What parental guidance should be provided for a healthy 9‑month‑old infant presenting with rhinorrhea and nasal congestion but a normal physical exam, including supportive care, red‑flag signs, and timing of the next well‑child visit?

Parental Guidance for a 9-Month-Old with Runny Nose and Congestion

First-Line Treatment: Saline Irrigation

Saline nasal irrigation is the primary and most effective treatment for nasal congestion in your 9-month-old infant. 1 This simple intervention helps remove mucus and debris from the nasal passages, temporarily reduces tissue swelling, and promotes drainage without the risks associated with medications. 1, 2

• Apply saline drops or spray to each nostril, then use gentle nasal aspiration with a bulb syringe or nasal aspirator to clear secretions. 1, 2
• This can be repeated multiple times throughout the day, especially before feedings and sleep, to help your baby breathe and eat more comfortably. 2, 3
• Saline irrigation is safe, well-tolerated, and has no serious adverse effects reported in infants. 3

What NOT to Use

Do not give your infant any over-the-counter cold medications, decongestants, or antihistamines. 1, 4 The FDA and American Academy of Pediatrics strongly recommend against these medications in children under 2 years of age because:

• They have not been proven effective for treating congestion in infants. 1, 4
• They carry serious safety risks, including 54 deaths from decongestants and 69 deaths from antihistamines in young children. 1, 4
• Major pharmaceutical companies voluntarily removed these products for children under 2 years from the market in 2007. 4

Expected Course

Most viral upper respiratory infections causing runny nose and congestion in infants are self-limiting and resolve within 7–10 days. 5 Your baby's nasal discharge may start clear and watery, then become thicker and cloudy (which is normal), before improving. 5

• Approximately 10% of children may still have symptoms at 3–4 weeks, which is still within the normal range for viral infections. 4
• The color of nasal discharge (clear, white, yellow, or green) does not indicate whether the infection is viral or bacterial—colored mucus is normal during viral colds. 5

Supportive Care at Home

• Hydration: Ensure your baby continues to feed well (breast milk or formula) to stay hydrated and help thin secretions. 1, 4
• Positioning: Keep your baby's head slightly elevated during sleep (by elevating the head of the crib mattress, not with pillows) to improve breathing comfort. 1
• Fever management: If your baby has fever and appears uncomfortable, acetaminophen (Tylenol) can be given for comfort—consult your pediatrician for proper dosing. 5, 4
• Humidity: A cool-mist humidifier in the room may help keep nasal passages moist, though evidence for steam therapy is limited. 1

Red-Flag Signs Requiring Immediate Medical Attention

Bring your baby to the doctor or emergency department immediately if you notice any of these warning signs:

• Breathing difficulty: Respiratory rate greater than 70 breaths per minute, grunting sounds, chest retractions (skin pulling in between ribs), or flaring nostrils. 5, 1, 4
• Oxygen problems: Blue or gray color around the lips or face (cyanosis). 5, 1, 4
• Feeding issues: Refusing to feed, unable to take liquids, or signs of dehydration (fewer than 4 wet diapers in 24 hours, no tears when crying, sunken soft spot). 5, 1, 4
• High fever: Temperature ≥39°C (102.2°F) lasting 3 or more days. 1, 6
• Lethargy or irritability: Excessive sleepiness, difficulty waking, or inconsolable crying. 5, 4
• Apnea: Any pauses in breathing or episodes where your baby stops breathing briefly. 5, 4

When to Follow Up with Your Pediatrician

Schedule a follow-up appointment if:

• Symptoms persist beyond 10 days without any improvement. 1, 6 At this point, bacterial sinusitis becomes more likely and may require antibiotic treatment. 6
• Your baby develops new or worsening symptoms after initially improving (such as new fever or increased irritability). 6
• You notice any of the red-flag signs listed above. 5, 1, 4
• Symptoms are not improving after 48 hours of home care with saline irrigation. 1, 4

Keep Your Well-Child Visits

Continue to attend all scheduled well-child visits as planned. 1 These routine appointments are important for monitoring your baby's growth, development, and immunizations, and are separate from managing this acute illness. Your pediatrician can address any ongoing concerns about the congestion during these visits if symptoms persist.

Common Pitfalls to Avoid

• Do not assume that thick, colored nasal discharge means your baby needs antibiotics—this is a normal part of viral colds. 5
• Do not use topical nasal decongestant sprays (like Afrin) in infants, as they have a narrow margin between therapeutic and toxic doses and can cause serious side effects. 1
• Do not delay seeking care if your baby shows any breathing difficulty or refuses to feed—these are urgent concerns in infants. 5, 1, 4
• Do not give honey to infants under 12 months of age due to the risk of botulism. 4