How many colds is too many?

Normal children may have up to 8 upper respiratory tract infections (URI's) per year.  Some sources state that up to 12 URI's per year may be normal, especially for children in daycare.  Even though this may be normal, parents often become worried when their child is sick as frequently as once per month.  So when should parents and pediatricians worry?  Does your child have an abnormal immune system?  Could this be asthma?  Could this be another chronic illness?  Should my child have an x-ray or bloodwork?  The purpose of this article is to explore an approach to these common questions.

How often does a normal child get sick?

Upper respiratory tract infections (a.k.a., colds, URI's) are the most common illness of children.  Normal, healthy children have an average of 6 to 8 URI's per year.  This is just an average... some kids, especially those in daycare or school, may get sick as frequently as once per month.  These infections are typically caused by a virus, are mild, don't need medicines to get better, and last less than a week.

What is a URI?

In simple terms, a URI is a "cold." URI's may also cause a sore throat, ear infections, runny or stuffy nose, cough or sneezing, or some combination of these symptoms.  The sinuses, tonsils, adenoids, nose, ears, mouth and throat are all connected by tubes, so viruses can easily pass from one area to the other.

When is a URI not a URI?

This is a good question for your doctor.  Most parents are familiar with the symptoms of a cold (i.e., runny or stuffy nose, cough, sneezing, sore throat, and/or mild fever).  If the symptoms seem to be excessive or last longer than a few days, you should see your doctor.  For example, if coughing lasts longer than 2-4 weeks, your doctor may want to evaluate your child for asthma (or a foreign body in the airway for younger children).  Most URI's or colds don't slow down an active child too much or for too long.  If your child isn't eating or drinking well or doesn't perk up in response to tylenol or motrin (check with your doctor before using medicines), then perhaps she needs to be evaluated by a doctor.

Is this asthma?

Asthma should be considered in any child with a prolonged cough, shortness of breath, persistent nighttime cough, and/or wheezing.  This is especially true when the other symptoms of a cold are not present.  Children with asthma often have a history of seasonal allergies, eczema (dry skin or skin rash), or other known allergies.  A doctor can diagnose asthma with a stethoscope exam and a detailed history.  Occasionally pulmonary function testing is necessary.  This is a test that involves blowing air into a machine.

Does my child have an immune system problem?

Kids get sick frequently.  Immune deficiencies are rare.  Physicians are trained that "common things are common" and that "uncommon things are uncommon."  A problem in the immune system should be considered when your child gets sick more frequently than expected (discussed above), has infections that are more severe than expected (i.e., multiple episodes of pneumonia), or has unusual infections (i.e., thrush in an older child).  Significant immune system problems typically cause frequent and severe infections in infants.  These children may have poor growth and other obvious abnormalities.

Could this be a chronic illness?

This should be discussed with your doctor... sorry, I know I am being evasive!  One of the major red flags of a chronic illness is poor weight gain or poor growth.

When is a chest X-ray helpful?

Chest x-rays can see pneumonia, hyperinflation (seen with asthma), and swelling of the airways (seen with RSV or other viruses).  Foreign bodies in the lung may not be visible but excess air in one lung may be a clue. 

When is bloodwork helpful?

Blood tests are often normal or near-normal during a cold or URI.  Blood tests may provide clues to a more serious infection or disease.  Blood tests are often not helpful or necessary for minor respiratory illnesses.

Does my child need antibiotics?

Most colds and URI's are caused by viruses and viruses aren't affected by antibiotics.  There are very few antiviral medicines that are helpful for respiratory infections.  Perhaps the one exception to this is medication available for influenza.

What can I do to help my child not get sick so frequently?

Well... you've probably heard it before... regular physician checkups, vaccines, and washing your hands!  Exposure to the normal number and type of illnesses early in life will help your child's immune system become stronger and more effective.

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