What is the management for a 3-year-old female with cough, cold, and fever?

Management of a 3-Year-Old Female (15kg) with Cough, Cold, and Fever

For this 3-year-old with cough, cold, and fever, manage at home with acetaminophen (150-225mg every 4-6 hours, maximum 5 doses/24 hours) and adequate fluids, avoiding aspirin and over-the-counter cough medications. 1

Initial Assessment and Triage

Determine fever severity and presence of high-risk features:

• Mild fever (<38.5°C) with cough and cold: Manage at home with supportive care 1, 2
• High fever (>38.5°C): Requires evaluation by healthcare professional to assess for complications 1, 3

Assess for red flags requiring immediate hospital referral: 1, 2, 3

• Signs of respiratory distress (markedly raised respiratory rate, grunting, intercostal recession, breathlessness)
• Cyanosis
• Severe dehydration
• Altered level of consciousness
• Complicated or prolonged seizure
• Signs of septicemia (extreme pallor, hypotension, floppy appearance)

Home Management (Mild Cases)

Antipyretic therapy:

• Acetaminophen 10-15 mg/kg every 4-6 hours (for 15kg child: 150-225mg per dose, maximum 5 doses in 24 hours) 2, 3, 4, 5
• Never use aspirin in children under 16 years due to Reye's syndrome risk 1, 3, 4

Supportive care: 1, 2, 4

• Ensure adequate fluid intake
• Monitor for worsening symptoms
• Educate parents that nasal discharge color change does not indicate bacterial infection

Avoid over-the-counter cough and cold medications:

• Do not use OTC cough/cold medications containing antihistamines or decongestants in children under 4 years 1, 6, 7
• These medications have minimal efficacy and potential for serious adverse events including death 1, 6
• Honey may be considered for cough relief in children over 1 year, though evidence is limited 1, 7

When to Escalate Care

Seek medical evaluation if: 1, 3

• Fever >38.5°C persists
• Breathing difficulties develop
• Severe earache occurs
• Vomiting >24 hours
• Drowsiness or altered behavior
• Not improving or deteriorating after 48 hours
• Fever persists beyond 3 days 5

Hospital Management (If Required)

Children requiring admission will need: 1, 2, 3

• Oxygen therapy if saturation ≤92%
• Intravenous fluids if unable to maintain hydration (at 80% basal levels with electrolyte monitoring)
• Antibiotics only if bacterial infection suspected (not for viral URI)
• Consider oseltamivir if influenza suspected and within 48 hours of symptom onset

Transfer to ICU/HDU if: 1, 3

• Failing to maintain oxygen saturation >92% despite supplemental oxygen
• Signs of shock
• Severe respiratory distress with elevated CO₂
• Recurrent apnea or irregular breathing
• Evidence of encephalopathy

Critical Pitfalls to Avoid

• Never use aspirin for fever control in children 1, 3, 4
• Avoid OTC cough/cold medications in young children due to lack of efficacy and potential toxicity 1, 6
• Do not prescribe antibiotics for uncomplicated viral upper respiratory infections 2, 4
• Do not underestimate subtle signs of respiratory distress in young children 3
• Ensure clear follow-up instructions and return precautions for parents 3

Expected Course

Most viral upper respiratory infections are self-limited, with symptoms lasting 7-10 days, though 7-13% of children may have symptoms lasting >15 days, particularly those in daycare 4. Fever alone at day 10 does not indicate bacterial infection requiring antibiotics 4.