Do Colds Increase in Winter?

Many parents notice their children get more colds during fall and winter months. Several factors contribute to this seasonal pattern. Cold weather drives people indoors where they have closer contact with others, facilitating virus transmission. Dry indoor air from heating can dry out the nasal passages, making them more susceptible to infection. Additionally, some cold viruses replicate more efficiently in cooler temperatures.

However, it's important to understand that cold weather itself does not cause colds - only viruses do. Children who play outside in winter without adequate clothing may become chilled, but this alone will not give them a cold unless they are exposed to a cold virus.

What Are the Symptoms of a Cold in Children?

Cold symptoms in children typically include runny or stuffy nose, sneezing, sore throat, mild cough, low-grade fever, decreased appetite, and general fussiness. Symptoms usually peak around days 2-3 and gradually improve over 7-10 days, though cough may persist for 2-3 weeks.

Recognizing cold symptoms helps parents understand what their child is experiencing and when to seek medical attention. Cold symptoms usually appear 1-3 days after exposure to the virus, a period known as the incubation period. The first sign is often a scratchy or sore throat, followed by nasal symptoms.

The progression of a typical cold follows a predictable pattern. In the first day or two, your child may seem slightly off, with a scratchy throat and some sneezing. By days 2-4, nasal symptoms peak with abundant clear discharge that may turn thicker and yellow-green over the following days. This color change is normal and does not necessarily indicate a bacterial infection. A mild cough often develops as mucus drips down the throat, particularly at night.

Most children also develop a low-grade fever during the first few days of a cold, typically under 38.5°C (101.3°F). Higher fevers can occur, especially in young children, but a high fever alone does not distinguish a cold from other respiratory infections. By the end of the first week, symptoms begin to improve, though a residual cough may persist for two to three weeks.

Common Symptoms by Age Group

Cold symptoms can vary somewhat depending on the child's age, and knowing what to expect for your child's age group can be helpful.

When Nasal Discharge Changes Color

Many parents worry when their child's nasal discharge changes from clear to yellow or green, assuming this indicates a bacterial infection requiring antibiotics. However, this color change is a normal part of the immune response. As white blood cells fight the virus, they collect in the mucus, giving it a yellow or green tint. This color change typically occurs around days 3-5 of a cold and does not necessarily mean your child needs antibiotics.

The color of nasal discharge alone cannot determine whether an infection is viral or bacterial. What matters more is the overall trajectory of symptoms - are they improving or worsening? A cold with green mucus that is gradually getting better is still just a cold, while worsening symptoms after initial improvement may warrant medical evaluation regardless of mucus color.

How Long Does a Cold Last in Children?

A cold in children typically lasts 7-10 days, with symptoms peaking around days 2-3 and gradually improving thereafter. While most symptoms resolve within two weeks, a residual cough may persist for up to 3 weeks. If symptoms worsen after day 5 or last longer than 2 weeks, consult a healthcare provider.

Understanding the natural course of a cold helps parents know what to expect and when to be concerned. Most colds follow a predictable pattern, though individual children may experience slight variations. Knowing the typical timeline can prevent unnecessary worry while also helping identify when a cold might be developing into something more serious.

During the first three days, symptoms typically escalate rapidly. Your child may wake up with a scratchy throat and by evening have a full-blown runny nose, sneezing, and mild fever. The second and third days are usually the worst, with peak nasal congestion, the most abundant discharge, and the highest likelihood of fever. Children often feel their worst during this period and may be quite irritable and reluctant to eat.

From days 4-7, gradual improvement begins. The fever typically resolves by day 3-4. Nasal discharge may become thicker and change color before beginning to decrease in quantity. Your child's energy and appetite should slowly return. By the end of the first week, most children are feeling significantly better, though some symptoms persist.

During week two, residual symptoms gradually resolve. A lingering cough is very common and can persist for 2-3 weeks after other symptoms have resolved. This cough results from residual inflammation and post-nasal drip, not ongoing infection. As long as your child is otherwise well with no fever and the cough is improving (even if slowly), this prolonged cough is not concerning.

When Should I Take My Child to the Doctor for a Cold?

Seek medical care if your child has: difficulty breathing or rapid breathing, high fever over 39°C (102.2°F), fever lasting more than 3 days, symptoms worsening after day 5, severe ear pain, persistent crying or extreme irritability, refusal to drink fluids, or if your baby is under 3 months old with any fever.

Most colds in children can be managed at home with supportive care, but certain warning signs require medical evaluation. Knowing when to seek care helps ensure your child receives appropriate attention while avoiding unnecessary doctor visits for uncomplicated colds.

The most important warning signs relate to breathing difficulties. If your child is breathing rapidly, working hard to breathe (you can see the muscles between the ribs pulling in), or making wheezing or grunting sounds, seek medical care promptly. In infants, watch for flaring nostrils, which can indicate respiratory distress. These symptoms may suggest the cold has progressed to involve the lower respiratory tract or that another condition is developing.

