I'm a Parent and a Pediatrician: Here's When I Worry About a Cold

A pediatrician and father of five offers advice on what to do and when to worry about cold symptoms in your toddler.

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Father taking care of ill little girl. Daughter feeling bad at home

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Before I had kids, I admit I was a little judgmental of parents who took sick children out in public. I’d see a toddler with two snot streams running down their face, snicker at the resemblance to a walrus, and swear that I would never let my future offspring walk around like that. I’m sure you can guess how that turned out: I’ve had enough walrus moments with my own kids to fill a nature documentary.

The average child will catch six colds in the first year of life. The tricky part is that what seems like a cold can sometimes be something worse. Most fevers, coughs, and runny noses are harmless, but occasionally, they can be signs of more serious conditions like bronchiolitis, sinusitis, middle-ear infections, influenza, COVID-19, or even pneumonia.

But no parent wants to waste time and money dragging a sick kid to unnecessary medical visits, exposing their child to even more germs in the waiting room, or giving antibiotics that won’t alleviate symptoms and could cause more harm than good.

To avoid these scenarios, it helps to look at one symptom at a time. Read on to learn about common cold symptoms in toddlers—and when they could be something else.

Cough and Cold Medicines

The American Academy of Pediatrics (AAP) says that children younger than 6 shouldn't use cough and cold medicine, as they're not established as safe and effective treatments.

Fever

Colds often cause fever in babies and toddlers (an effect of the immune system cranking up to fight the infection). Fevers associated with a cold in young children usually last for about two days.

While a fever isn't always something to worry about, a high temperature may be the symptom that worries parents most. Whether it also concerns doctors depends on the child’s age, how long the fever has lasted, and, in some cases, how high it is. Typically, you’ll first notice they look either pale or flushed and are warm to the touch.

How to confirm a fever

The first step with potential fever is to confirm that there actually is one. The human hand makes a poor thermometer, so you should always get a temperature reading with an approved thermometer if you're concerned.

The way you check also matters. Some types of thermometers, in order of accuracy, include:

  • Rectal thermometer (Use for babies and young children)
  • Oral thermometer (Use for older children who can reliably hold one under their tongue)
  • Ear thermometer (Can be used for children older than 6 months)
  • Temporal artery (forehead) thermometer (Use in any child)
  • Armpit thermometer (Double-check with the more accurate method if it indicates fever)

Oral and rectal thermometers remain the gold standards for accuracy. Doctors consider a temperature over 100.4 degrees Fahrenheit a fever. When to worry depends on several factors, including a child's age and other symptoms.

When to worry about a fever

For infants under 2 months, doctors consider fever a medical emergency since it can be a sign of a serious infection. Take your newborn to an emergency room if they have a fever. Newborns under a month with fevers are often hospitalized for a couple of days for observation.

It's important to note that the number on the thermometer can’t tell you whether your child has a viral or bacterial infection or how serious it is. If your child is older than 3 months, the significance of fever depends on whether other symptoms are present and how long they last. The AAP advises calling a health care provider for a fever in the following situations:

  • A child under 3 months with a fever over 100.4 F
  • A temperature over 104 F in a child of any age
  • A fever that persists longer than 24 hours in a child under 2
  • A fever that persists longer than three days in a child over 2

While many parents worry that a high fever will cause brain damage, this is not a concern for a temperature under 107 F. Healthy children don’t generally get temperatures this high from illness but instead from external issues, like being locked in a hot car.

Runny Nose

It used to be thought that the color of nasal mucus could tell you whether a child had a bacterial or viral infection. The myth went: If it's green, the infection is bacterial, not viral, and the child needs antibiotics.

That's since been disproven. In fact, snot almost always turns green during a cold. According to the Centers for Disease Control and Prevention (CDC), nasal discharge with a cold starts clear and runny, then turns white, yellow, or green after a few days. This does not indicate a need for antibiotics.

Now, when looking at runny noses as a symptom in toddlers, doctors pay attention to two things: The snot's duration and its severity. Duration is easy. Most colds get better in about a week. So, a child with a runny nose for longer than that may have something else going on, like a bacterial sinus infection. Some signs of a sinus infection to watch out for include:

  • Cold symptoms for more than 10 days
  • Thick yellow discharge and a fever for a few days in a row
  • Sinus headache
  • Dark circles around the eyes
  • Bad breath

Other conditions can make your child's nose run. Environmental allergies bring clear, watery snot, sneezing, and itching. Mucus draining from only one nostril suggests a foreign body is stuck in the child’s nose. On the more extreme end, clear nasal drainage following a severe head injury can indicate a dangerous skull fracture.

boy in robe lying on sofa with soup
Priscilla Gragg

Earaches

Middle-ear infections (known medically as acute otitis media) lead to more antibiotic prescriptions than any other childhood illness. But not all earaches are caused by ear infections.

