The common cold in children: Clinical features and diagnosis

INTRODUCTION — The epidemiology, clinical features, complications, and diagnosis of the common cold in children will be discussed here. The treatment and prevention of the common cold in children; the clinical features, diagnosis, and management of coronavirus disease 2019 (COVID-19) in children; and the common cold in adults are discussed separately.

●(See "The common cold in children: Management and prevention".)

●(See "COVID-19: Clinical manifestations and diagnosis in children".)

●(See "COVID-19: Management in children".)

●(See "The common cold in adults: Diagnosis and clinical features".)

●(See "The common cold in adults: Treatment and prevention".)

DEFINITION — The common cold is an acute, self-limiting viral infection of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge (rhinorrhea), sore throat, cough, low-grade fever, headache, and malaise. It can be caused by members of several families of viruses; the most common are the more than 100 serotypes of rhinoviruses.

VIROLOGY

Viral causes — The symptoms of the common cold can be caused by a variety of viruses (table 1). Rhinoviruses, which include more than 100 serotypes, cause up to 50 percent of colds in children and adults [1]. (See "Epidemiology, clinical manifestations, and pathogenesis of rhinovirus infections".)

Many of the other viruses that cause colds also cause other characteristic clinical syndromes in children [2]:

●Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – COVID-19 (see "COVID-19: Clinical manifestations and diagnosis in children")

●Common cold coronaviruses (eg, human coronavirus [HCoV] 229E, HCoV-OC43, HCoV-NE63, HCoV-HKU1) – Pneumonia and croup (see "Coronaviruses", section on 'Respiratory syndromes')

●Influenza viruses – Influenza, pneumonia, and croup (see "Seasonal influenza in children: Clinical features and diagnosis", section on 'Clinical features')

●Respiratory syncytial virus (RSV) – Bronchiolitis in children younger than the age of two years (see "Bronchiolitis in infants and children: Clinical features and diagnosis", section on 'Clinical features' and "Respiratory syncytial virus infection: Clinical features and diagnosis in infants and children", section on 'Clinical manifestations')

●Parainfluenza viruses – Croup (see "Croup: Clinical features, evaluation, and diagnosis", section on 'Clinical presentation' and "Parainfluenza viruses in children", section on 'Clinical presentation')

●Adenoviruses – Pharyngoconjunctival fever (palpebral conjunctivitis, watery eye discharge, and pharyngeal erythema) (see "Pathogenesis, epidemiology, and clinical manifestations of adenovirus infection")

●Coxsackievirus A (an enterovirus) – Herpangina (see "Hand, foot, and mouth disease and herpangina", section on 'Herpangina')

●Other nonpolio enteroviruses – Aseptic meningitis (see "Viral meningitis in children: Clinical features and diagnosis", section on 'Clinical features')

●Human metapneumovirus – Pneumonia and bronchiolitis [3,4] (see "Human metapneumovirus infections", section on 'Children')

Subsequent immunity — Rhinoviruses, adenoviruses, influenza viruses, and enteroviruses produce lasting immunity, but immunity does little to prevent subsequent colds because there are so many serotypes. RSV, parainfluenza viruses, and coronaviruses do not produce lasting immunity [2,5]. Reinfection may occur, but subsequent infection with the same agent is generally milder and of shorter duration.

EPIDEMIOLOGY

●Seasonal patterns – The common cold may occur at any time of year, but there is typically a high prevalence during the fall and winter months as the different viruses move through the community in a predictable manner. In the northern hemisphere, this yearly epidemic begins with an increase in the number of rhinovirus infections in September [6], followed by parainfluenza viruses in October and November. The winter months are characterized by an increase in respiratory syncytial virus, influenza virus, and common cold coronavirus infections [7]. Adenovirus infections are continuously present at a low rate throughout the common cold season. The epidemic finally ends with a small wave of rhinovirus infections in March and April [8]. Enteroviruses most often cause illness in the summer but can be detected throughout the year. SARS-CoV-2 is present year-round.

