The Common Cold and Influenza in Children

The common cold and influenza (flu) are the most common childhood illnesses. Both illnesses are caused by viruses and both are contagious. Colds usually last for a week to 10 days while the flu can last for several weeks.

The Common Cold

The common cold is an upper respiratory tract infection that is common among children, particularly among those in the first two years of age. It is so common that children in Malaysia will have at least 10 to 12[1] of these infections a year. The rate is even higher for those who spend many hours in crowded enclosed spaces such as nurseries, daycare, kindergarten or school. Other than the fact that they have high exposure to the illness in these places, young children catch colds very easily because they have immature immune systems.

Causes of the Common Cold in Children

Contrary to popular belief, colds are not caused by getting wet in the rain or being in cold weather. Colds are spread by viruses that irritate and inflame the upper respiratory tract such as the nose and throat. The infection can be caused by more than 200 different types of viruses although most colds are caused by rhinoviruses[2].

To catch a cold, the child must come into contact with someone who is infected with one of the cold viruses. In nurseries and daycare or anywhere where it is crowded, they have high susceptibility. All it takes is for one child to have a cold and before you know it, it is spread among the others.

How the Common Cold is Spread

Colds are spread through various means. It is spread:

· Through the Air − such as when a person with a cold sneezes, coughs or talks. The airborne droplets containing the virus are then breathed in by the next person. The virus then sticks to the inside the person’s nose (nasal membranes) and starts infecting the person. Within one to three days[3] – a cold’s incubation period – the new person will start showing symptoms. A cold is contagious for up to two weeks. This means that if you are infected, you can potentially pass the virus to others even before your symptoms show until you improve in seven to 10 days.

· By Touch: Colds can also be spread when you touch the infected person or touch objects that the infected person has touched such as doorknobs, toys, crayons, towels and so on. This is why it is so easy for children to spread the illness. They typically don’t wash their hands often and they constantly touch other people or objects and toys and then they touch their nose, mouth and eyes.

· Seasonal Patterns: The common cold occurs at any time of the year although most colds occur during the cooler, monsoon months in Malaysia.

Symptoms[4] of the Common Cold

· Stuffy, runny nose

· Scratchy, tickly throat leading to mild hacking coughs

· Sneezing

· Watery eyes

· Sore throat

· Low grade fever

· Achy muscles and bones

· Generally feeling unwell

As the days wear on, the mucus from the nose which started out clear will become thicker and yellow, brown or green. This is common as it doesn’t mean the child has another more serious illness.

Since there is no cure for colds[5], the treatment is only for the symptoms. There is no vaccine for the common cold as the Rhinovirus mutates very quickly and comes in many varieties. For this reason, there is no vaccine to fight off colds as there is for the flu.

The treatment is to reduce symptoms by resting and drinking plenty of water. Because colds are caused by viruses, treatment with antibiotics don’t work.

Complications[6] of the Common Cold

Most children who have colds do not develop complications. This is not to say that complications do not happen. Every cold has the potential to lead to complications such as:

· Middle Ear Infections (Otitis Media) − A cold can cause fluid to accumulate in the middle ear. This causes the eustachian tube (a thin tube that runs from the middle ear to the back of the nose) to become swollen or blocked. If the child develops a fever with a temperature higher than 38°C after the first three days of cold symptoms, an ear infection may be to blame. Ear infections can cause pain in the ear, fever, temporary hearing loss, irritability and loss of appetite.

· Sinusitis – Children with nasal congestion that does not improve over the course of 10 days may have a bacterial sinus infection. The sinuses are air-filled spaces in the skull that are located behind the forehead, nasal bones, cheeks and eyes. The child will have a fever after the cold symptoms subside, have bad breath, nausea, poor appetite, pain or pressure in the face, which also can be felt in the ears, teeth and throat[7], a headache or pain behind the eyes.

· Asthma – Colds can cause wheezing in children who have not wheezed before. The sneezing, coughing, headache and nasal congestion of a cold triggers asthma symptoms such as wheezing, shortness of breath and chest pain. It can also worsen asthma in children who have a history of this condition.

