What is the best course of treatment for an infant with cough coryza (common cold), considering their age and potential respiratory distress?

Management of Cough and Coryza in Infants

For infants with cough and coryza (common cold), provide supportive care only—do not use over-the-counter cough and cold medications, as they are ineffective and potentially dangerous in children under 2 years of age. 1

Immediate Safety Assessment

First, determine if the infant requires hospitalization by assessing for:

• Respiratory distress signs: retractions (chest wall pulling in), nasal flaring, grunting, or tachypnea (>60 breaths/min in infants 0-2 months, >50 breaths/min in infants 2-12 months) 2, 3
• Hypoxemia: oxygen saturation <90-92% on pulse oximetry mandates immediate hospitalization 2, 3
• Age consideration: infants under 3 months are at significantly higher risk for severe disease and should be evaluated carefully for possible hospitalization 2
• Feeding difficulties: inability to feed or signs of dehydration require medical evaluation 1

Grunting is particularly concerning—it indicates severe disease and impending respiratory failure requiring immediate hospitalization. 3

Supportive Care at Home (For Mild Cases)

If the infant has only mild upper respiratory symptoms without respiratory distress or hypoxemia, manage with:

• Nasal suctioning: gentle bulb suctioning of nostrils to clear secretions and improve breathing 1, 4
• Hydration: ensure adequate fluid intake through frequent breastfeeding or formula feeding 2, 4
• Fever management: use acetaminophen (if >2 months old) or ibuprofen (if >6 months old) for comfort 1
• Positioning: keep infant in upright or semi-upright position to help with breathing 1
• Humidity: humidified air may help thin secretions 4

What NOT to Do

Avoid all over-the-counter cough and cold medications in infants under 2 years. 1 The evidence is clear on this:

• Between 1969-2006, there were 54 deaths associated with decongestants in children under 6 years (43 in infants under 1 year) 1
• 69 deaths were associated with antihistamines (41 in children under 2 years) 1
• These medications have not been proven effective for symptom relief in young children 1
• Major pharmaceutical companies voluntarily removed these products for children under 2 years from the market in 2007 1

Do not use:

• Topical decongestants in infants under 1 year (narrow therapeutic window with risk of cardiovascular and CNS toxicity) 1
• Codeine-containing medications (risk of serious respiratory depression) 5
• Bronchodilators or corticosteroids (not beneficial for viral upper respiratory infections) 6, 4
• Antibiotics (unless bacterial infection is confirmed) 1, 6

When to Seek Urgent Medical Attention

Parents should bring the infant to medical care immediately if:

• Respiratory rate >70 breaths/min (infants) or >50 breaths/min (older infants) 1
• Difficulty breathing, grunting, or cyanosis (blue color) 1
• Oxygen saturation <92% if measured at home 1
• Not feeding well or showing signs of dehydration (decreased wet diapers, no tears, sunken fontanelle) 1
• Persistent high fever ≥39°C (102.2°F) 1

Expected Clinical Course and Follow-Up

• Most viral upper respiratory infections resolve within 1-3 weeks 1
• Approximately 10% of children may still have cough at 3-4 weeks 1
• If cough persists beyond 4 weeks, the infant needs formal evaluation including chest radiograph and systematic assessment for chronic cough causes 5, 1

Special Consideration: Bronchiolitis

If the infant develops wheezing in addition to cough and coryza, consider bronchiolitis (most common in infants <6 months): 6, 7

• Typically starts with 2-4 days of upper respiratory symptoms (congestion, rhinorrhea, mild fever) 7
• Progresses to lower respiratory symptoms (wheezing, increased cough, respiratory distress) 7
• Management remains supportive with nasal suctioning, hydration, and oxygen if needed 6, 4
• Bronchodilators and corticosteroids are not recommended for infants 1-23 months with bronchiolitis 6

Critical Pitfalls to Avoid

• Do not dismiss young age: infants under 3-6 months with any concerning features should be evaluated for possible hospitalization regardless of initial symptom severity 2
• Do not rely on nasal discharge color: green or yellow mucus does not distinguish viral from bacterial infection 1
• Do not delay evaluation if symptoms worsen: if the infant is not improving or deteriorating after 48 hours, medical re-evaluation is necessary 1
• Do not use chest physiotherapy: it is not beneficial and should not be performed 1