A tiny passage called the eustachian tube runs from each middle ear to the nose, and viral illnesses and allergies can clog these tubes with mucus, causing pain. Colds can also cause fluid to collect in the middle ear (serous otitis media), which can be uncomfortable but is not a bacterial infection (and therefore, does not require antibiotics). Swimmer’s ear (otitis externa), where excess moisture collects in the outer ear, can be terribly painful but is treated very differently from otitis media.

There are also several other causes of earache that have nothing to do with colds or ear infections—everything from changes in altitude to swollen adenoid glands. In some cases, children with an earache won't need any treatment beyond pain relief, but that’s best determined by an in-person exam. So if your child has severe or worsening ear pain, drainage from the ear, or an earache with fever, see the doctor.

Cough

A cough may be the most annoying cold symptom in a toddler since it often keeps everyone in the household awake. Plus, according to the CDC, coughs from colds can linger for a couple of weeks.

Cold viruses cause coughing by inflaming airways and producing nasal drainage, which drips into the lungs and must be forced back out. Normal coughs can sound dry, wet, or barking, but other cough-related symptoms should prompt you to seek care.

RSV

Newborns and infants, especially if born prematurely, can contract bronchiolitis, a viral infection often ushered in by respiratory syncytial virus (RSV), which can lead to life-threatening wheezing.

To diagnose bronchiolitis in babies, doctors look for the following signs of respiratory distress:

  • A grunting sound with each breath
  • Flaring of the nostrils
  • Skin pulling under or between the ribs
  • Breathing too fast (more than 60 times per minute)
  • Bluish skin tone

Call a health care provider if you hear a high-pitched wheeze or notice any of these signs.

Croup

Another concerning sign is, in some ways, the opposite of a wheeze: stridor. Wheezing occurs when someone is breathing out, while stridor is a high-pitched noise that children make as they are breathing in.

A child with croup may have stridor when they are crying or upset, but if you hear stridor occurring when your child is resting, head for an urgent-care center or the emergency department right away. If your child seems very short of breath, call 911 immediately.

Asthma

Wheezing with a cough is a hallmark of asthma. If your child has already been diagnosed with asthma and you find yourself giving rescue medicine more often than every four hours or for more than one day in a row, it’s time to call a health care provider.

Also call if your child seems short of breath during normal activities like walking or running, or can’t say long sentences without catching their breath.

Peneumonia

A cough can also indicate pneumonia. Children with pneumonia may have a fever beyond the first two days of an illness and may also complain of chest pain or shortness of breath. Pneumonia can be quite dangerous, so seek care soon if you’re seeing this combination of symptoms.

Other Symptoms To Watch Out For

In addition to the more common symptoms of a cold, some other things may warrant concern.

Headache

Mild to moderate headaches are common with colds, especially when your child also has a fever. But if a severe headache is accompanied by vomiting, light sensitivity, or a stiff neck, it could indicate meningitis. Meningitis is a serious infection of the fluid around the brain, and your child should be checked out immediately if they exhibit any of these symptoms.

Sore throat

Sore throats are certainly common with colds as well, especially scratchy ones that hurt worse with coughing. In kids older than age 3, we also worry about strep throat (it’s not impossible for strep to afflict a child younger than 3, just less likely).

Strep throat symptoms include:

  • Fever
  • Pain when swallowing
  • Rapid onset sore throat
  • Very red throat
  • Red tonsils with white patches
  • Red spots on the roof of the mouth
  • Swollen lymph nodes

Be aware that strep should never be treated with antibiotics without a health care provider first performing a rapid strep test, throat culture, or both.

Stomachache, vomiting, diarrhea

Colds may come with some muscle aches but generally don’t cause tummy aches, vomiting, or diarrhea. These accompanying symptoms suggest influenza (the flu), especially during the fall, winter, and spring.

Whether your child needs a flu test depends on their age, how long they have been sick, and whether they have other conditions like asthma or heart disease. Call a health care provider if you suspect the flu. They can tell you whether a visit is in order.

Key Takeaways

Cold symptoms in toddlers are usually nothing to worry about. However, there are some signs to watch out for that could indicate a cold has developed into something more severe or is another type of infection. Symptom duration and severity are some key things to keep an eye on. Trust your intuition and seek medical care if you're worried.

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Sources
Parents uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Colds, cough (0-12 months). American Academy of Pediatrics. n.d.

  2. Common Cold. American Academy of Pediatrics. 2023.

  3. Fever and your baby. American Academy of Pediatrics. 2021.

  4. Fever: When to call the pediatrician. American Academy of Pediatrics. 2022.

  5. Fever. National Library of Medicine. 2022.

  6. Common cold. Centers for Disease Control and Prevention. 2023.

  7. The difference between sinusitis and a coldAmerican Academy of Pediatrics. 2015.

  8. Respiratory distress syndrome (RSD). National Heart, Blood, and Lung Institute. 2022.

  9. Meningitis infections in infants and children. American Academy of Pediatrics. 2023.

  10. Strep throat: All you need to know. Centers for Disease Control and Prevention. 2024.

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