Cough and cold in babies, home care and why cough syrups are not advised

Most coughs and colds in babies are caused by viruses and get better on their own. Your job is to keep your baby comfortable, fed and watched. Cough syrups do not help young children and can harm them, so Dr Dutta almost never advises them. Below are the questions parents ask her most often in clinic, with short answers.

How long does a cold last in a baby?

A cold usually improves within a week, but a runny nose and cough can hang on for two weeks or more. This is normal and does not mean the cold has "gone to the chest".

A large review of studies in children found that in 9 out of 10 children, cold symptoms had settled by about 15 days. An acute cough took up to 25 days to settle in 9 out of 10 children.¹ So a cough in week three, in a child who is eating, playing and breathing comfortably, is usually just slow healing of the airways.

What matters more than the number of days is the direction. A child who is slowly getting better is fine. A child who improves and then gets worse again, with new fever, needs to be seen.

Why does my child get so many colds?

Young children catch colds again and again because their immune system is meeting each virus for the first time. There are hundreds of cold viruses, and immunity to one does not protect against the next.

In a German study that followed over 1,300 children from birth, up to 11 respiratory infections a year in the first two years was within the normal range. By school age, this dropped to about 4 a year or fewer.² Children who start daycare or playschool early catch more colds at first, but they tend to have fewer later on.³

Older siblings, crowded homes and cigarette or chulha smoke also add to the count. Frequent colds alone do not mean your child has "weak immunity". Dr Dutta looks for other warning signs, such as poor weight gain, repeated pneumonia or unusual infections, before she worries.

What is the difference between a cold and something more serious?

A cold mainly affects the nose and throat: sneezing, runny or blocked nose, mild cough and sometimes a low fever. A child with a simple cold still feeds, wets nappies and plays in between.

Things that point to a more serious illness include fast or hard breathing, a high fever lasting more than 3 days, refusing feeds, fewer wet nappies, unusual sleepiness, or a cough with a "whoop" or long bouts that end in vomiting. These need a doctor, not home care. See the list at the end of this page.

How do I clear my baby's blocked nose?

Use saline (salt water) nose drops and a gentle suction bulb or nasal aspirator. This is the safest and most useful thing you can do for a blocked nose in a baby.

Babies breathe mainly through the nose, so a blocked nose makes feeding hard. Put a drop or two of saline in each nostril shortly before a feed and before sleep. Wait a minute, then gently suck out the loosened mucus. Wipe the outer nose with a soft wet cloth.

A Cochrane review found that nasal saline may ease cold symptoms a little and causes only mild side effects such as brief stinging.⁴ The trials were small, so Dr Dutta sees saline as a comfort measure, not a cure. Do not use decongestant nose drops meant for adults in babies unless a doctor has prescribed them.

Are cough syrups safe for children under 2 or under 4?

No. Dr Dutta does not recommend cough and cold syrups for children under 4, and they are especially risky under 2. They do not work better than a dummy medicine, and they can cause serious side effects.

A Cochrane review of trials in children found that cough suppressants, antihistamines and decongestant mixtures were no more effective than placebo (a dummy medicine).⁵ In the United States, investigators linked the deaths of three babies under 6 months to these medicines.⁶ A later study of child deaths linked to these products found that most were in children under 2 years. Most of those deaths followed non-medical use, such as giving the medicine on purpose to make a child sleep, which is one more reason to keep these syrups out of the house.⁷

Many syrups sold in India combine two or three drugs, and the same drug can be hidden in two products. That makes accidental overdose easy. If a chemist or relative suggests a syrup, show them this page, or ask your paediatrician first.

What about cough syrups for older children?

For children over 4, the evidence is still weak. Most trials show little or no benefit, so Dr Dutta rarely prescribes them even at this age.⁵

If a cough is stopping an older child from sleeping, honey, warm fluids and raising the head of the bed are her first choices. A cough is the body's way of clearing mucus. Silencing it with medicine does not make the infection end sooner.

Does honey help cough in children over 1 year?

Yes, a little. For children aged 1 year and older, a spoon of honey before bed can ease a cough and help sleep.

A Cochrane review found that honey probably reduces how often children cough compared with no treatment or placebo, and may work about as well as a common cough suppressant.⁸ The benefit was seen mainly in the first 1 to 3 days. In her practice, Dr Dutta suggests a small spoonful, alone or in warm water, and brush teeth afterwards when you can.

