What is the approach to managing fever, cough, and cold of viral origin in children between 1 to 15 years old?

Management of Viral Upper Respiratory Infections in Children Ages 1-15 Years

For children with mild fever and cough from viral infections, manage at home with antipyretics (acetaminophen or ibuprofen) and fluids—antibiotics are not indicated and cause more harm than benefit. 1, 2

Risk Stratification and Initial Triage

The approach depends on fever severity and presence of complications:

Mild Cases (Fever <38.5°C with cough/cold symptoms)

• Manage at home with supportive care only 3, 1
• Parents should provide antipyretics and ensure adequate fluid intake 3, 1
• No medical evaluation needed unless symptoms worsen 1

Moderate Cases (Fever >38.5°C with cough/influenza-like symptoms)

• Requires evaluation by a healthcare professional (nurse or doctor if under 7 years) 3
• If no high-risk features present: provide antipyretic advice and fluids 3
• Children under 1 year should be seen by a GP regardless 3

High-Risk Cases Requiring GP or Emergency Assessment

Children with fever >38.5°C PLUS any of the following:

• Chronic comorbid conditions (asthma, heart disease, immunocompromised) 3
• Breathing difficulties (increased respiratory rate, grunting, intercostal recession) 3, 4
• Severe earache 3
• Vomiting >24 hours 3
• Drowsiness or altered consciousness 3

These children may require antibiotics for suspected bacterial superinfection 3

Red Flags Requiring Immediate Hospital Referral

Transfer immediately if any of the following are present: 1, 4, 2

• Respiratory distress (markedly raised respiratory rate, grunting, intercostal recession) 3, 4
• Cyanosis or oxygen saturation <92% 3, 1, 4
• Severe dehydration 3, 1, 2
• Altered conscious level or extreme drowsiness 3, 1, 2
• Signs of septicemia (extreme pallor, hypotension, floppy infant) 3, 1, 2
• Complicated or prolonged seizures 3, 1

Home Management Protocol

Antipyretic Therapy

• Acetaminophen: 10-15 mg/kg every 4-6 hours (maximum 5 doses in 24 hours) 1, 4, 5
• Ibuprofen is equally safe and effective as an alternative 5
• NEVER use aspirin in children under 16 years due to Reye's syndrome risk 3, 1, 2
• Goal is comfort, not temperature normalization 2, 5

Cough and Cold Medications

• Do NOT use over-the-counter cough and cold medications in children under 4 years due to lack of efficacy and potential toxicity 1, 6, 7
• For children 4-6 years: dextromethorphan 2.5 mL every 12 hours (maximum 5 mL in 24 hours) 6
• For children 6-12 years: dextromethorphan 5 mL every 12 hours (maximum 10 mL in 24 hours) 6

Supportive Measures

• Adequate fluid intake to prevent dehydration 3, 1, 2
• Rest and observation for worsening symptoms 4, 2
• Saline nasal irrigation may provide symptom relief 2

When Antibiotics Are NOT Indicated

Antibiotics should NEVER be prescribed for: 2, 8

• Common cold or nonspecific upper respiratory infection 2
• Acute bronchitis without bacterial superinfection 2
• Viral pharyngitis (unless Group A Strep confirmed) 2

Antibiotics cause more harm than benefit in viral infections and contribute to antibiotic resistance 2

Mandatory Reassessment Criteria

Instruct parents to return or re-consult if: 1, 2

• Fever persists beyond 4-5 days 2
• Symptoms persist beyond 10 days 2
• Worsening after initial improvement 2
• Development of severe symptoms (respiratory distress, altered consciousness) 2
• Severe earache develops 2
• Vomiting >24 hours 2

Review at 48-72 hours is critical to detect complications such as pneumonia or bacterial superinfection that would require antibiotic therapy 4, 2

Hospital Management (If Required)

Children requiring admission typically need: 3, 4

• Oxygen therapy if saturation ≤92% 4
• Intravenous fluids (at 80% basal levels with electrolyte monitoring) 4
• Antibiotics if bacterial infection suspected 3, 4

ICU/HDU Transfer Criteria

• Failing to maintain SaO2 >92% in FiO2 >60% 3
• Signs of shock 3
• Severe respiratory distress with raised PaCO2 (>6.5 kPa) 3
• Recurrent apnea or irregular breathing 3
• Evidence of encephalopathy 3

Common Pitfalls to Avoid

• Never use aspirin for fever control in children under 16 years—risk of Reye's syndrome 3, 1, 2
• Avoid prescribing antibiotics for uncomplicated viral infections—they provide no benefit and cause harm 1, 2
• Do not use OTC cough/cold medications in children under 4 years—lack of efficacy and potential toxicity 1, 6, 7
• Do not focus on normalizing temperature—focus on overall comfort and well-being 2, 5

Expected Clinical Course

Most viral upper respiratory infections are self-limited, with symptoms lasting 7-10 days, though some children may have symptoms lasting >15 days 1, 8