When my sons were 2 and 3, they had a tough winter. Over the course of a month, they passed around multiple colds, seemingly catching one as soon as they shook the last. One evening I arrived at my in-law's to pick up the boys, and my mother-in-law greeted me: "I think there's something really wrong with the boys." My mother-in-law, a retired special education teacher who raised four children, prodded my husband and me to take the boys to their doctor.

We chose not to take her advice, even though my sons had been coughing, and fighting runny noses and congestion for four to five weeks. The mother in me felt for my sick little boys. But the trained pediatrician in me knew that these were merely cold symptoms, and that colds are very common in young children, especially babies and toddlers - and especially in cold weather.

While your parental instincts may push you to panic when kids are sick, it's frequently not warranted, particularly for colds. Young children in the Washington, D.C., area typically contract 10-12 viruses between September and April, some suffering from as many as 15. Most colds are no more harmful to children than the one that will inevitably strike you this season (probably when you have Strathmore tickets), and don't necessitate a trip to a doctor. Some symptoms, however, do warrant close scrutiny.

With cold season upon us, here's what to expect when the virus hits your child, how to treat it and when to actually be concerned.

What to expect

Children contract viruses more often when they are very young because they put almost anything in their mouths, introducing pathogens into their systems. Colds are most common here in the fall and winter. They spread in fall when kids return to school and are clustered in large groups, and then are passed to younger siblings at home. Winter is popular because many viruses replicate in our noses and do so more efficiently when noses are cold: Cold weather cracks the skin and admits viruses like an incapacitated guard dog.

When your child comes down with a cold, you can diagnose it by looking for a runny nose, cough or congestion. Temperatures may rise to 103 or 104 degrees, but that does not necessarily mean a child is very sick. (But if the temperature exceeds 104.5 - or 100.4 for children younger than 2 months - get medical help.) A cold could last as long as two weeks, and may seem longer because your child may start another cold before the previous one ends (like my boys did).

How to minimize and treat

The best way to minimize cold activity is to wash your child's hands or apply hand sanitizer. Treat colds by applying many of the same remedies we recommend for adults. Kids over 1 year old can have tea with honey. Soups and other liquids are also recommended. Many young children won't want to eat, but make sure they still get plenty of fluids. Giving them a bath or taking them into the shower (around the humid air) also helps with congestion. To make them more comfortable, kids older than 2 can be propped up with a pillow, and you can place an object underneath a mattress to elevate a child's head if they are over 6 months old. Children experiencing fever can have Advil or Tylenol (generics work just as well), although these medications won't cure colds.

Do not give your young child over-the-counter, multi-symptom cold medicines. They are not recommended for kids under 6 years. Do not use aspirin or antibiotics either. Antibiotics work on bacteria, but will not kill a virus like the common cold. In most cases, the recommended treatments should be enough.

Another Perspective on the Use of Antibiotics

As previously mentioned, antibiotics should not be taken to treat colds - or any virus. They won't cure the problem and can lead to side effects, including diarrhea, allergic reactions and stomach aches. Antibiotics do not treat symptoms; they attack the bacteria that cause infections.

What antibiotics actually do is a common misconception among parents - one that many doctors unfortunately indulge sometimes, when they acquiesce to parents who ask for antibiotics. (Though rates vary by health plan - you can see Maryland plans here - the National Committee for Quality Assurance found that, in 2014, one of every seven children who saw the doctor for a cold received an antibiotic.) In addition to not helping your child, this misguided prescribing also contributes to a major public health problem: helping superbugs develop resistance.

Antibiotics do have their role in medicine. Pediatricians, for example, typically prescribe them to treat conditions including: urinary tract infections, ear infections, strep throat, skin infections, pink eye, sinus infections and pneumonia.

So if your child is ill and you suspect she may have one of these conditions, consult your doctor. Last year a 6-year-old girl came from an urgent care to see me, looking tired and weak. When I examined her, I thought I heard something internally and ordered an x-ray. Sure enough, she had pneumonia. I prescribed her antibiotics and she soon recovered.

But in early December I examined a poor 6-year-old boy who was sick with a cold and a 100-degree fever that seemingly would not end. His parents asked for antibiotics, but an x-ray confirmed he did not have pneumonia. I gave him medication to treat his wheezing, but no antibiotics, and he soon improved too.

Antibiotics would not have helped this boy. They are not needed to aid most kids with ear infections either, because more than four in five ear infections go away on their own.

The lesson: Don't give your child antibiotics unless you have to. If you are worried your child has a bacterial infection, consult your doctor. But be aware: Many doctors prescribe antibiotics even if they don't think they are necessary to appease emotional parents.

At the least, think of the superbugs.

When to consult a doctor

Some cases, however, demand you consult with a doctor. Colds can lead to complications including pink eye, ear infections and breathing problems, such as wheezing and pneumonia. If your child has a fever lasting longer than three or four days, experiences shortness of breath or has audible wheezing, call or e-mail your doctor and ask about a visit. Same goes if your child is lethargic or irritable.

If necessary, your doctor will examine the child, look for signs of complications and treat them. Most of the time, kids are fine, but your doctor will ask you to return if symptoms get worse.

Last winter I examined a 7-month-old boy at my Kensington office. His parents brought him in because, in addition to his runny nose and congestion, he made a rattling noise while breathing the night before. I looked for any signs of complications, found none, and sent him home. While I understood his parents' concern, I would have preferred the parents e-mail me with the boy's symptoms rather than bringing him in. I could have confirmed the symptoms were normal, saved them a trip and protected the boy from picking up something else from other children.

By contrast, a 3-year-old girl did need medical attention last year. She started wheezing while living through her fifth cold of the season, so I ordered an inhaler that she used for the rest of the winter. The girl was healthy and inhaler-free by April. We are monitoring her closely this year to avoid having to escalate her treatment again.

She is the exception. Most colds run their course and kids get better with rest and the remedies I mentioned.

It is natural for parents to worry. But don't start with a trip to the doctor, as my mother-in-law suggested to care for our boys eight years ago. That night, I shrugged. My husband chuckled. The boys showed no symptoms of potential complications, and my husband knew his mother would never have taken him to the doctor when he had a cold - no matter how long it lasted.

My mother-in-law had the best intentions back then, as yours may now. When it comes to handling colds, though, not much has changed. So relax and know that this is normal, no matter how concerned you - or grandma - get.


Dr. Elizabeth Valois is a board-certified pediatrician with Mid-Atlantic Permanente Medical Group in Kensington. In addition to her general practice, she specializes in newborn care and tackling pediatric obesity.