Upper Respiratory Infections (URIs)

by Warren P. Silberstein, M.D.

Upper Respiratory Infections (URIs) are one of the most common causes of illness in childhood. The average child has 6-12 URIs per year. With symptoms that can last a week or more, some children seem to spend the entire winter with a URI. The best known and most frequent URI to afflict mankind is the common cold. URIs include any infection in the nose, throat, sinuses, and ears. Most are caused by viruses. Technically, Streptococcal pharyngitis (Strep throat) is a URI, but since Strep is primarily a throat infection without respiratory symptoms, doctors don't generally include Strep throat when talking about URIs. Sinus infections and ear infections are usually bacterial complications of viral URIs. For the most part, when doctors talk about URIs they are talking about the common cold, influenza, croup (which we'll talk about in a separate article), and a large variety of viruses that cause cold symptoms but make you sicker than the common cold. The major symptoms of URIs include fever, cough, runny or stuffy nose, sore throat, loss of appetite, headache, body aches, and fatigue. Lower Respiratory Tract Infections such as bronchitis, pneumonia, and bronchiolitis are not URIs although they may start with a URI or develop as a complication of a URI.

Many patients visit their doctor for URIs because they believe that they need antibiotics to get better. Since virus infections don't respond to treatment with antibiotics, that is a misconception. However, URIs can sometimes lead to bacterial complications like sinusitis, bronchitis, and pneumonia, and many of the symptoms of these complications such as stuffy head, nasal discharge, cough, and fever, are the same as the symptoms caused by the URI. The only distinction may be that the symptoms are more severe or last longer.

There are many myths and misconceptions about URIs including the following:

If you pay any attention to the TV ads for cold medicines, the advertisers would have you believe that there is a special medicine that works wonders for each of the different varieties of cold symptoms. The first and most important thing that you should understand about cold medicines is that the only thing they do is relieve symptoms. Cold medicines do not cure colds. They cannot make you get better faster. It is not necessary to take a cold medicine just because you have a cold. All medicines have side effects, so if a person's cold symptoms are not very bothersome, he shouldn't take unnecessary medicine and risk its side effects. This is an especially important point with regard to infants because cold medicines can make infants extremely irritable.

Even though colds are not serious illnesses newborns have a very hard time dealing with them. Newborns are obligate nose breathers which means that they try to breathe through their noses no matter how stuffed their noses are. Older infants have learned to breathe through their mouths, but they still have an extremely hard time nursing and sleeping when they have colds. Since cold medicines can make infants extremely irritable, the best way to manage infants' cold symptoms is without medication except for the treatment of fever. A vaporizer or cool mist humidifier at the bedside can help relieve nasal stuffiness. Normal saline (salt water) nose drops are also helpful to relieve stuffiness. When the nasal stuffiness is most severe, the best thing to do is to suction the baby's nose with a bulb syringe. The bulb syringe usually has a broad removable tip that looks too big for the baby's nostrils. Before suctioning you should put a drop or two of saline (salt water) nose drops into the nostril. Squeeze the bulb and then insert the tip into the nostril. Pinch both nostrils closed around the tip of the bulb and then slowly release the suction to pull the mucus down from above. When the infant is sleeping, keep the head of the crib slightly elevated by putting a pillow or rolled blanket under the head of the mattress.

There are only a few basic ingredients in cold medicines so let's try to make some sense of them.

URIs are usually minor illnesses even though they may be major nuisances. The symptoms can often be managed at home without a doctor visit. Even if your child has many URIs each year it usually just means that he is unfortunate enough to be exposed to lots of them. Frequent colds don't suggest any underlying medical problem. The best way to prevent colds is to wash your hands and teach your children to wash their hands, especially before touching your face if you've been with someone who has a cold.

For some children colds are more than just a nuisance. Children with asthma may have increased asthma symptoms with URIs. Children who are prone to ear infections are more likely to have an ear infection if they get a cold. Influenza can make children and adults much sicker than colds and has a higher rate of complications such as pneumonia. Any child who seems very sick or has any worrisome symptom with a URI should see the pediatrician. Persistent symptoms such as cough or fever require evaluation to be sure that the child doesn't have bronchitis, pneumonia, or sinusitis. Sore throats with swollen glands may be part of a viral URI, but should be evaluated to rule out Strep throat since Strep should be treated with antibiotics to prevent complications.

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