●Transmission – Viruses that cause colds are spread by three mechanisms [2]:

•Hand contact – Self-inoculation of one's own conjunctivae or nasal mucosa after touching a person or object contaminated with cold virus

•Inhalation of small particle droplets (droplet nuclei or aerosols) that become airborne from sneezing or coughing

•Deposition of large particle droplets that are expelled during sneezing and land on nasal or conjunctival mucosa (typically requires close contact with an infected person)

The most successful means of viral spread for the majority of upper respiratory infections (URI), including rhinoviruses, is transmission of infectious secretions from contaminated fingers and hands to the mucous membranes of the nose or eyes of a susceptible recipient [9]. Young children are more often responsible than adults for transfer of infection within the home [10]. The risk of person-to-person transfer is dependent upon the amount of time people spend together, the proximity of their contact with one another, and the amount of virus shed by the infected patient. Accordingly, larger households have an increased prevalence of rhinovirus [10]. In experimental studies, rhinovirus was efficiently transferred from hand to hand after minimal contact (10 seconds) and subsequent contact with nasal or conjunctival mucosa resulted in infection [11]. Particle aerosols were an inefficient method of rhinovirus transmission [11,12]. However, both influenza virus and coronavirus can be transmitted via aerosols. Preventive measures related to the COVID-19 pandemic (eg, mask-wearing, avoiding crowds) have slowed the overall spread of cold viruses in children. (See "Seasonal influenza in children: Clinical features and diagnosis", section on 'Transmission' and "Coronaviruses", section on 'Epidemiology'.)

Substantial titers of rhinovirus are present in nasal secretions of infected individuals. Low titers of rhinovirus are present in saliva in approximately one-half of infected individuals. Viral contamination of the hands of infected individuals is common. Rhinoviruses may remain viable on human skin for as long as two hours [13]. Rhinoviruses also can survive for up to one day on inanimate surfaces, although porous materials such as tissues and cotton handkerchiefs do not appear to support virus survival [13-16].

Surface contamination of pediatric office toys with respiratory viral ribonucleic acid (RNA) does not appear to be an important method of transfer. In an observational study, approximately 20 percent of the toys in a pediatric office waiting room were contaminated with picornavirus RNA (rhinovirus or enterovirus). Cleaning with a disposable germicidal wipe (containing quaternary ammonium with alcohol) was only modestly effective in removing the viral RNA, but transfer from the toys to the fingers was inefficient [17].

●Period of infectivity – Rhinovirus shedding peaks on the third day after inoculation; this coincides with a peak in symptoms [18,19]. In experimental studies, viral titers in nasal washings returned to near baseline values by five days after inoculation [18]. Low levels of viral shedding may persist for up to two weeks.

The period of infectivity for other viruses that cause the common cold is discussed in individual topic reviews. As examples, (see "Respiratory syncytial virus infection: Clinical features and diagnosis in infants and children", section on 'Transmission and incubation period' and "COVID-19: Epidemiology, virology, and prevention", section on 'Transmission').

●Incubation period – The incubation period (time between contact with infectious material until the onset of symptoms) for most common cold viruses is 24 to 72 hours.

PATHOPHYSIOLOGY — Symptoms of the common cold are largely due to the innate immune response to infection rather than to direct viral damage to the respiratory tract [20]. After deposition on nasal or conjunctival mucosa, cold viruses attach to receptors on epithelial cells in the nasopharynx and enter the cells [2]. During rhinovirus infection, viral replication occurs in only a small number of nasal epithelial cells [21,22]. The infected cells release cytokines, including interleukin (IL)-8, which attracts polymorphonuclear cells (PMNs) [23-25]. Large numbers of PMNs (100-fold increase) accumulate in the nasal secretions and mucociliary clearance is slowed [26].

Symptoms usually appear one to two days after viral inoculation, coinciding with the influx of PMNs in the nasal submucosa and epithelium [26-28]. The severity of symptoms correlates with mucosal IL-8 concentrations. A change in the character of the nasal discharge from clear to yellow/white or green correlates with the increase in PMNs but not with an increase in positive bacterial cultures [29]. The colored discharge may signify the presence of PMNs (yellow or white) or of PMN enzymatic activity (green color).

By an unknown mechanism, rhinovirus infection increases vascular permeability in the nasal submucosa, releasing albumin and kinins (bradykinin), which may then contribute to the symptoms of the common cold [26,30]. Bradykinin causes rhinitis and sore throat when sprayed into the noses of volunteers [31]. Histamine concentration does not increase in experimental rhinovirus infection [26,30]. (See "Epidemiology, clinical manifestations, and pathogenesis of rhinovirus infections".)

Histologic studies in young adults with natural and experimentally induced colds demonstrate that the nasal epithelium remains intact, although there is an influx of PMNs into the nasal submucosa and epithelium [27,28]. In vitro, rhinoviruses and coronaviruses do not cause gross destruction of nasal epithelial cells; however, adenoviruses and influenza A have a cytopathic effect, with resultant destruction of nasal epithelial cells [32].

