When is a Cough more than a Cold?

Most children get several viral upper respiratory infections, or colds, in the winter season. Young children in childcare can appear to have one continuous cold for months, as one virus overlaps with another with no recovery in between.

Sometimes, however, colds can develop into more significant conditions. When should a child be brought to the doctor?  Here are some tips to help parents make that decision.


Fever is a nonspecific sign that your child is fighting an infection, whether it is a common virus or more serious condition.  Thanks to vaccines, fevers today are rarely due to serious infections.

High body temperature is not dangerous, and is part of how our bodies fight off infections. Even fevers as high as 104-105 do not hurt the body or cause brain damage, and are not a reason alone to go the hospital.  However, when children have high fevers, they look and feel terrible. It can be frightening.

Doctors recommend treating fevers of 101 or above so the child feels better.  It is ok, though not necessary, to treat lower fevers if treatment is helpful.

Pediatricians want to see children who have had a fever for more than three days.  Any fever with pain, whether in the throat, ear, head or elsewhere, should be evaluated by a doctor.


It can be hard for children, particularly babies, to breath through congested noses. This is a mechanical problem, which improves somewhat with nasal saline drops, suctioning, and humidifiers.

Sometimes, however, colds can progress down into the lungs.

After a few days, a cough may get worse instead of better.  Children and babies may show signs of labored breathing, such as breathing fast, using their stomach muscles or sucking in around the ribs or clavicle with each breath.  

Whenever there is a concern for difficulty breathing, it is important to contact your pediatrician, even in the middle of the night.


When children feel sick they often refuse to eat. Babies with congested noses struggle to feed, and older children may need a lot of encouragement.  While it is ok to skip solids for a couple of days, it is important that sick children drink fluids.

Fluids with electrolytes and calories are better than water. Milk and formula are fine, while clear fluids, such as electrolyte solutions, may be easier for children to keep down.  Older children often are happy to eat popsicles and juices that may not be part of their regular diet.

Minimal fluid intake can lead to dehydration, usually after a few days. Signs include decreasing urine output, dry lips or gums and absence of tears. Children with signs of dehydration need to be been by a doctor.

General Appearance

Children with viral infections look and feel lousy.  They are less active, fussy and don’t eat or sleep well. However, once the fever is reduced, they generally feel well enough to engage in reduced age-appropriate behaviors, such as sitting up, communicating and drinking. Children with very atypical behavior, such as marked weakness or irritability, particularly when without fever, need to be promptly evaluated by a physician.

Prolonged congestion

Sometimes the congestion just won’t go away.  If significant nasal congestion continues more than ten-fourteen days, children should be seen to make sure they have not developed a sinus infection.

Having a sick child at home is never easy. Thankfully, most childhood illnesses today resolve with time. Monitor your child, and contact your pediatrician for any of the concerns above so we can provide the care they need.