Can a cold cause nausea and vomiting?

Can a Cold Cause Nausea and Vomiting?

Yes, the common cold can cause nausea and vomiting, particularly in young children, though these are not typical symptoms in adults with uncomplicated viral upper respiratory infections.

Age-Dependent Presentation

In Children (Especially Under 2 Years)

• Gastrointestinal symptoms including nausea, vomiting, and diarrhea are common manifestations of viral respiratory infections in infants and young children 1, 2
• Children may present with sudden onset of high fever, chills, cough, headache, sore throat, fatigue, nasal stuffiness, conjunctivitis, otitis media, nausea, and vomiting 2
• Neonates and infants may present with non-specific signs resembling sepsis, including fever, pallor, floppiness, lethargy, poor feeding, episodes of apnea, irritability, and appearing toxic 2
• In young children presenting to primary care during non-pandemic influenza season, fever with non-specific symptoms or diarrhea and vomiting is common 1

In Adults

• Nausea and vomiting are NOT typical features of the common cold in adults 3
• Adults typically present with abrupt onset of constitutional and respiratory signs including fever, chills, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis—but gastrointestinal symptoms are notably absent from this typical presentation 2
• The common cold in adults is characterized by nasal congestion, rhinorrhea, sore throat, and cough, lasting 7-10 days 3, 4

Important Clinical Distinctions

When GI Symptoms Suggest Something Other Than a Simple Cold

• If an adult presents with prominent nausea and vomiting alongside respiratory symptoms, consider influenza rather than the common cold 1, 2
• Gastrointestinal infections and food poisoning are the most common causes of acute nausea and vomiting in adults, not viral upper respiratory infections 5
• During viral illness outbreaks (such as COVID-19), nausea, vomiting, and diarrhea may accompany respiratory symptoms, though the overall prevalence is lower than initially estimated 1

Red Flags Requiring Further Evaluation

• Fever >38°C (100.4°F) persisting beyond 3 days or appearing after initial improvement 3, 4
• "Double sickening" pattern (initial improvement followed by worsening) 3, 4
• Severe unilateral facial pain suggesting bacterial sinusitis 3, 4
• Hemoptysis (any amount warrants chest radiograph) 3

Clinical Pearls

• The key distinction is age: young children commonly have GI symptoms with viral respiratory infections, while adults typically do not 1, 2, 6
• Colds in preschoolers differ from those in adults: fever is common in children during the first 3 days, colored nasal secretions may be the only indication of nasal involvement, and colds in children last 10-14 days compared to less than a week in adults 6
• Approximately 25% of patients continue with cough and nasal discharge up to 14 days—this is normal and does not indicate bacterial infection 3, 4
• If nausea and vomiting are the predominant symptoms in any age group, consider alternative diagnoses including gastroenteritis, food poisoning, medication side effects, or other systemic illnesses 7, 5