CLINICAL FEATURES

Frequency and duration — Children younger than six years have an average of six to eight colds per year (up to one per month, September through April), with a typical symptom duration of 14 days [1,33,34]. Young children in daycare appear to have more colds than children cared for at home. However, when they enter primary school, children who attended daycare are less vulnerable to colds than those who did not [35,36].

Older children and adults have an average of two to four colds per year, with a typical symptom duration of five to seven days [1,8]. The duration of symptoms is increased among cigarette smokers [37].

Symptoms and signs

Symptom profile — The symptom profile of the common cold varies from patient to patient, in part due to age and in part due to the causative virus. However, the wide range and overlapping manifestations of the various cold-causing viruses make it impossible to determine the specific causative virus without laboratory testing [1,5,34]. The clinical manifestations and diagnosis of COVID-19 in children are discussed separately. (See "COVID-19: Clinical manifestations and diagnosis in children".)

In infants, fever and nasal discharge are common manifestations. Additional manifestations may include fussiness, difficulty feeding, decreased appetite, and difficulty sleeping.

In preschool- and school-aged children, nasal congestion, nasal discharge, and cough are the predominant symptoms. In a prospective study of 81 colds in school-aged children (5 to 12 years), caregivers recorded signs and symptoms during the first 10 days of illness [34]. Signs and symptoms included cough, sneeze, feverishness (defined as ill-appearing, flushed, warm to touch), congestion, nasal discharge, and headache; sore throat and hoarseness were not evaluated. Rhinovirus RNA was detected in 46 percent of episodes. The frequency and duration of the various manifestations were as follows (figure 1):

●Nasal congestion was reported in 59 percent at the onset of illness, peaked (88 percent) on day 3, and persisted in ≥75 percent on day 7

●Runny nose peaked (72 percent) on day 3 and persisted in ≥50 percent on day 6

●Cough was reported in 46 percent at onset, peaked (69 percent) on day 1, and persisted in ≥50 percent on day 8

●Sneezing was reported in 36 percent at the onset of illness, peaked (55 percent) on day 1, and persisted in ≥35 percent on day 6

●Feverishness was reported in 15 percent at the onset of illness and declined over the first three days

●Headache was reported in 15 percent at the onset of illness, 20 percent on day 1, and approximately 15 percent through day 4

Approximately three-quarters of children remained symptomatic on day 10 of illness.

Fever — Fever may be the predominant manifestation of the common cold during the early phase of infection in young children [2]. It is uncommon in older children and adults. (See "The common cold in adults: Diagnosis and clinical features", section on 'Clinical features'.)

New onset of fever or recurrence of fever (if one was present at the onset of illness) may indicate secondary bacterial infection (eg, acute otitis media, sinusitis, pneumonia). (See 'Complications' below.)

Nasal manifestations — Nasal congestion, nasal discharge, and sneezing are common in children [34]. Examination may reveal erythema and swelling of the nasal mucosa and nasal discharge. Nasal discharge may be clear initially but often becomes colored (yellow or green) within a few days [2]. Coloring of the nasal discharge is probably related to the increase in number or enzymatic activity of polymorphonuclear cells [29]. Coloring of the nasal discharge does not indicate bacterial superinfection or acute bacterial sinusitis [1,29]. (See 'Pathophysiology' above.)

Acute bacterial sinusitis may be indicated by persistence of nasal discharge for more than 10 days without improvement, severe symptoms, or worsening symptoms (as defined below). (See 'Sinusitis' below.)

Cough — Cough occurs in more than two-thirds of children with the common cold and may be the most bothersome symptom for the child's caregivers [34,38]. Cough may affect the child's sleep, school performance, and ability to play; it also may disturb the sleep of other household members and be disruptive in the classroom [39]. The cough may linger for an additional week or two after other symptoms have resolved but should gradually improve. Diagnoses other than the common cold should be considered if the cough worsens or fails to improve. (See 'Differential diagnosis' below.)

Other symptoms and signs — Other symptoms and signs of the common cold may include sore throat (typically an early manifestation), hoarseness, headache, irritability, difficulty sleeping, decreased appetite, anterior cervical adenopathy, and conjunctival injection. Vomiting and diarrhea are uncommon [1,2,34].

