What is the adjunct therapy for fever, cough, and malaise in children?

Adjunct Therapy for Fever, Cough, and Malaise in Children

The primary adjunct therapy for fever, cough, and malaise in children includes antipyretics (acetaminophen or ibuprofen) and adequate fluid intake, with aspirin strictly avoided in children under 16 years due to risk of Reye's syndrome. 1, 2

Initial Assessment and Management

Mild Symptoms (Treat at Home)

• Children with mild cough and low-grade fever should be managed at home with antipyretics and adequate fluids 2
• Acetaminophen (10-15 mg/kg every 4-6 hours, not exceeding 5 doses in 24 hours) is recommended for fever control 3, 4
• Ibuprofen is an alternative antipyretic option for children 2
• Ensure adequate hydration to prevent dehydration 3, 2

Moderate Symptoms (Community Health Professional)

• Children with high fever (>38.5°C) and cough should be evaluated by a healthcare professional 1, 2
• Children under 7 years should be seen by a nurse or doctor 1
• If no high-risk features are present, manage with antipyretics, fluids, and consider oseltamivir for influenza-like symptoms in children over 1 year 1, 2
• Children under 1 year should always be evaluated by a physician due to higher risk of complications 1, 2

High-Risk Features (GP or Emergency Department)

Children should be assessed by a GP or in the emergency department if they have:

• High fever (>38.5°C) with chronic comorbid disease 1
• Breathing difficulties 1, 2
• Severe earache 1
• Vomiting >24 hours 1
• Drowsiness 1, 2

Treatment Approach

Antipyretics

• Acetaminophen remains the antipyretic of choice for most children 3, 5
• Dosing: 10-15 mg/kg every 4-6 hours (not exceeding 5 doses in 24 hours) 3
• Alternative: Ibuprofen at appropriate weight-based dosing 2
• IMPORTANT: Never use aspirin in children under 16 years due to risk of Reye's syndrome 1, 2

Hydration

• Ensure adequate oral fluid intake to prevent dehydration 3, 2
• If unable to maintain hydration orally, consider IV fluids (at 80% basal levels with electrolyte monitoring) in hospital setting 3

Additional Therapies

• For suspected influenza in children over 1 year, consider oseltamivir if within 48 hours of symptom onset 1, 2
• For children at high risk of complications, consider antibiotics in addition to antipyretics and fluids 1
• Children under 1 year with no high-risk features should be treated with antipyretics and fluids with a low threshold for antibiotics if they become more unwell 1

Hospital Management

If hospital admission is required:

• Provide oxygen therapy if saturation is ≤92% 3
• Administer IV fluids if needed 3
• Provide antibiotics and oseltamivir as appropriate 1

Common Pitfalls to Avoid

• Using aspirin for fever control in children under 16 years 1, 2
• Relying solely on temperature measurement without assessing overall clinical status 5, 6
• Failing to recognize signs of serious illness requiring medical attention 2, 6
• Overuse of antibiotics for likely viral infections 7
• Underestimating the importance of adequate hydration 3, 2

Follow-up Recommendations

• Review children treated at home if deteriorating or not improving after 48 hours 3
• Provide families with information on managing fever, preventing dehydration, and identifying signs of deterioration 3, 7
• Monitor for complications if the child remains febrile or unwell after 48 hours of treatment 3