What treatment should I give to a pediatric patient presenting with cough and runny nose?

Management of Pediatric Cough and Runny Nose

For a pediatric patient with cough and runny nose, supportive care without medications is the recommended first-line approach, as most cases represent viral upper respiratory infections that are self-limited and do not require pharmacologic intervention.

Assessment and Diagnosis

• Most pediatric cough and runny nose cases are due to viral upper respiratory infections (URIs), which are self-limited and benign 1
• Differentiate between viral URI and bacterial sinusitis:
  • Viral URI: typically improves within 10 days, may include fever for 1-2 days, mucus that starts clear and becomes colored 2
  • Bacterial sinusitis: persistent symptoms >10 days without improvement, severe symptoms with high fever (≥39°C) for ≥3 days, or worsening pattern after initial improvement 2

First-Line Management

Supportive Care (Recommended)

• Adequate hydration and rest 3, 1
• Saline nasal drops/spray to relieve nasal congestion 1
• Antipyretics (acetaminophen or ibuprofen) if needed for fever or discomfort 4
• Positioning in supported sitting position to help with breathing if needed 4

Medications to Avoid

• OTC cough and cold medications should be avoided in children under 6 years of age due to lack of proven efficacy and potential toxicity 2
• Antihistamines should not be used for acute cough and runny nose unless allergic rhinitis is suspected 2
• Topical decongestants should be used with caution in children under 1 year due to narrow margin between therapeutic and toxic dose 2
• If topical decongestants are used in older children, limit to short-term use (≤3 days) to prevent rebound congestion (rhinitis medicamentosa) 2

When to Consider Antibiotics

Antibiotics should only be considered in specific circumstances:

• For suspected bacterial sinusitis (symptoms persisting >10 days without improvement, severe symptoms with high fever, or worsening pattern) 2
• For children under 5 years with suspected bacterial pneumonia, amoxicillin is first choice 2
• For children 5 years and older with suspected atypical pneumonia, macrolide antibiotics (azithromycin, clarithromycin) may be considered 2

Special Considerations

• Monitor for signs of respiratory distress requiring medical attention: increased respiratory rate, labored breathing, oxygen saturation <92% 4
• Young children with mild symptoms of lower respiratory tract infection generally do not need antibiotics 2
• If symptoms persist beyond 7 days or worsen with fever, rash, or persistent headache, medical reevaluation is warranted 5

Parent Education

• Explain the expected course of viral URI (typically 7-10 days, with symptoms often continuing for at least 10 days) 6
• Emphasize that colored mucus alone does not indicate bacterial infection 2
• Advise that fewer than 1 in 15 children develop bacterial sinusitis during/after a cold 2
• Instruct on warning signs requiring medical attention: difficulty breathing, inability to drink, persistent high fever, or worsening symptoms after initial improvement 4

Follow-up

• Consider follow-up if symptoms persist beyond 10 days or worsen after initial improvement 2
• Reevaluate if fever persists for more than 3 days or if respiratory distress develops 4

Remember that most pediatric respiratory infections are viral, self-limited, and require only supportive care. Medications should be used judiciously, with careful consideration of potential risks and benefits.