Viral upper respiratory infections in the age of COVID

Your toddler has had a cough and runny, stuffy nose on and off for months. They also attend daycare and have a sibling in preschool. You are worried about the symptoms. You are also exhausted because your child’s coughing and congestion is not letting either of you sleep at night. Does this sound familiar?

You ask yourself, “Is this normal?” and “What is wrong with my child?”

Well, to calm your fears, this is a common scenario for families with young children in daycare and preschool. We see children like this at pediatric clinics, urgent cares and emergency rooms daily. In the United Kingdom and the United States, viral respiratory tract infections or “colds” account for over a third of pediatric consultations in primary care. A brief discussion about the frequency of young children becoming infected and how long the symptoms of infection last will give you more of a proper perspective on how concerned you should be.

Most upper respiratory tract infections are caused by viruses which represent approximately 90% of all respiratory infections. These infections mainly occur in children less than 5 years of age who can experience up to 5 or 6 episodes a year.

Viral respiratory infections are more prevalent in children who attend daycare or kindergarten as they can experience a 2 to 3 times greater risk of acquiring infections in these settings. Also, one study showed that 3 to 6 different viruses may spread in the same kindergarten at the same time and another study revealed that children could be infected with more than one virus approximately 5% of the time.

The impact of young children getting together in settings like daycare and kindergarten cannot be stressed enough. This has been especially apparent during the COVID-19 pandemic. With the public health interventions instituted to try and reduce the spread of COVID-19 (i.e., discontinuing in-person schooling, wearing masks, environmental disinfection, etc.), one study discovered an approximate 80% decrease in childhood viral respiratory infections. The bottom line is that kids frequently get sick when they gather.

Aside from the regularity of contracting viral respiratory infections, the length of illness is often a concern for parents. In a systematic review of the literature, one study evaluated the length of “cold” symptoms in children. Cough only resolved in 50% of children by 10 days (about 1 and a half weeks) and 90% by 25 days (about 3 and a half weeks). Common “cold” symptoms lasted from 7 to 15 days (about 1 to 2 weeks), and only about 50% of children improved by the 10th day of the illness. For nonspecific respiratory symptoms, 50% of children improved by day 7 or 8, and 80% improved by the 14th day of the illness. So, it seems that cough, congestion, runny nose, and other “cold” symptoms can last for quite a while without concern for severe illness.

Nevertheless, warning signs of a more serious respiratory infection are prolonged fever, appearance of new or worsening symptoms and trouble breathing. These warning signs should prompt further evaluation and management by your medical team. While fevers can persist for a while, clinicians usually feel less comfortable if the fever lasts for a week or more.

The longer a “cold” lasts with prolonged fever or a fever starting after an initial period of no fever, we become concerned that the viral infection has allowed a bacterial infection to develop on top of the initial viral infection.

Viral upper respiratory tract infections commonly precede bacterial ear infections and pneumonia. New symptoms, like ear pain, can indicate an ear infection. Also, a worsening cough with a prolonged fever or new-onset fever while having a persistent cough can be suspicious for bacterial pneumonia.

Finally, when an infant or child breathes faster than normal for age, develops retractions (sucking in of the skin just above the sternum at the base of the neck and the area below the ribcage just above the stomach area) and/or starts nasal flaring (widening of the nostrils with taking breaths inward), the child shows that he/she is having trouble breathing. The “cold” or viral upper respiratory tract infection, at this point, has moved from a normal course to something that should be evaluated by a health care professional.

So, when you ask, “Is this normal?” and “What is wrong with my child?” — the answer will most commonly be: “Yes, this is normal” and “Nothing is seriously wrong with your child.”

Symptoms of a “cold” or a viral upper respiratory tract infection can occur repeatedly and persist for quite a while, making it seem that your child has been sick for months at a time. With all this said, if you have any concerns or questions about your child’s health, you should always feel free to speak with your medical team because your concerns are always valid. It is the health care professionals’ duty to make sure that your child’s illness is following a normal course and nothing is seriously wrong with your child.