What is the best management for a child with a 5-day history of fever, dry cough, and sore throat?

Management of a Child with Fever, Dry Cough, and Sore Throat

The child's presentation is consistent with a viral upper respiratory tract infection (URTI) that should be managed with supportive care including adequate hydration, paracetamol for fever and discomfort, and close monitoring for worsening symptoms.

Clinical Assessment

The child presents with:

• 5-day history of fever, dry cough, and sore throat
• Poor appetite and reduced oral intake for 3 days
• Normal vital signs (temperature now 36.4°C, SpO2 100% on room air)
• Red and slightly swollen throat
• No respiratory distress, good air entry, and no abnormal breath sounds
• No signs of serious illness requiring urgent intervention

Management Plan

1. Supportive Care

• Hydration: Encourage small, frequent sips of fluids to maintain hydration, especially important given the 3-day history of reduced intake 1
• Fever management: Continue paracetamol as needed for fever and discomfort at appropriate weight-based dosing (15 mg/kg/dose, not exceeding 5 doses in 24 hours) 2
• Rest: Advise continued rest and isolation from siblings until symptoms resolve 1

2. Monitoring

Advise parents to seek further medical attention if:

• Fever persists beyond 4-5 days or returns after improvement 1
• Breathing becomes difficult or rapid 1
• Child becomes drowsy, disoriented, or confused 1
• Cough worsens or persists beyond 3 weeks 1
• Unable to maintain adequate hydration

3. Antibiotic Therapy

• Antibiotics are not indicated at this time as the presentation is consistent with a viral URTI 1, 3
• The throat swab culture results should be reviewed when available
• If Group A beta-hemolytic streptococcus is identified in the throat culture, appropriate antibiotic therapy should be initiated 3

4. Prevention of Transmission

• Maintain good hand hygiene for the child and family members 1
• Continue isolation from siblings until symptoms improve 1
• Avoid sharing utensils and personal items

Rationale

Most URTIs in children are viral in origin and self-limiting, typically resolving within 1-3 weeks 1. The absence of respiratory distress, normal oxygen saturation, and good air entry indicate that this is likely an uncomplicated URTI rather than a lower respiratory tract infection requiring antibiotics 4.

The child's presentation does not meet criteria for immediate antibiotic therapy as outlined in guidelines, which recommend antibiotics only for those who are systemically very unwell, have features of serious illness, or have specific risk factors 5.

Key Points for Parents

• URTIs are common in children and most are caused by viruses that resolve without antibiotics
• Adequate hydration is crucial during illness
• Use paracetamol appropriately for fever and discomfort
• Monitor for warning signs that would require reassessment
• Good hand hygiene can help prevent spread to other family members