What is the assessment and plan for a breastfed infant presenting with a low-grade fever, stuffy nose, and cough, with a mother suspecting allergies, and who has not been seen since the newborn visit, with notable oral and ear examinations?

From the Guidelines

The infant presents with low-grade fever (101°F), stuffy nose, cough, and white patches in the mouth, suggesting a possible viral upper respiratory infection with oral thrush, and I recommend treating the oral thrush with nystatin oral suspension 100,000 units (1 mL) applied to each side of the mouth four times daily after feedings for 7-14 days, as the most recent and highest quality study does not provide a direct recommendation for this specific case, but the American Academy of Pediatrics guidelines support the use of nystatin for oral thrush 1.

The respiratory symptoms and low-grade fever suggest a viral infection rather than allergies, as the infant's symptoms are consistent with a common viral upper respiratory infection, and the mother's suspicion of allergies is not supported by the clinical presentation.

• The infant's age and symptoms are consistent with a viral infection, and the risk of serious bacterial infection is low, as stated in the clinical policy for well-appearing infants and children younger than 2 years of age presenting to the emergency department with fever 1.
• The white patches in the mouth are consistent with oral thrush (candidiasis), a common fungal infection in infants that develops when the normal balance of organisms in the mouth is disrupted.
• For fever and discomfort, acetaminophen (Tylenol) can be given at 10-15 mg/kg every 4-6 hours as needed, as this is a common and effective treatment for fever and discomfort in infants.
• The respiratory symptoms should be managed with nasal saline drops and gentle suctioning with a bulb syringe before feedings and sleep, as this can help to relieve congestion and make breathing easier.
• Ensure adequate hydration by continuing breastfeeding, as breast milk is an important source of nutrition and hydration for infants.
• Since the child hasn't been seen since the newborn visit, a complete physical examination is necessary, including assessment of growth parameters, development, and vaccination status, as this is an important part of routine pediatric care.
• The child should be scheduled for regular well-child visits to ensure proper development and timely vaccinations according to the recommended schedule, as this is an important part of preventive pediatric care, and the management of community-acquired pneumonia in infants and children older than 3 months of age should be guided by clinical practice guidelines 1.

From the FDA Drug Label

If pregnant or breast-feeding ask a health professional before use. The FDA drug label does not answer the question.

From the Research

Assessment and Diagnosis

• The patient is a baby with a low-grade fever of 101, stuffy nose, and cough, and the mother suspects allergies 2.
• The mother states that the baby has not been seen since the new baby visit and has been breastfed, with no allergies to medications, and uses the church clinic for vaccines.
• Assessment of the mouth shows white cheeks, and the ears need to be assessed.

Treatment and Management

• For upper respiratory tract infections (URTIs), recommended therapy involves symptom management with over-the-counter drugs, though the Food and Drug Administration advises against use of these drugs in children younger than 6 years 2.
• Acute rhinosinusitis is typically viral, and a bacterial etiology is more likely if symptoms last longer than 10 days, the temperature is greater than 39°C (102.2°F), or if symptoms worsen after initial improvement 2.
• Antibiotics are not recommended unless symptoms worsen or do not improve after an additional 7 days 2.
• For acute otitis media, antibiotics are recommended in all children younger than six months, in those between six months and two years if the diagnosis is certain, and in children with severe infection 3.

Antibiotic Use

• Delayed antibiotics probably resulted in a reduction in antibiotic use compared to immediate antibiotics, but was not shown to be different to no antibiotics in terms of symptom control and disease complications 4.
• The strategy of no antibiotics further reduced antibiotic use compared to delaying prescription for antibiotics 4.
• Delaying prescribing did not result in significantly different levels of patient satisfaction compared with immediate provision of antibiotics, but delay was favoured over no antibiotics 4.

Patient Satisfaction and Clinical Outcomes

• Patient satisfaction probably favoured delayed over no antibiotics, but there was probably no difference in patient satisfaction between delayed and immediate antibiotics 4.
• For many clinical outcomes, there were no differences between prescribing strategies, but symptoms for acute otitis media and sore throat were modestly improved by immediate antibiotics compared with delayed antibiotics 4.
• There were no differences in complication rates, and reconsultation rates and use of alternative medicines were similar for delayed, immediate and no antibiotic strategies 4.