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Harvard Commentaries
Harvard Commentaries
Reviewed by the Faculty of Harvard Medical School

A Parent's Life A Parent's Life

Protecting Your Kids From Colds and Flu

October 14, 2012

By Claire McCarthy

Boston Children's Hospital

It's fall, and that chill in the air means that the cold and flu season is upon us once again. Over the next few months, we will see lots of sniffles, sneezes, coughs, sore throats and other symptoms, in children and adults alike. It's important to know about these illnesses and how best to prevent them.

What Are These Illnesses?

Colds and the flu (influenza) are respiratory infections, meaning they affect the parts of the body that help with breathing (from the nose down into the lungs). Although these infections are different, it can be hard to tell which one someone has.

The common cold, also known as an upper respiratory infection (URI), tends to affect the nose and throat. It is caused by many viruses, including rhinoviruses, adenoviruses, and respiratory syncytial virus. Symptoms include stuffy nose, sneezing, scratchy throat, hoarse voice, dry cough (usually from mucous dripping down the throat), and slight fever. Most people get better completely within five days, though sometimes the symptoms can last up to two weeks. Even with cold symptoms, people generally can keep up with their usual activities.

The flu, ccaused by the influenza virus, can look like the common cold with only nose and throat symptoms, but often is more serious, involving the lungs and other parts of the body. The flu typically causes sudden onset of fever, chills, sore throat, cough and runny nose and also may cause headache, muscle aches, tiredness, nausea, vomiting and diarrhea. The fever can last up to five days or so, and symptoms often limit people's activity levels. The illness starts to improve by the end of that first week. Some people may continue to cough and feel "out of it" for two weeks or longer.

These respiratory illnesses often look different in young children than in adults. For example, respiratory syncytial virus (RSV) causes only mild cold symptoms in adults and older children. But in children under 2, RSV often causes bronchiolitis, a more serious illness with inflammation and swelling of the linings of the small airways in the lungs. Children with bronchiolitis usually have a nonstop runny nose and a "tight" or harsh-sounding cough; they also may have wheezing, fast breathing (tachypnea), difficulty feeding, and trouble breathing. Most children with RSV bronchiolitis recover completely in one to two weeks, with any breathing problems beginning to improve as early as the third day.

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Keep Those Germs Away

Although colds and the flu are more common during the winter months, they are caused by viruses, not by exposure to cold air or going out with wet hair.

These viruses are spread through physical contact, such as when you touch, kiss or shake hands with infected people and their secretions (for example, from a runny nose) and then touch your eyes, mouth, or nose with the dirty hand. Many viruses can live for at least half an hour on the hands and for several hours on counter tops, toys, and other surfaces.

They also are spread through the air, on tiny droplets of infected water that come out when someone with a cold or flu sneezes or coughs near you.

Since prevention truly is the best medicine, use careful hygiene and regular housecleaning to help prevent these respiratory illnesses.

    • Wash your hands often, and teach your children to wash theirs, scrubbing with soap and warm water for at least 15 seconds (about as long as one verse of "Happy Birthday"). You can also use one of the alcohol-based hand cleaners (even though they are called antibacterial gels, they also kill viruses).
    • Change cloth towels often and launder them in hot water. Use disposable tissues when wiping noses, and wear a mask if you are coughing or sneezing frequently. Regularly wipe down all surfaces, including toys, with a virus-killing disinfectant.
    • Finally, try to avoid exposing young children, particularly infants, to secondhand tobacco smoke, which increases the risk of severe viral respiratory infections.

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Get Your Flu Shots Now!

Many cases of the flu can be prevented with the influenza vaccine, which is safe for children as young as 6 months of age.

Because young children are at higher risk of getting very sick from the flu, the flu shot is recommended for ALL children between 6 months and up to 19 years of age. This is especially important for children who have certain diseases that put them at risk of serious complications from the flu, including significant heart disease, lung disease (for example, asthma or cystic fibrosis), diabetes, sickle-cell disease, kidney disease, muscular dystrophy, or HIV infection.

Everyone who should or wants to be vaccinated against the flu must receive the seasonal flu vaccine every year, because the viral strains from last year's vaccine will not fully protect against the viral strains expected to be around the United States this year.

Flu shots are usually given as early as possible beginning in September for maximum protection throughout the winter flu season. Children younger than 9 years of age who have never had a flu shot before need two doses of the vaccine at least one month apart.

There is also a flu vaccine (FluMist) that is sprayed up the nose (instead of a shot). It protects against the same strains of the flu as the flu shot. It can be given to healthy children age 2 and older. Because it is not a shot, some children may be more accepting of this type of vaccine. However, this vaccine contains a weak but "live" form of the virus and should not be given to children who have known problems with wheezing or their immune system.

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Preventing RSV Infections

For some children, including premature infants, those who can't fight infection well (immunocompromised), and those with certain forms of heart or lung disease, RSV infections can be even more serious. A medication called palivizumab (Synagis) that fights against RSV infections can help to prevent them in these children. Parents of premature infants or children under 2 years of age with serious medical problems should discuss their child's risk of RSV infection with the doctor as soon as possible, and ask whether this medicine would be helpful.

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Henry H. Bernstein, D.O. is a senior lecturer in Pediatrics at Harvard Medical School. In addition, he is chief of General Academic Pediatrics at Children's Hospital at Dartmouth and professor of pediatrics at Dartmouth Medical School. He is the former associate chief of General Pediatrics and director of Primary Care at Children's Hospital Boston.

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