COLDS

DIAGNOSTIC CRITERIA (Don’t use this protocol unless the following are present).

*Runny or stuffy nose.

*The nasal discharge may be clear, yellow or green.

*The child usually has other symptoms of a cold.

Nonessential Findings

*Usually associated with a fever and sore throat.

*Sometimes associated with a cough, hoarseness, red eyes and swollen lymph nodes in the neck.

Cause

*Colds are caused by viruses. Healthy children average 6-10 colds a year. Those in daycare will generally get even more.

See Other Protocol

*HAY FEVER (ALLERGIC RHINITIS) for runny nose caused by allergies.

*Cough.

TRIAGE ASSESSMENT QUESTIONS FOR COLDS

See Immediately in Emergency Department or in Office (ask primary care physician).

*Child sounds very sick or weak to the triager, (R/O sepsis).

See Immediately in Office

*Difficulty breathing (per caller) not relieved by cleaning out the nose(R/O pneumonia).

*Age<12 weeks with fever>100.4 F rectally (R/O sepsis).

See Today

*Earache (R/O otitis media).

*Cloudy discharge from the ear canal (R/O otitis media with ruptured eardrum).

*Fever >105 F (R/O serious bacterial infection).

Continued……..

COLDS

Triage assessment questions con’t

See Today or Tomorrow

* Parent wants child seen.

*Fever present >3days (R/O bacterial super infection-usually otitis media).

*Blocked nose interferes with sleep after using nasal washes several times.

*Yellow scabs around the nasal openings (R/O nasal strep impetigo).

*Nasal discharge present >10 days (R/O strep rhinitis in infants, sinusitis, allergic rhinitis).

*Sinus pain or pressure present (around cheekbone or eye) present>24 hours after nasal washes and pain medication (R/O sinusitis).

*Sore throat present >24 hours (R/O strep pharyngitis.

Home Care

*Cold (upper respiratory infection) with no complications.

HOME CARE ADVICE FOR COLDS

1.  Reassure the caller: It sounds like a cold that can be treated at home.

2.  For a Runny Nose With Profuse Discharge, Blow or Suction the Nose.

a.  Reassure the parent that the nasal mucus and discharge is washing viruses and bacteria out of the nose and sinuses.

b.  Blowing the nose is all that’s needed. For younger children, use nasal suctioning.

c.  Apply petroleum jelly to the nasal openings to protect them from irritation (cleanse the skin first).

3.  For a Blocked Nose: Use Nasal Washes

a.  Use warm water or saline nose drops to loosen up the dried mucus, followed by blowing or suctioning. Instill 2-3 drops in each nostril at a time (Caution: If <1 yr old use 1 drop at a time). Repeat nose drops until clear. Do nasal washes at least 4 times a day or whenever our child can’t breathe through the nose.

b.  Saline nose drops---Add ¼ teaspoon of table salt to 1cup of warm water.

c.  Importance: A young infant can’t nurse or drink from a bottle unless the nose is open.

d.  Note: Most stuffy noses are blocked by dried sticky mucus. Suction alone or blowing the nose cannot remove it.

Continued……

COLDS

Home care Advice for colds con’t

4.  Humidifier: If the air in your home is dry use a humidifier.

5.  Medicines: Cold medicines are not helpful. They can’t remove dried mucus from the nose. Antibiotics are not helpful unless your child develops an ear or sinus infection.

The providers at Tonawanda/Island Pediatrics do not recommend cold and cough medicines for children less than 5 years of age. They have been proven ineffective and/or potentially dangerous. We would be glad to have you speak further with one of our doctors if you are considering using them with your child.

6.  Treatment for Associated Symptoms of Colds

a.  Fever-Use acetaminophen or ibuprofen for muscle aches, headaches, or fever>102 F.

b.  Sore Throat-Use warm chicken broth for >1 yr old and salt water gargle if able.

c.  Cough-Use cough drops for children >5 years old and warm liquids for younger children >1 year old.

d.  Red Eyes-Apply warm soaks to eyes frequently with wet cotton balls or wash

cloth. (If pus, see Eye With Pus).

7.  Expected Course: Fever 2-3 days, nasal discharge 7-10 days, coughs 2-3 weeks.

8.  Call back if:

a.  Fever lasts >3 days.

b.  Nasal discharge lasts >10 days.

c.  Your child becomes worse.

d.  Cough lasts >3 weeks.

e.  Fever goes away >24 hours AND then returns.

11/16/07