How to Treat a Baby with a Cold

The common cold is caused by more than 200 different types of viruses, with rhinovirus causing approximately 30%-40% of all colds. Other culprits are coronavirus, adenovirus, respiratory syncytial virus, and parainfluenza virus. The viruses invade your cells, hijack the cellular machinery, and force your own cells to crank out more virus. Fascinating! Yes, but also really annoying for about 10-14 days.


One of the most miserable aspects of getting a cold is the congestion and mucus. This is true for babies, kids and adults. Babies have a much harder time with mucus because a young baby can’t easily breathe through his or her mouth except when crying. Until approximately age three or four months babies haven’t developed the reflex to open their mouth if their nose is blocked. Newborns have tiny nasal passages (only about 1/10 inch in each nostril), so it takes very little change in that small space to cause big symptoms. Newborns with the least bit of nasal stuffiness often make snorting noises when eating, after crying, or if they have a cold. This is why a young baby with a stuffy nose is so uncomfortable and why you need to help your little one keep the nose clear of mucus.

Nose Anatomy

Your baby’s nose is an extraordinary filter and passageway. The lining of the nose has tiny glands that make the wet, slippery mucus that keeps the nose from becoming dry and allows air to flow more smoothly. There are lots of blood vessels in the nose to warm up the incoming air so it’s the right temperature when it arrives in the lungs. Millions of tiny hairs prevent large and small particles, like dust and pollution, from going down into the lungs. And of course, smell! A complex set of nerves sitting just above the nasal passageway samples the smells coming in. Smell is one of the most basic senses and is directly linked to the deepest parts of our brain where we store emotion and memory. Your baby bonds with you, in part, through smell. (Another reason to keep the nose happy and healthy!)

How to use saline drops or nose spray with your baby

It’s simple, really. All you need to do is hydrate and flush. Saline is the best liquid to use, because it has the same amount of salt as bodily fluid, and has no other dangerous chemicals. Taste whichever brand you buy. Some taste better than others. DO NOT use any other nasal spray, other than saline spray, in a baby.

Hold your baby at about a 45-degree angle or higher in your arms, not lying flat, so that he or she won’t feel like saline is going down the throat.  Place the nozzle in one side of the baby’s nose, and gently squeeze the bottle a few times. Aim the bottle to the back of the head. (Anatomy surprise! The nasal passage is actually parallel to a line from nose to the ear, not up towards the top of the head).  Repeat on the other side.  Most of the saline will drip back out, but some of it will go through to the back of the nasal cavity.

If your baby has a lot of liquid mucus congestion, use a bulb syringe to remove it out with short, quick bursts of suction. After you spray saline, suction out the excess. And follow up with more saline. It’s not a pleasant feeling, but many babies actually get used to this routine. They feel so much better afterwards, so it’s worth the temporary discomfort.

Do not use a tube device, or “snot sucker” for suctioning your baby. The filters will not trap viral particles that you are breathing in. Also, anytime you put something in your mouth that may have virus on it, you risk getting sick yourself.

Important: For a newborn you need to be careful with suctioning. Their nasal passage is so delicate that sometimes the congested sound is due to swollen tissues inside the nose, not liquid mucus. If you use a bulb syringe it will actually irritate the nose and cause more swelling. So if you can’t see lots of goopy boogers dripping out, just use the saline to hydrate.

Other ways to hydrate the upper airways

A cool mist humidifier in your baby’s room may also help, to keep the nose moist.  Make sure you read the package insert instructions on how best to keep your humidifier clean, and avoid using any menthol or medicated additives to the water tank. You can also sit in a steamy bathroom for 15 minutes and try to feed your baby. That will encourage moist air through the nose.  Keep your home temperature around 72 degrees. A very warm home will only create a drier environment. When sick your baby will need to feed more to stay hydrated, especially with a fever. Offer feeds frequently, and try to offer milk before and after using saline drops.

DO NOT use over-the-counter cold and cough medicines in babies and children. Most over-the-counter cough and cold medicines (aside from acetaminophen and ibuprofen) are not recommended for children under the age of 6 according to the American Academy of Pediatrics. If your baby has fever for more than three or four days, or you feel like his symptoms are getting worse rather than better, you should see your doctor.  Don’t use honey for a cough in babies under 1. Some honey carries a dangerous bacteria that can make your baby very sick or paralyzed (botulism).

Treat a Fever

If your baby is 3 months old or younger and has a fever, you should contact your pediatrician immediately.

Acetaminophen may be used to treat a fever if your baby is 4 months old or older, and ibuprofen can be used if your baby is over 6 months. Just be sure to consult your pharmacist or pediatrician about the correct dosage and make sure you are using the dosing for infant drops and not child drops. Use Pacidose by AGGIE MD to make sure your child is getting the full amount.

After 6 months of age, you can alternate the doses of ibuprofen and tylenol so your child is more comfortable and you can keep a fever down.  Keep track of what medicine you gave and when in a safe place. It’s easy to forget what was last given when you are sleep-deprived at 4 AM! Another middle of the night trick: put different colored tape for each medicine on your Pacidose syringe, and put that same colored tape on the acetaminophen or ibuprofen bottle. You can easily draw up the right amount of the right medicine in a dim room.

Don’t Prop Baby Up for Sleep

Although it may seem like your little one’s congestion would benefit from sleeping on an incline, it’s not a good idea. The American Academy of Pediatrics advises against letting your baby sleep in the car seat, so put him down on his back in a crib or bassinet. Sick babies might need smaller, more frequent feeds, so be prepared to get up more often during the night.

Wash Your Hands

According to the Centers for Disease Control (CDC), 80 percent of all infectious diseases are transmitted through the hands. Anyone coming into the home during cold and flu season should wash hands. Before touching a baby you should wash your hands again. For older babies, you can wash their hands or use sanitizing wipes. Be sure the sanitizer or wipe liquid is dry before letting your child free, as it’s not good for your child to ingest the alcohol.

Recognizing the symptoms of a worsening infection

There’s no cure for the viruses that cause a cold. But, sometimes a virus can allow bacteria to flourish. Contrary to what many think, the color of the mucus is not a reliable way to tell if a bacteria or virus is present. A better indicator is the overall picture for your baby. If your child had symptoms of a cold (runny nose, poor feeding, fever) and seemed to get better, then gets worse again, a bacterial infection may be setting in. Symptoms like tugging on ears, or persistent cough, might mean a middle ear infection or pneumonia. You have the best sense of your child’s well being, so if you are worried, see your doctor.