From the Guidelines
For a 22-month-old with human rhinovirus, treatment should focus on symptom management, as this viral infection typically resolves on its own within 7-10 days, and the primary goal is to reduce morbidity, mortality, and improve quality of life. The most recent and highest quality study 1 suggests that management of viral rhinosinusitis (VRS) is primarily directed toward relief of symptoms, and antibiotics are not recommended for treating VRS since they are ineffective for viral illness and do not provide direct symptom relief.
Symptom Management
To manage symptoms, the following can be considered:
- Ensuring the child stays well-hydrated with frequent small amounts of water, breast milk, or formula
- Using a bulb syringe or nasal aspirator with saline drops (2-3 drops per nostril) to clear nasal congestion before feedings and sleep
- Giving acetaminophen (Tylenol) at 10-15 mg/kg every 4-6 hours as needed for fever or discomfort, typically 120 mg for a 22-month-old, but confirming dosing based on exact weight 1
- Avoiding cough and cold medications as they're not recommended for children under 4 years due to potential side effects and limited efficacy
- Using a cool-mist humidifier in the child's room to help ease breathing
- Elevating the head of the bed slightly by placing a towel under the mattress
Monitoring and Follow-up
It is essential to monitor the child's condition and contact a doctor if:
- The child has difficulty breathing
- Persistent high fever above 102°F (38.9°C)
- Decreased fluid intake
- Symptoms worsening after 7-10 days, as these could indicate a secondary infection requiring medical attention 1
Additional Considerations
Topical intranasal steroids may have a role in managing VRS, although they do not have a Food and Drug Administration (FDA) indication for this purpose, and the magnitude of effect is small, with 66% of patients improving with placebo at 14 to 21 days, rising to 73% with steroid therapy 1. However, the decision to use topical intranasal steroids should be based largely on patient preference, considering the modest clinical benefit and potential cost.
From the Research
Treatment for 22 Month Old Human Rhinovirus
- There is currently no licensed vaccine for rhinovirus, as the large variety of rhinovirus serotypes has posed significant challenges for research 2.
- Antiviral drugs and small molecule inhibitors of rhinovirus infection, as well as antiviral host defense peptides, are being explored as potential therapeutics for human rhinovirus 2.
- Recent evidence suggests that rhinovirus is a significant contributor to respiratory illness in both high-risk and low-risk populations of children 3, 4.
- Clinicians should have a high level of vigilance when managing children with positive respiratory viral testing for HRV/ENT given the potential for clinical outcomes similar to and, in some instances, worse than known highly pathogenic viruses 4.
- Topical nasal therapies, such as saline irrigations, may be effective in treating chronic rhinosinusitis, but there is insufficient evidence to support a clear benefit of topical antibiotics or antifungal therapies 5.
- The use of nasal corticosteroids is not contraindicated in the context of COVID-19, and nasal irrigation with saline solution does not appear to increase the risk 6.