Middle ear abnormalities — Middle ear abnormalities are common during the course of an uncomplicated cold [40,41]. In an observational study of 86 children (2 to 12 years) with colds, two-thirds had abnormal middle ear pressure (assessed by tympanometry) at some point during the two weeks after onset [40]. Abnormal middle ear pressures were most common during the first week. They shifted from ear to ear and were present only intermittently during the course of the cold.

Abnormal middle ear pressure may predispose to the development of acute otitis media. The development of acute otitis media is not affected by treatment with combination decongestant-antihistamines [42]. (See 'Acute otitis media' below.)

The cause of abnormal middle ear pressure during the common cold is unknown. Viral nasopharyngitis may result in Eustachian tube dysfunction and abnormal middle ear pressure, or abnormal middle ear pressure may result from the viral infection of the mucosa of the middle ear and/or Eustachian tube.

Radiographic features — Self-limiting radiographic abnormalities of the paranasal sinuses are common during the course of an uncomplicated cold:

●In a study of 31 healthy young adults with recent onset of cold symptoms, abnormalities of the paranasal sinuses were evident on computed tomographic (CT) scans during the acute phase of illness in 27 (87 percent) [43]. Antibiotics were not administered, and follow-up CT scans two weeks later showed complete resolution or marked improvement in 11 of the 14 subjects evaluated (79 percent).

●In another study, 37 (62 percent) of 60 children (4 to 7 years old) with a cold had major abnormalities (more than one-third volume loss or air-fluid level) in their maxillary and/or ethmoid sinuses by magnetic resonance imaging (MRI). Twenty-six of the 37 had a follow-up MRI at two weeks: 30 percent had a new cold, and two had received an antibiotic. At follow-up, the major abnormalities were no longer present in 54 percent of ethmoid and 65 percent of maxillary sinuses [44].

It is unknown whether these abnormalities are the result of impaired sinus drainage or the result of actual viral infection of the sinus mucosa. Nose blowing has been demonstrated to propel nasal secretions into the paranasal sinuses [45]. However, the degree to which this contributes to the accumulation of fluid in the sinuses is uncertain.

COMPLICATIONS

Acute otitis media — The majority of children with a cold have abnormal middle ear pressure at some point during its course. (See 'Middle ear abnormalities' above.) Abnormal middle ear pressure may predispose to acute otitis media (AOM).

The risk of secondary acute otitis media is greatest among children 6 to 11 months of age [2]. AOM may be indicated by new-onset fever and earache after the first few days of cold symptoms. (See "Acute otitis media in children: Clinical manifestations and diagnosis", section on 'Clinical presentation'.)

Approximately one-third to one-half of colds in young children are complicated by development of AOM as defined by acute onset of symptoms, inflammation of the tympanic membrane, and fluid in the middle ear [46-48]. However, bacterial or suppurative otitis media, defined as a bulging tympanic membrane with purulent material behind it or purulent otorrhea from perforation of the tympanic membrane [49], occurs in only 5 to 19 percent of young children with colds [48]. In a prospective study, the frequency of AOM was increased among children who had middle ear effusion before they developed the cold [48].

Asthma exacerbation — Viral upper respiratory infections (URI) commonly are associated with wheezing in susceptible children and are associated with at least 50 percent of asthma exacerbations in children. (See "Asthma in children younger than 12 years: Initial evaluation and diagnosis", section on 'Respiratory tract infections'.)

Sinusitis — Viral URI is the most important risk factor for the development of bacterial sinusitis. Between 6 and 13 percent of viral URIs in children are complicated by acute bacterial sinusitis [47]. (See "Acute bacterial rhinosinusitis in children: Clinical features and diagnosis", section on 'Predisposing factors'.)

Secondary bacterial infection of the paranasal sinuses may be indicated by any one of the following (see "Acute bacterial rhinosinusitis in children: Clinical features and diagnosis", section on 'Clinical features'):

●Persistent nasal symptoms without improvement for more than 10 days

●Severe symptoms (temperature ≥39°C [102.2°F], ill-appearance, purulent nasal discharge for three to four days)

●Worsening symptoms (exacerbation of nasal discharge or cough, new onset fever, or recurrence of fever)

Lower respiratory tract disease — Bacterial pneumonia is an uncommon complication of the common cold. It may be indicated by new-onset fever after the first few days of cold symptoms. Prolonged cough in the absence of a new fever may signify viral lower respiratory tract infection. (See "Community-acquired pneumonia in children: Clinical features and diagnosis", section on 'Clinical presentation'.)

