What to do for a 7-month-old infant with Upper Respiratory Tract Infection (URTI) symptoms, including a sore throat, decreased feeding, and stopping feeding after short intervals?

Management of 7-Month-Old with URTI and Feeding Difficulties

Focus on supportive care with close monitoring for dehydration, as this is most likely a self-limited viral URTI that does not require antibiotics. 1, 2

Immediate Assessment

Evaluate hydration status urgently - this is the primary concern when an infant stops feeding:

• Check for signs of dehydration: decreased urine output, dry mucous membranes, prolonged capillary refill, lethargy, sunken fontanelle 3
• Monitor for tachycardia and tachypnea as indicators of moderate dehydration 3
• At 7 months, infants are particularly vulnerable to rapid dehydration with decreased oral intake 3

Determine if This is Viral URTI (Most Likely)

Most URTIs in this age group are viral and self-limited, typically lasting 5-7 days with symptoms peaking at days 3-6 1:

• Nasal congestion/discharge (may become purulent without indicating bacterial infection) 1
• Cough 1
• Low-grade fever in first 24-48 hours 1
• Sore throat causing feeding refusal 2

Do NOT prescribe antibiotics for uncomplicated viral URTI - they provide no benefit and cause harm 1, 2

Rule Out Bacterial Complications Requiring Antibiotics

Only consider antibiotics if the infant meets stringent diagnostic criteria for specific bacterial infections 1, 2:

Acute Otitis Media (AOM)

• Requires middle ear effusion AND moderate/severe bulging tympanic membrane OR mild bulging with ear pain/erythema 2
• If diagnosed: First-line is amoxicillin 90 mg/kg/day 2

Acute Bacterial Sinusitis

• Requires symptoms that are persistent >10 days without improvement, worsening after initial improvement, or severe (high fever ≥39°C with purulent discharge for 3-4 consecutive days) 1
• At 7 months, sinusitis is uncommon as sinuses are not fully developed 1

Group A Streptococcal Pharyngitis

• Do NOT test or treat in children <3 years - GAS pharyngitis is rare in this age group 1, 2

Supportive Care Management (Primary Treatment)

Provide the following supportive measures 2, 4:

Hydration Strategy

• Offer frequent small feeds to maintain hydration despite sore throat 2, 3
• If breastfed: continue breastfeeding on demand, more frequently 3
• If formula-fed: offer smaller, more frequent bottles 3
• For impending dehydration: oral rehydration solution (ORS) in small, frequent amounts over 3-4 hours is successful in >90% of cases 3

Symptom Relief

• Appropriate antipyretics for fever (acetaminophen or ibuprofen at appropriate weight-based doses) 2
• Nasal saline drops/spray to help clear nasal congestion and facilitate feeding 2
• Humidified air may provide comfort 4

What NOT to Do

• Do NOT perform chest physiotherapy - it provides no benefit 2
• Do NOT prescribe antibiotics for viral URTI 1
• Do NOT use cough suppressants or decongestants in infants 4

Follow-Up Instructions

Instruct parents to return or call if 2:

• Infant is deteriorating or not improving after 48 hours
• Signs of dehydration develop (decreased wet diapers, lethargy, dry mouth)
• High fever (≥39°C) persists beyond 48-72 hours
• Breathing difficulty develops
• Infant refuses all feeds

Critical Pitfalls to Avoid

Common errors that worsen outcomes:

• Prescribing antibiotics for viral URTI causes unnecessary adverse events (diarrhea, rash, anaphylaxis) and contributes to antibiotic resistance 1, 2
• Failing to assess hydration status adequately - dehydration is the primary risk in infants with decreased feeding 3
• Using broad-spectrum antibiotics when narrow-spectrum would suffice (if bacterial infection truly present) 1
• Not providing clear return precautions to parents 2

The key distinction: Viral URTIs improve gradually after day 3-6, while bacterial complications either persist beyond 10 days, worsen after initial improvement, or present with severe symptoms from onset 1