What is the initial treatment for a 12-year-old patient presenting with cough, fever, and common cold symptoms?

Treatment for a 12-Year-Old with Cough, Fever, and Common Cold

For a 12-year-old with cough, fever, and common cold symptoms, provide symptomatic management with acetaminophen or ibuprofen for fever and pain, ensure adequate hydration, and use nasal saline irrigation—antibiotics are never indicated for uncomplicated viral upper respiratory infections and over-the-counter cough and cold medications have not been proven effective in this age group. 1, 2, 3

Initial Assessment and When to Escalate Care

First, determine if this is simple viral illness or requires more aggressive intervention:

• Mild symptoms (low-grade fever <38.5°C, mild cough): Manage at home with supportive care 4
• High fever (>38.5°C) with cough: Should be assessed by a healthcare professional 4
• Red flags requiring immediate evaluation: Breathing difficulties, severe earache, vomiting >24 hours, drowsiness, or fever persisting >3 days 4, 1, 2

The common pitfall here is diagnosing bacterial sinusitis too early—87% of patients show sinus abnormalities on CT during viral colds that resolve without antibiotics, so do not diagnose bacterial infection within the first 10 days of symptoms. 1

Symptomatic Treatment Approach

For Fever and General Discomfort

• Ibuprofen 400-800 mg every 6-8 hours is effective for headache, ear pain, muscle/joint pain, malaise, and also improves sneezing 1, 2
• Acetaminophen/paracetamol is an alternative for fever and pain 2, 3
• Never use aspirin in children under 16 years due to Reye's syndrome risk 4

For Nasal Congestion

• Saline nasal irrigation is the safest first-line approach to clear nasal passages without medication risks 3, 1
• Oral decongestants (pseudoephedrine or phenylephrine) provide modest benefit in adolescents and can be used for up to 3 days 1
• Topical nasal decongestants are effective but strictly limit to 3-5 days maximum to avoid rebound congestion 1, 2, 3

For Cough

• Honey (for children over 1 year) may offer relief and is superior to no treatment or diphenhydramine 4, 3
• Dextromethorphan at 60 mg provides maximum cough suppression effect in adults, though standard OTC doses are likely subtherapeutic and efficacy in adolescents is not well-established 1, 5
• Avoid codeine-containing medications due to potential for serious side effects including respiratory distress 4

What Does NOT Work

• Over-the-counter cough and cold medications should not be prescribed until proven effective, as they have not shown efficacy greater than placebo in children aged 7 years 4, 3
• Antibiotics provide no benefit for uncomplicated common cold and contribute to antimicrobial resistance 1, 2, 6, 7
• Non-sedating antihistamines (newer generation) are ineffective 4, 1

Supportive Care Measures

• Adequate hydration helps thin secretions and facilitates recovery 2, 3
• Cool-mist humidifier in the child's room helps thin secretions 3
• Avoid irritants such as tobacco smoke that may worsen symptoms 3

Expected Timeline and Follow-Up

• Normal duration: Cold symptoms typically last 7-10 days 1, 2
• Extended symptoms: Approximately 25% of patients continue with cough and nasal discharge up to 14 days—this is normal and does not indicate bacterial infection 4, 1, 2, 3
• Re-evaluate if: Cough persists beyond 10 days without improvement, fever persists >3 days or appears after initial improvement, or symptoms worsen after 48 hours of home management 1, 2, 3

When to Consider Bacterial Complications

Only suspect bacterial infection if at least 3 of 5 criteria are present: 1

• Discolored (purulent) nasal discharge
• Severe local pain
• Fever >38°C (100.4°F)
• "Double sickening" pattern (initial improvement followed by worsening)
• Elevated inflammatory markers

Remember that only 0.5-2% of viral upper respiratory infections develop bacterial complications. 1

Special Consideration for Influenza Pandemic Context

If this occurs during an influenza pandemic or confirmed influenza season, children with high fever (>38.5°C) and cough should be assessed for oseltamivir treatment, particularly if they have chronic comorbid disease or are at risk for complications. 4