Complications related to SARS-CoV-2 — Complications related to SARS-CoV-2 include multisystem inflammatory syndrome in children, a life-threatening condition characterized by inflammation of the heart, lungs, kidneys, and other organs; myocarditis; and pericarditis. These complications are discussed separately. (See "COVID-19: Multisystem inflammatory syndrome in children (MIS-C) clinical features, evaluation, and diagnosis" and "Clinical manifestations and diagnosis of myocarditis in children".)

Other complications — Other complications of the common cold in children may include epistaxis, conjunctivitis, and pharyngitis. (See "Causes of epistaxis in children", section on 'Mucosal irritation' and "Conjunctivitis", section on 'Viral conjunctivitis' and "Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis", section on 'Viral infections'.)

DIAGNOSIS — The diagnosis of the common cold is made clinically, based upon history and examination findings, including exposure to someone with a cold, nasal congestion, nasal discharge, sore throat, fever (in young children), anterior cervical adenopathy, and erythema of nasal mucosa and oropharynx [2]. Laboratory tests are not helpful in making the diagnosis. (See 'Clinical features' above.)

Clinical features that may indicate a diagnosis other than an uncomplicated cold include persistent fever, high-fever (>39°C [102.2°F]), ill-appearance, absence of nasal symptoms, oral mucosal lesions (eg, the posterior vesicles of herpangina), wheezing, focal findings on lung examination (eg, dullness to percussion, reduced air entry, crackles, bronchial breathing), hemoptysis, acute onset of cough or difficulty breathing (may suggest inhaled foreign body), and/or features of a chronic respiratory disorder (eg, poor weight gain, finger clubbing, over-inflated chest, chest deformity, atopy) [39,50,51]. Chest radiography may be warranted in children with focal findings on lung examination, relentlessly progressive cough, hemoptysis, or features of an undiagnosed chronic respiratory disorder [39]. (See 'Complications' above and 'Differential diagnosis' below.)

Laboratory testing can identify the viral pathogen if it is necessary to do so (eg, if SARS-CoV-2 is a consideration) [1]. The wide range and overlapping manifestations of the various cold-causing viruses make it impossible to clinically determine the causative virus in an individual patient [1].

DIFFERENTIAL DIAGNOSIS — The differential diagnosis of the common cold includes other causes of rhinitis and/or cough [1,2,39]. These conditions usually can be differentiated from the common cold by history and physical examination.

●Allergic, seasonal, or vasomotor rhinitis; rhinitis medicamentosa – Historical features usually differentiate these disorders from the common cold (eg, previous history, pattern of onset, exposure, etc) (see "An overview of rhinitis")

●Acute bacterial sinusitis – Patients with acute bacterial sinusitis may complain of facial pain; acute bacterial sinusitis is differentiated from the common cold by the persistence, increased severity, or worsening of symptoms (see "Acute bacterial rhinosinusitis in children: Clinical features and diagnosis", section on 'Acute bacterial rhinosinusitis')

●Nasal foreign body – Clinical features suggestive of nasal foreign body include unilateral, fetid, purulent, or blood-stained nasal discharge; the foreign body usually can be seen with anterior rhinoscopy after suctioning purulent secretions (see "Diagnosis and management of intranasal foreign bodies")

●Structural abnormalities of the nose or sinuses – Structural abnormalities of the nose or sinuses may result in nasal congestion or stuffiness; these lesions usually are not associated with other manifestations of the common cold (eg, cough, sore throat, fever)

●Inhaled foreign body – Clinical features suggestive of inhaled foreign body may include acute onset of cough, a choking episode, monophonic wheezing, and localized decreased air entry (see "Airway foreign bodies in children", section on 'Presentation')

●Pertussis – Pertussis classically begins with mild cough and coryza (catarrhal phase); however the cough gradually increases and becomes paroxysmal (see "Pertussis infection in infants and children: Clinical features and diagnosis", section on 'Classic presentation')

●Influenza – Although influenza virus may cause the common cold, it usually causes more severe illness; abrupt onset of fever (often >39°C [102.2°F]), headache, myalgia, and malaise in addition to cough, sore throat, and rhinitis (see "Seasonal influenza in children: Clinical features and diagnosis", section on 'Clinical features')

●COVID-19 – The clinical manifestations of COVID-19 in children are variable. Some children present with symptoms of upper respiratory tract infection (see "COVID-19: Clinical manifestations and diagnosis in children", section on 'Clinical manifestations')

●Bronchitis – Most cases of acute bronchitis are caused by viruses and should not be treated with antibiotics. However, chronic cough (lasting >4 weeks) that is wet-sounding may be a symptom of protracted bacterial bronchitis for which antibiotic treatment is indicated. Protracted bacterial bronchitis is discussed separately. (See "Causes of chronic cough in children", section on 'Protracted bacterial bronchitis'.)