Fever patterns also provide important information. While fever is common during the first few days of a cold, certain fever patterns warrant evaluation. Any fever in an infant under 3 months requires prompt medical assessment, as young infants have less mature immune systems and fewer reserves to fight infections. In older children, fever over 39°C (102.2°F) or fever lasting more than 3-4 days should be evaluated.

The trajectory of symptoms matters as much as the symptoms themselves. The classic "double worsening" pattern - where symptoms improve for a day or two and then worsen again - may indicate a secondary bacterial infection such as ear infection, sinusitis, or pneumonia. Similarly, if your child is not improving at all after 5-7 days, or if symptoms are actually getting worse rather than better, medical evaluation is appropriate.

Signs That May Indicate Complications

While most colds resolve without complications, some children develop secondary bacterial infections that require treatment. Watch for these signs that may indicate a complication:

• Ear infection (otitis media): Ear pain, pulling at ears, fever returning after initial improvement, unusually fussy
• Sinus infection (sinusitis): Nasal symptoms lasting more than 10 days without improvement, severe facial pain, fever returning after initial improvement
• Pneumonia: Persistent or worsening cough, rapid or labored breathing, fever recurring after improvement, chest pain
• Croup: Barking cough (sounds like a seal), hoarse voice, stridor (high-pitched sound when breathing in)

How Can I Treat My Child's Cold at Home?

Treat a cold at home by ensuring adequate rest and fluids, using saline nasal drops to relieve congestion, giving paracetamol or ibuprofen for fever and discomfort, running a cool-mist humidifier, and offering honey (for children over 1 year) to soothe cough. Over-the-counter cold medicines are not recommended for children under 6.

Since colds are caused by viruses, antibiotics are not effective and are not appropriate treatment. Instead, home care focuses on keeping your child comfortable while their immune system fights off the infection. Most children recover well with simple supportive measures.

Rest is essential during a cold. While your child doesn't need to stay in bed, limiting strenuous activities helps the body direct energy toward fighting the infection. Most children naturally become less active when they're not feeling well. Let your child guide activity level - if they want to play quietly, that's fine, but encourage rest periods and early bedtimes.

Adequate fluid intake is crucial during a cold. Fluids help keep mucus thin and easier to clear, prevent dehydration (especially if your child has a fever), and soothe a sore throat. Offer water, diluted juice, clear soups, or warm herbal tea frequently throughout the day. For infants, continue breastfeeding or formula feeding as usual - breast milk provides antibodies that can help fight infection.

Nasal congestion is often the most troublesome symptom. Saline nasal drops or spray can help loosen thick mucus and relieve stuffiness safely in children of all ages. For infants, follow saline drops with gentle suctioning using a bulb syringe. For older children who can blow their nose, teach them to blow gently with one nostril at a time to avoid pushing mucus into the ear canals.

Fever and Pain Management

Fever is the body's natural response to infection and helps fight viruses, so treating fever is not always necessary. However, if your child is uncomfortable or the fever is preventing sleep or adequate fluid intake, fever-reducing medication can help.

Paracetamol (acetaminophen) can be given to children of all ages, including infants. Follow dosing instructions based on your child's weight, not just age. Ibuprofen can be used in children over 6 months of age and may last longer than paracetamol. Never give aspirin to children due to the risk of Reye's syndrome.

Always use the measuring device provided with the medication and give the correct dose based on your child's current weight. When in doubt, consult your pharmacist or healthcare provider for dosing guidance.

Cough Relief

Cough during a cold serves a purpose - it helps clear mucus from the airways. However, a persistent cough can be exhausting and interfere with sleep. Safe approaches to ease cough include:

• Honey: For children over 1 year old, a spoonful of honey before bed can soothe cough. Studies show honey is as effective as some cough medicines. Never give honey to infants under 1 year due to botulism risk.
• Warm fluids: Warm water with honey and lemon, warm apple juice, or clear soup can soothe the throat and loosen mucus
• Humid air: A cool-mist humidifier in the bedroom can add moisture to dry air and ease cough, especially at night
• Elevate the head: For children over 1 year, slightly elevating the head of the bed can reduce post-nasal drip and nighttime cough

How Can I Prevent My Child from Getting Colds?

Prevent colds by teaching proper hand hygiene (washing with soap for 20 seconds), teaching children to cough and sneeze into their elbow, avoiding touching the face, keeping sick family members separated when possible, ensuring adequate sleep and nutrition, and keeping your child home when they're contagious.

While it's impossible to prevent all colds - and some exposure helps build immunity - certain measures can reduce how often your child gets sick. Good hygiene practices are the most effective prevention strategies, as cold viruses spread primarily through respiratory droplets and contaminated surfaces.

