What is the recommended treatment for rhinovirus (common cold) in babies?

Treatment of Rhinovirus (Common Cold) in Babies

Rhinovirus infection in babies is a self-limiting illness that requires only supportive care—there are no effective antiviral treatments, and antibiotics should not be used unless bacterial co-infection is documented. 1

Primary Management Approach

The cornerstone of management is supportive care focused on maintaining hydration and comfort:

• Ensure adequate hydration and assess fluid intake regularly, as this is the most critical intervention for babies with rhinovirus infection 1
• Provide supplemental oxygen only if oxygen saturation falls persistently below 90% in previously healthy infants 1
• Use acetaminophen or ibuprofen for fever or discomfort as needed for symptom relief 1
• Consider nasal saline irrigation to help clear nasal secretions and provide symptomatic relief 2, 1

What NOT to Use

Understanding what to avoid is as important as knowing what to provide:

• Do not use antibiotics unless there is documented bacterial co-infection, which is rare—only 1 patient out of 48 hospitalized children with rhinovirus had concomitant bacterial infection in one study 3
• Do not use systemic or nasal corticosteroids, as evidence does not support their use in post-viral respiratory infections in children 2, 1
• Do not use antihistamines, as they show no benefit over placebo in children with post-viral respiratory illness 2
• Do not use bronchodilators routinely—they should only be continued if there is documented clinical improvement 1
• Palivizumab has no role in treatment of established rhinovirus infection; it is only for RSV prophylaxis in high-risk infants and should never be used as treatment 1, 4

Clinical Context and Severity

Rhinovirus can cause serious illness in young infants, particularly those under 12 months:

• 86% of hospitalized children with rhinovirus are less than 12 months of age, with bronchiolitis being the most common presentation 3
• Preterm infants are at particularly high risk for severe disease requiring respiratory support 5
• The clinical presentation in young infants can mimic RSV infection, with respiratory distress, wheezing, poor feeding, and apnea 3, 6

Monitoring and Follow-Up

• As the infant's clinical course improves, continuous oxygen saturation monitoring is not routinely needed 1
• Premature infants and those with underlying heart or lung disease require close monitoring during oxygen weaning 1
• Watch for signs of respiratory distress including increased work of breathing, poor feeding, or apnea

Prevention Strategies

Since treatment options are limited, prevention becomes paramount:

• Practice meticulous hand hygiene—this is the single most important measure to prevent transmission 1, 4
• Keep babies away from individuals with respiratory symptoms 4
• Avoid exposure to tobacco smoke, which increases susceptibility to respiratory infections 2, 1
• Encourage breastfeeding to decrease the risk of lower respiratory tract disease 2, 1
• Limit exposure to crowded settings during respiratory virus season when feasible 4

Common Pitfalls to Avoid

• Overuse of antibiotics when there is no evidence of bacterial co-infection—this was done in 54% of hospitalized children with rhinovirus despite only 2% having documented bacterial infection 1, 3
• Continuing bronchodilator therapy without documented benefit 1
• Inadequate infection control measures leading to nosocomial transmission, particularly in NICU settings where 78% of preterm infants with severe rhinovirus acquired it nosocomially 1, 5
• Confusing rhinovirus with RSV and inappropriately using RSV-specific prophylaxis or treatments 1