What are the treatment recommendations for a 12-month-old infant with a runny nose and cough?

Management of Runny Nose and Cough in a 12-Month-Old

Do not use over-the-counter cough and cold medications in your 12-month-old child, as they are ineffective and potentially dangerous at this age. 1, 2

What NOT to Do (Critical Safety Information)

• Never give cough suppressants, decongestants, or antihistamines to children under 2 years of age due to risk of serious morbidity and mortality, including 54 deaths from decongestants and 69 deaths from antihistamines in young children between 1969-2006. 2
• Avoid topical nasal decongestants in infants under 1 year due to narrow margin between therapeutic and toxic doses, with risk of cardiovascular and central nervous system side effects. 2
• Do not give honey to infants under 12 months due to risk of infant botulism. 3
• Do not use chest physiotherapy, as it provides no benefit and should not be performed. 1, 2, 3

Recommended Home Care (What You Should Do)

Symptom Management

• Use acetaminophen or ibuprofen to manage fever and keep your child comfortable, which can also help with coughing. 1, 2, 3
• Ensure adequate hydration by offering frequent fluids (breast milk, formula, or water if appropriate) to help thin secretions. 1, 2, 3
• Gentle nasal suctioning with saline drops followed by bulb syringe aspiration can help clear nasal passages and improve breathing. 2, 4

Environmental Measures

• Eliminate tobacco smoke exposure completely, as this exacerbates respiratory symptoms and impairs recovery. 1
• Maintain adequate rest for your child. 3

When to Seek Immediate Medical Attention

Contact your healthcare provider or go to the emergency department if your child develops any of these warning signs:

• Respiratory rate greater than 70 breaths per minute 1, 2, 3
• Difficulty breathing, grunting, or working hard to breathe 1, 2, 3
• Blue color around lips or face (cyanosis) 1, 2
• Oxygen saturation less than 92% (if you have a home monitor) 1, 2, 3
• Not feeding well or refusing to eat 1, 2, 3
• Signs of dehydration (decreased wet diapers, no tears when crying, dry mouth) 1, 2, 3
• Intermittent apnea (pauses in breathing) 1, 2

Follow-Up Timing

• Schedule a follow-up visit if symptoms worsen or do not improve within 48 hours of starting home care measures. 1, 2, 3
• If cough persists beyond 4 weeks, your child will need systematic evaluation including chest radiograph to identify underlying causes, as this transitions from acute to chronic cough requiring different management. 1, 2

What to Expect (Natural Course)

• Most viral upper respiratory infections resolve within 1-3 weeks, though 10% of children may still have cough at 25 days. 2
• Runny nose and cough are typically viral in this age group and will resolve with supportive care alone. 2, 5

Antibiotics: When They Are NOT Needed

• Do not request antibiotics for simple runny nose and cough, as young children with mild lower respiratory symptoms do not need antibiotics. 1, 2, 3
• Antibiotics are only indicated if your child develops signs of bacterial pneumonia (high fever ≥39°C for 3+ days, severe respiratory distress, or oxygen saturation <92%). 1, 2, 3
• Color of nasal discharge does not indicate need for antibiotics, as green or yellow mucus occurs with viral infections. 2

Common Pitfalls to Avoid

• Do not assume the cough needs medication to stop—cough is a protective mechanism that helps clear secretions from the airways. 1
• Do not use multiple over-the-counter products thinking combination therapy will help; these remain dangerous regardless of how many you use. 2
• Do not delay seeking care if your child develops warning signs while waiting to see if symptoms improve on their own. 1, 2, 3