Allergies vs. colds in children

If your child seems to constantly have a runny nose, cough or congestion, you are not alone.

"It's not unusual for kids to get six to eight colds per year, lasting from 10-14 days," explains Michael Lee, M.D., a pediatrician with Children's Health℠ and Professor at UT Southwestern. "Additionally, seasonal allergies have become more prevalent."

So how can parents tell if it's a cold or allergies? Dr. Lee explains the difference between causes and symptoms in kids.

What's the difference between a cold and allergy symptoms in children?

When exposed to certain particles – such as animal dander, pollen, trees and grasses – children may have an allergic response. This occurs when the immune system overreacts to allergens, triggering the release of histamine and other chemicals into the bloodstream.

This response causes common allergy symptoms in kids, including:

• Itchy, watery eyes

• Runny nose

• Cough and congestion

• Sneezing

• Sometimes a sore throat

The common cold, on the other hand, is a contagious viral infection. Children pick up cold viruses through direct person-to-person contact, contact with airborne respiratory droplets or by touching viruses on surfaces.

Common cold symptoms in kids can include:

• Runny nose

• Cough and congestion

• Sneezing

• Sore throat

• Fatigue

• Slight body aches

• Fever, in some cases

Does my child have allergies or a cold?

While many allergy and cold symptoms in toddlers and children are similar, parents can look for certain clues to help tell the difference between a cold vs. allergy.

1. If your child is under age 1, it's likely a cold

It is unusual for a baby under 1 year old to be diagnosed with seasonal allergies. "With allergies, you typically must be exposed to things a number of times to get an allergic response," explains Dr. Lee. "It's not that a baby can't have an allergic reaction to something during the first year of life, but typical seasonal allergies usually involve older kids."

2. Fever usually signals a cold or viral infection, not allergies

If your child has a fever, it's likely that they have a cold or another type of viral illness, and not an allergy. "Fever is one of my big tiebreakers. Allergies do not cause fevers in children," explains Dr. Lee.

3. Fatigue and exhaustion usually indicate cold or viral illness

If your child has cold symptoms and feels wiped out and exhausted, it's probably a cold or viral illness. "Children who suffer from seasonal allergies don't feel well, but usually they can still function and attend school," explains Dr Lee.

4. Check your child's eyes for allergy symptoms

Itchy, watery eyes more commonly indicate allergies, not a cold. Also, look for a purple and red discoloration under your child's lower eyelid – called an "allergic shiner." Some shiners indicate swelling and congestion caused by allergies. Others are genetic.

5. Notice your child's nasal discharge

A clear, thin nasal discharge – along with itchy, watery eyes – suggests that your child may be dealing with allergies. Of course, children with a common cold may also have clear secretions. A thick nasal discharge, regardless of color, suggests a cold or other infectious process.

6. Duration of symptoms

Common cold symptoms rarely last longer than two weeks. Allergy symptoms will linger as long as the child is exposed to the allergen. With seasonal allergies, your child may have symptoms for many weeks at a time during pollen seasons in the spring, summer or fall.

7. Horizontal nasal line indicates possible allergy

When children rub their nostrils up and down and wiggle their nose side to side, the movement creates a wrinkle or crease on top of their nose. Often, the line or crease is white or reddish in color. "If a child has been dealing with an itchy, sneezy, runny nose for weeks, and we see a horizontal line on the nose, we suspect allergies," explains Dr. Lee. "That crease is pretty much exclusive to allergy sufferers who rub their nose."

8. If antihistamines work, it's probably an allergy

For children over age 1 year, you can use an antihistamine to help determine whether they have colds or allergies. "Try a non-sedating antihistamine. If your child gets no relief within the next day or two, it's probably a cold virus," explains Dr. Lee. "However, if symptoms clear up quickly with the antihistamine, your child probably suffers from seasonal allergy symptoms."

How to treat allergies and colds in children

Once you've determined if your child has a cold or allergy, you can take steps to provide relief.

Treating seasonal allergy symptoms in children

• Minimize symptoms at home by washing clothes after being outside, vacuuming often and using air filters and purifiers.

• Try a non-sedating oral antihistamine, such as Zyrtec or Claritin. Your child should get relief within a day or two.

• If the antihistamine helps, but not much, add a nasal steroid such as over-the-counter Flonase which you spray into the nose. Sometimes you need both antihistamine and nasal spray to control allergies.

• You can also try nasal spray only. If your child gets relief, skip the oral antihistamine.

Treating common cold symptoms in children

• Use saline solution in the nose to loosen congestion and help children blow their noses. Or, suck out the congestion with a bulb syringe.

• Try certain home remedies to help relieve your child's symptoms. For children over age 1 year, a spoonful of honey by mouth may help soothe a sore throat. (Do NOT give honey to babies under the age of 1 year.)

• Use acetaminophen or ibuprofen, as prescribed by your doctor, to treat aches, pain and fever.

• For children over age 2 years, you can use mentholated ointments on top of the chest to soothe and calm coughs, especially nighttime coughs.

• For children over age 6 years, you can use a topical decongestant such as nasal spray to help relieve nasal congestion. If used, use at night for no more than 3 days in a row.

• Learn when to consult your physician if your young baby has common cold symptoms.

Keep in mind that oral cough and cold medications are not recommended for children under the age of 6 years. "Typically, I try to avoid oral cough and cold medications for children of any age," says Dr. Lee. "They are not effective and can have potential side effects, such as elevated blood pressure."

If your child's cold and allergy symptoms last more than two weeks, consult your doctor. If you are concerned your child’s symptoms are COVID-19, you should also contact your child’s pediatrician. Learn more about allergies vs. COVID-19.

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