It often seems that runny noses and coughs are as much a part of early childhood as diaper changes and baby food. Especially if your infant is in day care, it might seem that he always has a runny or crusty nose. How do you determine whether that runny nose is a sign that you should see a doctor?

The Common Cold and Sinus Infections

The common cold is the most frequent cause of a runny nose in younger kids. Like most other viral infections, there is no treatment for the common cold, and you often just have to treat your child's symptoms until he gets over them on his own.

These symptoms typically begin with a clear runny nose, low-grade fever, and a cough. Over the next few days the symptoms may worsen, with a higher fever and worsening cough. The runny nose might become yellow or green before going away over the next one to two weeks. It is important to understand that this is the normal pattern for a cold and does not mean that your child has a sinus infection or needs antibiotics. The belief that any runny nose that turns yellow or green is a sinus infection has led to the great overuse of antibiotics and the creation of resistant bacteria that are difficult to treat. Of course, if your child is very fussy, is not eating or drinking, or has trouble breathing, then a trip to your doctor is a good idea.

To help your infant feel better during his cold, you might use saline nasal drops and frequent suctioning with a nasal aspirator to clear your infant's nose, a cool-mist humidifier or vaporizer, and an age-appropriate dose of a pain and fever reducer. Keep in mind that the FDA now warns against using cold and cough medicines in children under age two years though, so they should be avoided. Also, when considering using a pain and fever reducer, remember that children and infants should not take aspirin because of the risk of Reye syndrome, a life threatening liver disorder.

While a yellow or green runny nose is typically caused by a common cold, if the infection lingers for more than ten to fourteen days and is worsening, or if the child has a high fever for more than three or four days and appears ill, then he may really have a sinus infection that requires antibiotics.

Bronchiolitis

Often starting out with typical cold symptoms of a runny nose and mild cough, infants with bronchiolitis will develop wheezing, a worsening cough, and trouble breathing as the infection gets in their lungs.

Usually caused by the respiratory syncytial virus (RSV), bronchiolitis can quickly turn into a serious infection that sometimes requires hospitalization so the patient can receive intravenous fluids, oxygen, and further care. Younger infants, especially those born prematurely, are especially prone to serious infections and complications from bronchiolitis.

Bronchitis

The same viruses that cause the common cold can also cause bronchitis, an infection of the bronchial tubes that lead to the lungs. Symptoms are also similar, with a cough, but the cough might be more productive than it is with a cold, and your child may not have much of a runny nose. Although the cough from bronchitis might last several weeks or longer, it doesn't usually need treatment with antibiotics. Over-the-counter cold and cough medicines are also not recommended, especially in light of the FDA warnings about using them in children under two years of age.

Croup

Croup is one of the scarier respiratory infections that your infant can get. Unlike most other viral infections, which start with mild symptoms that gradually worsen, an infant with croup usually wakes up in the middle of the night with a loud cough that sounds like a barking seal, and he may have trouble breathing.

Initial treatments might include going into the bathroom, closing the doors, and turning on all of the hot water. This “steam room” treatment will usually help your child to breathe. Just be sure to keep him away from the hot water. Other treatments might include using a cool-mist humidifier or simply walking outside if it is a cool or cold night.

More serious cases of croup are usually treated with steroids or a nebulized medicine called racemic epinephrine. Call your doctor or go to the emergency room if your child with croup is very irritable or is having a hard time breathing.

Whooping Cough

You should also be aware of the symptoms of whooping cough, or pertussis, which has made a recent resurgence because the vaccine wears off after several years. When younger children get pertussis, after a few days or weeks of cold symptoms, they often get coughing spasms or fits, which can be followed by the typical “whoop” as the child gasps for air. Many children also vomit after these coughing fits, which is known as post-tussive vomiting.

Routine immunization with the DTaP vaccine protects most infants from the bacteria that causes whooping cough, although it takes at least three doses to be protected, which leaves many infants unprotected until at least their six-month well-child checkup, when they get their third dose of DTaP. Unfortunately, the protection wears off in teens and adults, who can get sick and expose younger infants to pertussis. A newer vaccine — Tdap — can now protect teens and adults too.

To protect your younger children from whooping cough, you should keep them away from any older child or adult with a chronic cough or bronchitis, which is often the only symptom at that age. Because this condition is often overlooked, be sure to tell your doctor if you are worried that your child might have whooping cough. In addition to treatment with the antibiotic erythromycin, younger infants who have whooping cough are often hospitalized because of the risk of apnea, a condition that may cause a child to stop breathing.

Chronic Coughs

An infant with a chronic cough that lasts more than a few weeks can be frustrating to care for and treat. Is it a cold, sinus infection, bronchitis, or pneumonia? Or is it being triggered by allergies, asthma, or reflux? A chest x-ray, physical exam, and detailed review of all of your child's symptoms can help you figure out the cause of the cough. Persistent coughs might also need further evaluation by a pediatric pulmonologist.