Hand washing is the single most effective way to prevent cold transmission. Teach your child to wash hands thoroughly with soap and water for at least 20 seconds (singing "Happy Birthday" twice helps children time it correctly). Key times to wash include: after using the bathroom, before eating, after blowing the nose, after playing with shared toys, and after coming home from school or daycare.

When soap and water aren't available, alcohol-based hand sanitizers (at least 60% alcohol) are an acceptable alternative for children old enough to use them safely. Supervise young children to ensure they don't ingest the sanitizer.

Teach your child to cough and sneeze into their elbow rather than their hands. This "vampire cough" technique prevents virus transfer to hands that then touch surfaces and other people. Also teach children to avoid touching their eyes, nose, and mouth - the entry points for cold viruses.

Building a Strong Immune System

A healthy immune system helps children fight infections more effectively. While no supplement or food can prevent colds, overall good health supports immune function:

• Adequate sleep: Children need 10-14 hours of sleep (including naps) depending on age. Sleep deprivation impairs immune function.
• Balanced nutrition: A diet rich in fruits, vegetables, whole grains, and lean proteins provides nutrients that support immunity
• Regular physical activity: Moderate exercise supports immune health in children
• Stress management: Chronic stress can impair immune function even in children
• Up-to-date vaccinations: While there's no cold vaccine, staying current on other vaccines prevents illnesses that can weaken the immune system

When to Keep Your Child Home

Children are most contagious during the first 2-3 days of a cold when viral shedding is highest. Keeping sick children home during this period reduces transmission to classmates. However, since cold symptoms often persist beyond the contagious period, children don't need to stay home for the entire duration of symptoms.

General guidelines for keeping children home from school or daycare include: fever (wait until fever-free for 24 hours without medication), frequent productive cough that prevents comfortable participation, extreme fatigue or irritability, and inability to participate in regular activities.

How Can I Tell If It's a Cold or the Flu?

While cold and flu share some symptoms, flu typically comes on suddenly with high fever, severe body aches, extreme fatigue, and can cause serious complications. Colds develop gradually with milder symptoms focused on the nose and throat. When in doubt, especially in young children or those with chronic conditions, consult your healthcare provider.

Distinguishing between a cold and influenza (flu) can be challenging since both are viral respiratory infections with overlapping symptoms. However, several key differences can help parents tell them apart. Understanding these differences is important because flu can cause serious complications, especially in young children, while colds rarely do.

The onset of symptoms provides a major clue. Colds typically develop gradually over 1-3 days, starting with a scratchy throat and progressing to nasal symptoms. Flu, in contrast, strikes suddenly - a child may seem fine in the morning and be severely ill by afternoon with high fever, chills, and body aches.

The severity and type of symptoms also differ. Cold symptoms are generally mild to moderate and centered in the nose and throat - runny nose, sneezing, sore throat, and mild cough. Flu causes more systemic symptoms including high fever (often 39-40°C or 102-104°F), severe muscle aches, headache, extreme fatigue, and a dry, persistent cough. Children with flu often complain of body aches and feel too exhausted to play.

If you suspect your child has the flu, contact your healthcare provider. Antiviral medications may be recommended, especially for young children or those with underlying health conditions, and are most effective when started within 48 hours of symptom onset.

What Complications Can Develop from a Cold?

Most colds resolve without complications, but some children develop secondary bacterial infections including ear infections (otitis media), sinus infections (sinusitis), or lower respiratory infections like bronchitis or pneumonia. Children with asthma may experience worsening of their condition during colds.

While the vast majority of colds in children resolve completely within 1-2 weeks without any problems, a small percentage of children develop complications. Understanding potential complications helps parents recognize warning signs that warrant medical attention.

Ear infections (acute otitis media) are the most common complication of colds in young children. The Eustachian tubes that connect the middle ear to the throat are shorter and more horizontal in children, making it easier for bacteria to travel from the throat to the ear during a cold. Signs include ear pain (young children may pull or tug at their ears), fever returning after initial improvement, increased fussiness, and difficulty sleeping.

Sinus infections (sinusitis) can develop when cold symptoms persist beyond 10 days without improvement. Bacterial sinusitis should be suspected if nasal symptoms persist unchanged for more than 10 days, if symptoms initially improve and then worsen again ("double worsening"), or if there is severe onset with high fever and thick nasal discharge for more than 3 consecutive days.

Lower respiratory infections such as bronchitis, bronchiolitis (in infants), or pneumonia can occur when the viral infection spreads beyond the upper respiratory tract or when bacterial superinfection develops. Signs include persistent or worsening cough, rapid or labored breathing, fever that returns after initial improvement, and chest pain or discomfort.

Children with asthma often experience worsening of their asthma symptoms during colds. Respiratory viruses are the most common trigger for asthma exacerbations in children. If your child has asthma and catches a cold, monitor closely for increased coughing, wheezing, or difficulty breathing, and follow your asthma action plan.