What are the appropriate steps for a child with a cough and rhinorrhea?

From the Guidelines

For a child with a cough and rhinorrhea, the most appropriate initial step is to ensure rest and hydration, and consider using saline nasal drops and a cool-mist humidifier to ease congestion and coughing, as these measures can help manage symptoms and support the body's natural healing process 1. When evaluating a child with a cough and rhinorrhea, it is essential to consider the duration of the cough, as a chronic cough lasting more than 4 weeks may require further investigation and management according to pediatric-specific cough management protocols or algorithms 1. Some key considerations for managing a child with a cough and rhinorrhea include:

• Using saline nasal drops to loosen mucus and ease congestion
• Running a cool-mist humidifier in the child's room to reduce coughing and congestion
• Offering honey for children over 1 year to soothe the throat and suppress coughing
• Using acetaminophen or ibuprofen as directed for the child's age and weight to manage fever or discomfort
• Avoiding over-the-counter cough and cold medicines for children under 6 years old
• Keeping the child's head elevated during sleep to reduce postnasal drip and coughing
• Using a bulb syringe to gently suction out nasal mucus in infants It is crucial to monitor the child's symptoms and seek medical attention if they worsen, persist beyond two weeks, or are accompanied by high fever, difficulty breathing, or severe discomfort 1. In cases where the cough is chronic and unrelated to an underlying disease, a 2-week course of antibiotics targeted to common respiratory bacteria may be recommended, as suggested by the CHEST guidelines 1. Ultimately, the management of a child with a cough and rhinorrhea should be tailored to the individual child's needs and symptoms, and guided by the most recent and highest-quality evidence available 1.

From the FDA Drug Label

Purpose Cough suppressant Warnings ... Ask a doctor before use if you have • chronic cough that lasts as occurs with smoking, asthma or emphysema • cough that occurs with too much phlegm (mucus) Stop use and ask a doctor if • side effects occur. You may report side effects to FDA at 1-800-FDA-1088 • cough lasts more than 7 days, cough comes back, or occurs with fever, rash or headache that lasts.

For a child with a cough and rhinorrhea, the appropriate steps are to:

• Ask a doctor before using any medication, especially if the child has a chronic cough or cough with too much phlegm.
• Monitor the child's symptoms and stop use and ask a doctor if the cough lasts more than 7 days, comes back, or occurs with fever, rash, or headache that lasts.
• Consider consulting a doctor to determine the best course of treatment, as the FDA drug label does not provide explicit guidance on the management of cough and rhinorrhea in children 2 2.

From the Research

Appropriate Steps for a Child with a Cough and Rhinorrhea

• The child's symptoms should be evaluated to determine the underlying cause of the cough and rhinorrhea, as it may be a self-limiting condition resulting from a viral illness 3
• A thorough history taking is essential in diagnosing the cause of the cough, including questions about the duration, frequency, and characteristics of the cough, as well as any associated symptoms such as fever, nasal congestion, or sore throat 4
• Physical examination, chest radiography, and spirometry may be necessary to rule out any underlying conditions or diseases responsible for the cough 4
• The use of over-the-counter cough and cold medications is not recommended for acute cough in children, as they offer no symptomatic relief and may pose a risk of side effects and adverse reactions 3
• A "wait, watch, review" approach is recommended, where clinicians educate parents on expected illness duration and discuss safe, supportive care measures to alleviate the child's discomfort, such as hydration, rest, and saline nasal sprays 3
• If the child's symptoms persist or worsen, further evaluation and treatment may be necessary, including consideration of an aerodigestive team approach to evaluate a wide variety of causes of cough 5

Considerations for Anesthesia in Children with a Cough and Rhinorrhea

• Children with symptomatic infections, such as wheezing, purulent secretion, fever, and reduced general condition, should have anesthesia postponed for at least 2 weeks 6
• Preoperative inhalational therapy with salbutamol, avoidance of endotracheal intubation, use of a face mask or laryngeal mask, and intravenous induction with propofol may be considered for children with upper airway infections 6
• Prevention, early recognition, and immediate treatment of complications by an experienced anesthesiologist are crucial in managing anesthesia in children with a cough and rhinorrhea 6

Common Symptoms and Duration of a Cough and Rhinorrhea

• The most common symptoms of a common cold in school-aged children are nasal congestion, cough, and runny nose, which can last for at least 10 days 7
• Rhinovirus is a common cause of colds in children, and potential bacterial pathogens such as Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis may also be present 7