Influenza

Difference Between a Cold and a Flu

Both the flu and the common cold are contagious respiratory illnesses but they are caused by different viruses. The flu is caused by the influenza viruses (Influenza A or Influenza B virus strains[8]) whereas the common cold is caused by a number of different viruses such as Rhinoviruses, parainfluenza and seasonal coronaviruses. These seasonal coronaviruses are not the ones that cause Covid 19.

The Flu virus affects the nose, throat, airways and sometimes the lungs. Its symptoms can look deceptively just like the common cold, except that they are more severe.

Symptoms of Influenza include:

· A high-grade fever often reaching 39° or 40° C or feeling feverish and getting chills

· Cough

· Sore throat

· A runny or stuffy nose

· Muscle or body aches

· Headaches

· Fatique

· Vomiting and diarrhea, although this is more common in children than adults.

· Dehydration risk due to severe sore throat causing difficulties in swallowing which results in poor fluid intake.

As can be seen the symptoms are more or less exactly the same and it is impossible to tell whether you have the flu or a cold based on symptoms alone. Only a doctor can tell the difference when he runs some tests. The only thing that can be said about the difference is that flu symptoms usually come on suddenly such as with a high fever although one can have respiratory symptoms without the fever. Influenza is a more severe infection in that it can lead to hospitalisation and even death. Colds usually do not result in serious health problems.

Influenza in Malaysia

Like the common cold, the flu is very common in Malaysia and affects 5% to 15% of the population[9] annually. Outbreaks occur all year round with peaks during the rainy season and cooler months[10] between April to October and November to February. Again, it is not the rain that causes the flu but the fact that people tend stay indoors during the rainy season thereby making the transmission of the virus easier.

The flu can infect anyone but certain groups are at higher risk of developing serious flu related complications if they get infected. The groups include:

· Young children under five years old and especially those under two.

· Elderly individuals 65 years and older

· Pregnant women

· Individuals with chronic medical conditions such as asthma, diabetes, heart disease or weakened immune systems.

Complications of the flu

Just like the common cold, most people who get the flu will recover in a few days to less than two weeks but some people will develop complications that can be life threatening. These complications include:

· Ear infections

· Sinusitis

· Asthma

· Pneumonia – Influenza can lead to a bacterial pneumonia infection[11] which can affect one or both of the lungs. It is a serious condition in which the air sacs fill with pus and other liquid which could lead to respiratory failure, sepsis and lung abscess.

· Sepsis − The flu infection of the respiratory tract can trigger an extreme inflammation response in the body which can lead to sepsis[12] where the body responds improperly to an infection and turns on itself causing the organs to function poorly. Sepsis may progress to septic shock causing many organs to fail.

Do take note that it is an emergency if your child is exhibiting these warning signs of flu complications:

· Rapid breathing or having trouble breathing

· Bluish lips or face

· Ribs pulling in with each breath

· Chest pain

· Severe muscle pain in that the child refuses to walk

· Dehydration such as no urine for eight hours, no tears when crying

· Not alert or no interaction when awake

· Fever above 40°C that cannot be brought down with medicine

· In children younger than 12 weeks

· Fever or cough that improves but returns or worsens

· Worsening of chronic medical conditions

How to prevent getting the Common Cold and the Flu

The best defense against influenza is to get your child vaccinated, especially if he or she is under five years old. It will save him or her from having to go through the discomfort of the illness and developing serious complications and even hospitalisation. In severe cases, death can ensue.

The flu vaccine for children is available in many clinics and hospitals throughout Malaysia. For children above the age of six months, the vaccine is given in two doses followed by a yearly vaccine. For children older than nine, the vaccine is given in one dose followed by a yearly vaccine.

As for preventing the spread of the common cold and the flu, the following precautions can be taken:

· Stay away from people who have a cold or flu, especially during the first few days when they are most likely to spread the infection.

