What is the appropriate treatment for a child presenting with rhinorrhea (runny nose) and cough?

Management of Runny Nose and Cough in Children

For a child with runny nose and cough, supportive care measures are recommended as first-line treatment, with antibiotics reserved only for specific cases with suspected bacterial infection. 1

Supportive Care Measures

• Provide adequate hydration to help thin secretions 1
• Use antipyretics and analgesics (like acetaminophen or ibuprofen) to keep the child comfortable and help with coughing 2, 1
• Teach proper nose-blowing techniques and consider saline nasal sprays to relieve congestion 3
• Ensure the child is monitored for signs of deterioration, with parents educated about warning signs 2, 1
• Honey can be used for cough in children older than 1 year of age 4

Important Medication Restrictions

• Over-the-counter cough and cold medications should NOT be used in children under 2 years due to lack of efficacy and potential for serious toxicity 1
• Between 1969-2006, there were 54 fatalities associated with decongestants and 69 fatalities associated with antihistamines in young children 1
• Chest physiotherapy is not beneficial and should not be performed 2
• Dextromethorphan and other cough suppressants have not shown significant benefit over placebo in children 2, 5

When Antibiotics May Be Considered

• Young children with mild symptoms of lower respiratory tract infection generally do not need antibiotics 2, 1
• If bacterial infection is suspected (persistent symptoms >10 days, high fever, or worsening course after initial improvement), amoxicillin is the first choice for children under 5 years 2, 6
• For rhinosinusitis with persistent symptoms, amoxicillin for 7-10 days may be appropriate 2, 6
• For suspected bacterial pneumonia, amoxicillin is first choice for oral therapy in children under 5 years 2

When to Seek Medical Attention

• Respiratory rate >70 breaths/min in infants or >50 breaths/min in older children 2, 1
• Difficulty breathing, grunting, cyanosis, or oxygen saturation <92% if measured 2, 1
• Not feeding well or signs of dehydration 2, 1
• Persistent high fever or worsening symptoms 1
• No improvement after 48 hours of treatment 2, 1

Follow-up Recommendations

• Children being cared for at home should be reviewed by a healthcare provider if symptoms are deteriorating or not improving after 48 hours 2, 1
• For persistent cough beyond 4 weeks, further evaluation may be needed 1

Common Pitfalls to Avoid

• Overuse of antibiotics for viral upper respiratory infections 2, 6
• Using decongestants or antihistamines in young children, which can cause serious side effects 2, 1
• Assuming persistent cough indicates asthma without proper evaluation 2
• Failure to recognize signs of deterioration requiring medical attention 2, 1

Remember that most upper respiratory infections in children are viral and self-limited, with symptoms typically resolving within 7-10 days 3, 4.