Baby colds and blocked noses: safe relief and when to worry

Most colds in babies are caused by viruses and get better on their own. Healthdirect, the Australian Government health service, says younger children can take up to 2 weeks to recover, and a dry cough can hang around for several weeks after that. You can't cure a cold, but you can ease a blocked nose, keep feeds going and keep sleep safe. The most important job is watching your baby's breathing, feeding and alertness, because those tell you when a cold has become something more.

What are the symptoms of a cold in a baby, and how long does it last?

A cold usually brings a runny or blocked nose, sneezing, a cough and a mild temperature. The NHS says symptoms come on over 2 to 3 days and can last longer in young children than in adults. Babies breathe mostly through their nose, so a blocked nose tends to bother them most at feeds and sleep.

The Royal Children's Hospital Melbourne (RCH) says it's common for a dry cough to continue for several weeks after a cold, and to see a doctor about one lasting more than 4 weeks. Healthdirect says healthy preschool children often catch at least 6 colds a year, because they haven't met many viruses yet. Most children catch fewer as they get older.

Is it a cold or bronchiolitis?

Bronchiolitis is a chest infection that starts like a cold. The NHS bronchiolitis page says it affects babies and children under 2, and that babies under 6 months are at higher risk of serious illness. After the cold-like start, watch for:

• a cough
• breathing more quickly
• finding it hard to feed
• noisy breathing, such as wheezing or crackling
• being irritable

The NHS says symptoms are usually worst between days 3 and 5, and the cough usually gets better in 3 weeks. The RCH bronchiolitis fact sheet describes it in babies up to 12 months, says they may be sick for around 7 to 10 days, and says the cough can last up to 4 weeks. The RCH advises seeing a doctor if your baby is feeding less than half their normal amount.

Ask your midwife, GP or child-health nurse about RSV protection in pregnancy or for your baby. Our vaccinations guide covers what's offered in Australia, the UK and the US.

How can I clear my baby's blocked nose?

1. Use saline drops or spray. Healthdirect, the RCH and the American Academy of Pediatrics (AAP) all suggest salt-water (saline) drops or spray to loosen mucus. You can buy them without a prescription.
2. Suction gently. The AAP suggests drawing out the loosened mucus with a bulb syringe. Go gently.
3. Do it just before feeds. The AAP suggests suctioning before breast or bottle feeds, so your baby can breathe while they suck.
4. Keep the air moist if it's dry. The AAP suggests a humidifier, placed out of your child's reach. The NHS warns not to let children breathe steam from a bowl of hot water, because of the risk of scalding.
5. Keep your home smoke-free. The RCH says cigarette smoke and vaping make a cough worse, and the NHS bronchiolitis page says not to smoke around your child.
6. Hold your baby upright when they're awake. The NHS suggests this for babies with bronchiolitis, and many parents find it comforting during any cold.

How do I keep my congested baby safe at night?

It's tempting to prop up a snuffly baby, but it isn't safe. The AAP's advice on sleep with a stuffy nose says propping a baby up on towels or pillows, or tilting the mattress, is not safe, because a baby breathes most easily when their airway is straight.

• Put your baby on their back for every sleep, on a firm, flat mattress in their own cot or bassinet.
• Keep the cot clear of pillows, wedges, positioners, rolled towels and other soft items.
• If your baby falls asleep in a swing, bouncer or car seat, the AAP says to move them to their own sleep space as soon as you can.
• The NHS suggests checking on a baby with bronchiolitis regularly, including overnight.

For the full safe-sleep basics, see safe sleep and sleep products to avoid. For which night-time breathing sounds are normal, see baby sleep sounds.

What medicines can I give my baby for a cold?

Most baby colds need no medicine at all.

• Cough and cold medicines. The RCH says there's no evidence they help children and they can be harmful, especially under 6. Healthdirect says not to give decongestants, antihistamines or cough syrups. The NHS says decongestants shouldn't be used by children under 6. The AAP says over-the-counter cough and cold medicines aren't recommended under 4, and only on a doctor's advice from 4 to 6.
• Honey. Don't give honey to a baby under 12 months. The RCH, NHS and AAP all say this.
• Pain and fever relief. Healthdirect says paracetamol or ibuprofen can help with discomfort. Age limits apply, so check the label and ask a pharmacist. Our fever guide lists the age limits and what to do about a temperature.
• Antibiotics. The RCH and healthdirect say antibiotics don't help colds and coughs caused by viruses.
• Vitamins. Healthdirect says vitamin supplements don't treat or prevent colds.

How do I keep my congested baby feeding?

A blocked nose makes feeding hard work. The AAP says breastfeeding is still recommended for babies with colds, and that expressing milk into a cup or bottle may help if feeding at the breast is too difficult for a while. The RCH suggests feeding small amounts more often.

Keep an eye on wet nappies. Fewer than usual is an early sign of dehydration, and a baby under 6 months with any sign of it needs a doctor the same day. See dehydration signs and when your baby feeds less than usual.

When should I take my baby to the doctor for a cold?

Call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) or go to emergency now if your baby:

• is struggling to breathe, is breathing very fast, or is sucking in at the throat, between the ribs or under the ribs
• grunts with each breath, pauses in their breathing, or breathes irregularly
• has blue, grey or very pale skin, lips or tongue
• is floppy, very drowsy, or won't wake or stay awake
• has a seizure, or is choking
• is under 3 months and has a temperature of 38°C (100.4°F) or more
• is 3 to 6 months old and has a temperature of 39°C (102.2°F) or more
• has had no wet nappy for 12 hours, or shows severe signs of dehydration
• started coughing after choking on food or a small object (the RCH says go to hospital)

These come from the RCH, the NHS bronchiolitis page and the NHS urgent-help guide. For breathing trouble, colour changes, a seizure or a baby you can't wake, call your local emergency number (000 in Australia, 999 in the UK, 911 in the US) rather than driving. The NHS bronchiolitis page puts a dry nappy for 12 hours, and a fever under 3 months, under urgent GP advice; its urgent-help guide lists both among reasons to call an ambulance or go to A&E, so we use that stricter tier.

Get medical help today if your baby:

• is feeding much less than usual, or taking less than half their usual amount
• has fewer wet nappies than usual, or any sign of dehydration under 6 months
• has a cold that's getting worse, or isn't improving after 48 hours
• is under 6 months and has a cough, which the AAP cough symptom checker says needs a call to the doctor within 24 hours
• is very tired, irritable or not themselves

Talk to your GP or child-health nurse if:

• a cough has lasted more than 4 weeks, or is getting in the way of sleep or play
• cold symptoms haven't cleared after 10 days, as the NHS suggests
• the treatment you were advised to use isn't working as expected

If you're unsure which tier fits, call a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US).

What's worth noting when your baby has a cold?

Jot down when symptoms started, your baby's temperatures with times, feeds and wet nappies over the last 24 hours, and any medicine given. Note any advice you've already received, with the date. A short video of your baby's breathing can help a doctor see what you saw. Never delay getting help to finish your notes.