· Wash hands with soap and water after touching someone who has a cold or flu, or after touching an object they have touched.

· Make washing the hands a frequent practice, especially before eating, after using the toilet, and after playing.

· Use a hand sanitizer if soap and water are not available.

· If a child has a cold, wash his or her toys after play.

· Remind your child not to touch his or her face. The cold virus infects through the eyes, nose and mouth.

· Put up a second towel in the bathroom for healthy people to use. Keep these towels apart so that they do not overlap or touch each other.

· Do not place the family’s toothbrushes in the same place as the infected person’s toothbrush.

· Clean frequently-used surfaces such as doorknobs, tap handles and other places people often touch.

· Strengthen your child’s immune system by ensuring he eats a healthy diet, and making sure he gets enough sleep and exercise.

· Keep your child at home if he is sick so that he doesn’t spread his illness to other people.

· If your child is coughing and sneezing, teach him to cover his mouth or cough or sneeze into his elbow if he does not have a tissue. If he has coughed or sneezed into the tissue, dispose the tissue into a bin and make sure he washes his hands after that.

· If you are helping the child blow his nose, make sure you dispose of the tissue properly and wash your hands after that.

· Using a face mask is an additional strategy to reduce the spread of the respiratory viruses.

[1]Murugesan, M. (2024, June 12). #HEALTH: Respiratory infections common in children. NST Online. https://www.nst.com.my/lifestyle/heal/2024/06/1062473/health-respiratory-infections-common-children
[2]About rhinoviruses. (2024, April 24). Rhinoviruses. https://www.cdc.gov/rhinoviruses/about/index.html
[3]Seladi-Schulman, J., PhD. (2024, July 16). How long is a cold contagious? Healthline. https://www.healthline.com/health/incubation-period-for-cold
[4]Https://www.hopkinsmedicine.org/-/media/images/Johns-Hopkins-medicine-logo-horizontal-full-color.svg. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/common-cold https://www.whattoexpect.com/pregnancy/fetal-development/fetal-bones-skeletal-system/
[5]Colds: How to prevent them. (2023, January 31). Yale Medicine. https://www.yalemedicine.org/conditions/colds
[6]Patient education: The common cold in children (Beyond the Basics) - UpToDate. (n.d.). UpToDate. https://www.uptodate.com/contents/the-common-cold-in-children-beyond-the-basics/print
[7]Sinusitis (Sinus infection) (for parents). (n.d.). https://kidshealth.org/en/parents/sinusitis.html
[8]Collection Viewer - 278409. (2024, August 8). https://www.cdc.gov/widgets/micrositeCollectionViewer/index.html?chost=www.phdmc.org&cpath=/features/135-key-facts-about-influenza-flu&csearch=&chash=&ctitle=PHDMC%20%7C%20-%20Key%20Facts%20About%20Influenza%20(Flu)&wn=micrositeCollectionViewer&wf=/widgets/micrositeCollectionViewer/&wid=micrositeCollectionViewer1&mMode=widget&mPage=&mChannel=&cdcCollectionid=278409&cdcTheme=theme1&cdcGeotag=%7B%27continent%27:%20%276255149%27,%20%27country%27:%20%276252001%27,%20%27state%27:%20%275165418%27,%20%27region%27:%20%274518598%27%20%7D&chashOptMode=out#!/detail/127298

[9]Influenza – Malaysian Society of Infectious Diseases & Chemotherapy. (n.d.). https://adultimmunisation.msidc.my/influenza/

[10]Roberto. (2023, July 4). Influenza in Malaysia: Symptoms, Causes, Treatment & Prevention. Dr. Nurul Yaqeen. https://chestspecialistmalaysia.com/influenza-in-malaysia-symptoms-causes-treatment-prevention/

[11]Https://www.hopkinsmedicine.org/-/media/images/Johns-Hopkins-medicine-logo-horizontal-full-color.svg. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/pneumonia
[12]Sepsis - Symptoms & causes - Mayo Clinic. (2023, February 10). Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/sepsis/symptoms-causes/syc-20351214