I guess I shouldn’t complain too much about colds and flu — these two common illnesses are a large part of any primary care practice. Everyday I see several children who are excluded from school or day care, and I still have not been able to cure any of them.

Colds are caused by a variety of respiratory viruses — over 200 different types. Adults typically get two or three colds a year; children get twice as many. Younger children in day care or preschool can average up to nine per year, either separate infections, or back-to-back. I call this the Cold-of-the-Month Club.

The reason children get so many colds comes down to two factors: hygiene and immune response. As we all know, children do not have the most effective hygiene. They are poor hand-washers and excellent nose-pickers.  It can take several years and a several dozen colds to form a protective immune system against colds. Usually by age six, kids are doing a bit better in the cold department. We are never fully immune to viral infections, however. When children get colds at school or day-care, they bring them home.

By the time children show the symptoms of a cold, they have spread it around for at least a day. The contagious period for most colds is only for the first few days, even though the classic symptoms of a runny nose and coughing can hang on for a week or so. When you have one cold, you can still catch another before the first one abates. These back-to-back colds can cause symptoms to last a long time  I have video proof of my daughter coughing for about four months after starting preschool, all from these coalescing viruses. The more social a person becomes; the more colds they will acquire.

Hygiene practices in day care or preschool are pretty good; better than most homes. However, you can’t sanitize a child; only the things they touch. Hygiene procedures in elementary school are deplorable. I don’t think anyone disinfects surfaces anymore. The janitors just seem to empty the trash. Handwashing is one of the most effective cold preventative measures, and schools do stress it, but kids tend to skip it most of the time.

Kids cough and sneeze freely in the air. To limit the contamination of the hands, teachers often stress coughing and sneezing into the crook of the kids’ elbows, where they will contaminate their shirts in preparation for your after-school hug.

My sixth-grade teacher was a frightening tyrant when it came to covering your cough. She would openly chastise (yell at) any child who did not cover a cough with a tissue. As soon as she would hear a cough or sneeze, she would single you out with her homing sense. One day, a cough caught me off-guard. It was just a little hack, but I watched in horror as a loogie emerged from my throat and went sailing toward her desk where she was sitting. My heart stopped as this rogue loogie landed on her desk pad. I thought that my life was over, but I got an unexpected reprieve. She didn’t notice the gift, and mindlessly piled some papers on top of it. My heart started beating again.

There is nothing that can shorten the duration of a cold, and it seems silly to me to exclude a child from school when they have cold. If they are sick or feverish, they should be home, but if they just have a snotty nose, they really can go to school. Coughing can be disruptive in class, so there is nothing wrong with using a non-sedating cough suppressant or providing some cough drops. Drippy noses can be controlled with a non-sedating antihistamine, but this will not cure them. Only “tincture of time” will cure a cold. I can offer medical advice, symptom control suggestions, and exam a person for possible secondary infections, but only your immune system can cure a cold. If you get better while under my care, I will take the credit, though.

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