Why is honey not safe for babies under 1 year?

Never give honey, even a lick, to a baby under 12 months. Honey can carry spores that cause infant botulism, a rare but serious illness that weakens the muscles.

A recent review found honey was the only food source consistently confirmed in infant botulism, and health authorities everywhere advise against honey before 12 months.⁹ This includes honey mixed into ghutti, home remedies or dipped on a pacifier. Grandparents often mean well here, so please explain gently.

Is steam inhalation safe for a baby or child?

Dr Dutta does not advise steam inhalation from a bowl of hot water for babies or children. It has no proven benefit for colds, and it causes serious burns.

A Dutch burns study found that most people admitted with scalds from steam inhalation were children, and children needed skin grafts more often than adults.¹⁰ A child can tip the bowl in a second. If you want moist air, sit with your child in a bathroom with a hot shower running, keeping the child well away from the water. Keep the door open and stop if your child seems distressed.

Do vapour rubs and oils help a cold?

A vapour rub on the chest may help an older child sleep a little better, but it is not for babies. Never put it in or under the nose.

In a trial in children aged 2 to 11, parents rated a vapour rub better than no treatment for night cough and sleep, though skin irritation was more common.¹¹ There is no such evidence for babies, and strong camphor or menthol products can irritate a young child's airway. Mustard oil or other oils in the nose are not safe because oil can be breathed into the lungs.

Does my child need antibiotics for a cough and cold?

Almost never. Colds are caused by viruses, and antibiotics only kill bacteria.

Antibiotics will not shorten a cold, but they can cause diarrhoea, rashes and resistant germs. Green or yellow mucus is also common in viral colds and does not on its own mean a bacterial infection. Dr Dutta prescribes antibiotics only when she finds a specific bacterial problem, such as some ear infections or pneumonia.

What home care really helps a cold?

Fluids, rest, a clear nose and comfort are the backbone of cold care. Most of what helps is simple.

• Keep breastfeeding, and offer feeds more often but in smaller amounts.
• For older children, offer water, dal water, soups and fruit.
• Use saline drops and gentle suction before feeds and sleep.
• Give paracetamol in the right dose for weight only if your child is uncomfortable with fever. Do not give aspirin to children, as it is linked to Reye's syndrome, a rare but serious liver and brain illness.¹²
• Raise the head end of the mattress slightly for older children (not for babies, who should sleep flat on their back).
• Keep the home free of cigarette, agarbatti and mosquito coil smoke.

Can my baby catch a cold from the fan, AC, or a bath?

No. Colds come from viruses passed from person to person, not from cold air, a fan, or a bath.

In Kolkata's heat, a fan or AC set to a comfortable temperature is fine, and a daily bath is fine too. Dress your baby in light cotton and dry the hair after bathing. What spreads colds is close contact, coughing and unwashed hands. Ask visitors with a cold to stay away from a young baby, and have everyone wash hands before holding the baby.

When is a cough serious?

A cough is serious if it comes with breathing difficulty, if your child looks unwell, or if it keeps going beyond 3 to 4 weeks.

Watch your child's breathing when calm or asleep. Fast breathing, the skin pulling in between or below the ribs, grunting, or flaring nostrils are warning signs. A cough that comes in long bursts with a whoop or vomiting may be whooping cough. A sudden cough after choking on food or a small toy can mean something is stuck in the airway. A cough that lasts more than 4 weeks also needs a check-up.

When should I take my baby to a doctor or hospital?

Go to a doctor the same day, or to hospital urgently, if you notice any of these:

• Any fever (38 degrees C or more) in a baby under 3 months. This one is always urgent: go to hospital now, day or night.
• Fast breathing, chest pulling in, grunting, or blue or grey lips.
• Pauses in breathing, or a cough with a whoop or vomiting.
• Poor feeding, or fewer than half the usual wet nappies.
• Your baby is unusually sleepy, floppy or hard to wake.
• Fever lasting more than 3 days, or fever that returns after the child was getting better.
• Ear pain, or a cough lasting more than 3 to 4 weeks.
• A sudden cough after choking on food or a small object.
• You are worried. Your instinct as a parent counts.