Paeds · infectious-diseases
Viral upper respiratory tract infection and the common cold
Also known as Common cold · Viral upper respiratory tract infection (URTI) · Acute viral rhinitis · Acute nasopharyngitis · Viral rhinosinusitis · Coryza · Head cold · Acute viral sore throat with coryza
Fellowship guide to viral upper respiratory tract infection and the common cold in children. Covers the viral aetiology and seasonal patterns, the pathophysiology of acute mucosal inflammation, the typical seven-to-ten-day course and why cough lingers, the bedside assessment for red flags and complications, the evidence against antibiotics and the safety of over-the-counter cough and cold preparations, the symptomatic care that does work (analgesia, honey, saline), and the regional guideline differences for antimicrobial stewardship and school exclusion.
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Target exams
Red flags
- An infant under three months with fever and coryza — treat as a potentially serious bacterial infection and investigate, do not attribute the fever to a cold
- Increased work of breathing, grunting, nasal flaring, tracheal tug or recessions — the cold has become bronchiolitis or pneumonia, not simple coryza
- Stridor at rest, drooling, or a toxic, unwell child — think epiglottitis, peritonsillar or retropharyngeal abscess, not a sore throat
- Drowsiness, poor feeding, reduced urine output or a capillary refill over two seconds — dehydration or sepsis until examined
- Fever persisting beyond five days, or symptoms worsening after initial improvement — reconsider the diagnosis and look for otitis media, sinusitis or pneumonia
- Unilateral, foul-smelling or blood-stained purulent nasal discharge in a preschool child — a nasal foreign body, not a cold
- Cough or wheeze that persists well beyond two to three weeks, or any respiratory compromise in a child with asthma or cystic fibrosis
- Purulent nasal discharge used as the trigger for an antibiotic — purulence is inflammatory debris, not proof of bacterial infection
Life stages
Care settings
Clinical exam formats
Board mappings
- Infectious diseases — upper respiratory tract infection
- General and Community Paediatrics — common acute presentations
- Current 2026 PREP curriculum — essential general paediatrics: acute presentations
- Renewed curriculum for first-year trainees from 2027 — common childhood infections and antimicrobial stewardship
- Common acute childhood presentations
- Clinical Applications — infectious diseases
- Medical Sciences — principles of antimicrobial stewardship
- Short Cases — the febrile child
- Long Cases — recurring presentations and parental concern
- Infection, Immunology and Allergy — common viral respiratory infections
- Patient management — symptomatic and supportive care
- Health promotion and illness prevention — antimicrobial stewardship and school exclusion
- Foundation of Practice (FOP) — common acute infections
- Theory and Science (TAS) — principles of antibiotic use
- Applied Knowledge in Practice (AKP) — the febrile child
- Clinical — respiratory examination
- History — management of parental concern
- Communication — safety-netting and antibiotic stewardship
- General Pediatrics Content Outline — Domain related to Infectious Diseases
- General Pediatrics Content Outline — Universal Task 3: Diagnosis
- General Pediatrics Content Outline — Universal Task 4: Management and Treatment
- Patient Care: evidence-based management of viral upper respiratory tract infection
- Systems-Based Practice: antimicrobial stewardship and safe over-the-counter medication counselling
- Interpersonal and Communication Skills: safety-netting and managing parental expectation for antibiotics
- Medical Expert
- Health Advocate — antimicrobial stewardship
- Pediatrics EPAs related to acute respiratory presentations
Overview & Definition
The common cold is an acute, self-limiting viral inflammation of the mucosa of the upper respiratory tract — the nose, nasopharynx and throat — that produces the familiar cluster of nasal congestion, rhinorrhoea, sneezing, sore throat and cough. Most episodes resolve within seven to ten days, though a cough often lingers for two to three weeks as the airway recovers its normal reactivity. [1]
It is the most frequent illness in humans. A normal preschool child has six to eight colds each year, and a child in daycare or with older siblings may have up to ten or twelve, because so many different viruses circulate and immunity to one does not protect against another. Adults, by contrast, average only two to four colds a year. The sheer frequency is what makes the cold a core general-paediatrics topic: it is the everyday presentation behind most fever, cough and "is this serious?" consultations. [1] [2]
The fellowship trap is treating the cold as trivial. Most are, but the same viruses cause bronchiolitis, croup, pneumonia and acute otitis media, and a child who starts with a cold can deteriorate. The paediatrician's job is to recognise the self-limiting majority, give effective symptom relief, avoid antibiotics and unsafe over-the-counter drugs, and pick up the minority who need escalation. [1] [15]
References15ShowHide
- [1]Heikkinen T, Järvinen A. The common cold. Lancet, 2003.PMID 12517470
- [2]Troullos E, Baird L, Jayawardena S, et al. Common cold symptoms in children: results of an Internet-based surveillance program. Journal of medical Internet research, 2014.PMID 24945090
- [3]Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. American family physician, 2012.PMID 22962927
- [4]Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane database of systematic reviews, 2013.PMID 23733381
- [5]Arroll B, Kenealy T. Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials. BMJ, 2006.PMID 16861253
- [6]Shefrin AE, Goldman RD. Use of over-the-counter cough and cold medications in children. Canadian family physician Medecin de famille canadien, 2009.PMID 19910592
- [7]Mital R, Lovegrove MC, Moro RN, et al. US emergency department visits for acute harms from over-the-counter cough and cold medications, 2017-2019. Pharmacoepidemiology and drug safety, 2022.PMID 34757641
- [8]Oduwole O, Udoh EE, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane database of systematic reviews, 2018.PMID 29633783
- [9]Paul IM, Beiler J, McMonagle A, et al. Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Archives of pediatrics & adolescent medicine, 2007.PMID 18056558
- [10]Paul IM, Beiler JS, King TS, et al. Vapor rub, petrolatum, and no treatment for children with nocturnal cough and cold symptoms. Pediatrics, 2010.PMID 21059712
- [11]King D, Mitchell B, Williams CP, et al. Saline nasal irrigation for acute upper respiratory tract infections. Cochrane database of systematic reviews, 2015.PMID 25892369
- [12]Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane database of systematic reviews, 2013.PMID 23440782
- [13]Singh M, Das RR. Zinc for the common cold. Cochrane database of systematic reviews, 2011.PMID 21328251
- [14]Singh M, Singh M. Heated, humidified air for the common cold. Cochrane database of systematic reviews, 2013.PMID 23733382
- [15]Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics, 2013.PMID 23439909