●Bacterial pharyngitis or tonsillitis – Group A streptococcal tonsillopharyngitis usually is not accompanied by nasal symptoms, which are the predominant manifestation of the common cold in children (see "Group A streptococcal tonsillopharyngitis in children and adolescents: Clinical features and diagnosis", section on 'Clinical features')

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Here are the patient education articles that are relevant to this topic. We encourage you to print or email these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient education" and the keyword[s] of interest.)

●Basics topic (see "Patient education: Cough in children (The Basics)")

●Beyond the Basics topic (see "Patient education: The common cold in children (Beyond the Basics)")

SUMMARY

●Definition – The common cold is an acute, self-limiting viral syndrome of the upper respiratory tract, involving, to variable degrees, sneezing, nasal congestion and discharge, sore throat, cough, low-grade fever, headache, and malaise. (See 'Definition' above.)

●Virology – The symptoms of the common cold can be caused by a variety of viruses (table 1). Rhinoviruses cause up to 50 percent of colds in children and adults. Other common causes of colds in children include coronaviruses, influenza viruses, respiratory syncytial virus, and parainfluenza viruses. (See 'Virology' above.)

●Transmission – The majority of colds are transmitted by hand contact; cold-inducing viruses may remain viable on human skin for at least two hours and on inanimate surfaces for a day. A few cold viruses, like influenza and SARS-CoV-2, can be transmitted by aerosols. (See 'Epidemiology' above.)

●Clinical features

•Children younger than six years have an average of six to eight colds per year, with typical symptom duration of 14 days. Older children have an average of two to four colds per year, with a typical symptom duration of five to seven days. (See 'Frequency and duration' above.)

•Nasal congestion, nasal discharge, and cough are the predominant symptoms (figure 1). Yellow or green coloring of the nasal discharge does not indicate bacterial superinfection or acute bacterial sinusitis. (See 'Symptoms and signs' above.)

•Abnormal middle ear pressure occurs frequently during the course of the common cold, particularly during the first week. (See 'Middle ear abnormalities' above.)

•Radiographic abnormalities of the paranasal sinuses (rhinosinusitis) also occur frequently during the course of the common cold and resolve without antibiotic treatment. (See 'Radiographic features' above.)

●Complications – Complications of the common cold include acute otitis media, acute bacterial sinusitis, asthma exacerbation, and lower respiratory tract disease. Complications related to SARS-CoV-2 include multisystem inflammatory syndrome in children, myocarditis, and pericarditis. (See 'Complications' above.)

●Diagnosis – The diagnosis of the common cold is made clinically, based upon history and examination findings, including exposure to someone with a cold, nasal congestion, nasal discharge, sore throat, fever (in young children), anterior cervical adenopathy, and erythema of nasal mucosa and oropharynx. (See 'Diagnosis' above.)

Laboratory testing can identify the viral pathogen if it is necessary to do so (eg, if SARS-CoV-2 is a consideration). (See "COVID-19: Clinical manifestations and diagnosis in children", section on 'Approach to diagnosis'.)

●Differential diagnosis – A diagnosis other than the common cold should be considered if the child has fever >39°C (102.2°F), ill-appearance, absence of nasal symptoms, oral mucosal lesions, wheezing, focal findings on lung examination, hemoptysis, or features of a chronic respiratory disorder (eg, poor weight gain, finger clubbing, over-inflated chest, chest deformity, atopy). Laboratory tests are not helpful in making the diagnosis. (See 'Complications' above and 'Differential diagnosis' above.)

The differential diagnosis of the common cold includes other causes of rhinitis (eg, allergic, seasonal, vasomotor rhinitis; rhinitis medicamentosa; acute bacterial sinusitis; nasal foreign body; structural abnormalities of the nose or sinuses) and/or cough (eg, inhaled foreign body, pertussis, influenza, COVID-19, bronchitis, bacterial pharyngitis or tonsillitis). These conditions usually can be differentiated from the common cold by history and physical examination. (See 'Differential diagnosis' above.)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges J Owen Hendley, MD, now deceased, who contributed to an earlier version of this topic review.