What is the appropriate treatment for a 9‑year‑old child with a viral upper‑respiratory infection (common cold)?

Treatment of Common Cold in a 9-Year-Old Child

For a 9-year-old with an uncomplicated viral upper respiratory infection (common cold), provide supportive care only—antibiotics are never indicated, and combination antihistamine-decongestant products plus analgesics offer the most effective symptom relief. 1, 2

Core Management Principles

The common cold is a self-limiting viral illness that typically resolves in 7-10 days, with up to 25% of children experiencing symptoms for up to 14 days. 1, 2 Antibiotics provide no benefit for viral URIs and cause harm in up to 44% of children (most commonly diarrhea and rash) while contributing to antimicrobial resistance. 2, 3

Symptomatic Treatment Algorithm

First-Line Therapy

• Combination antihistamine-decongestant-analgesic products are most effective, with approximately 1 in 4 patients experiencing significant improvement (odds ratio of treatment failure 0.47; NNT 5.6). 1

• Oral analgesics for fever, headache, and malaise:

  • Ibuprofen 400 mg every 6-8 hours (also improves sneezing and nasal symptoms) 1, 4
  • Acetaminophen as alternative for pain and fever 1, 3
  • Naproxen for headache and cough reduction through anti-inflammatory mechanisms 5, 4

Nasal Symptom Management

• Oral decongestants: Pseudoephedrine or phenylephrine provide modest benefit for congestion 1, 3

• Topical nasal decongestants (e.g., oxymetazoline): For children 6-12 years, use 2-3 sprays per nostril every 10-12 hours, not exceeding 2 doses in 24 hours. 6 Critical caveat: Limit use to 3-5 days maximum to avoid rebound congestion (rhinitis medicamentosa). 1

• Nasal saline irrigation provides modest symptom relief and helps dilute secretions 1, 2, 3

Cough Management

• Dextromethorphan (60 mg for maximum effect, though standard OTC doses are likely subtherapeutic) 1
• Honey and lemon as a simple, inexpensive home remedy with patient-reported benefit 1
• Avoid opiate antitussives due to significant adverse effects without clear superiority 1

Supportive Care Measures

• Adequate hydration 2, 7
• Rest and comfortable humidity levels 2
• Proper hand hygiene to prevent transmission 2

When to Suspect Bacterial Complications

Do not diagnose bacterial sinusitis in the first 10 days of symptoms—87% of patients show sinus abnormalities on CT during viral colds that resolve without antibiotics. 8, 1 Suspect acute bacterial sinusitis only when: 8, 2

• Persistent symptoms ≥10 days without improvement, OR
• "Double worsening" (initial improvement followed by worsening), OR
• Severe onset with high fever (≥39°C) AND purulent nasal discharge for at least 3 consecutive days 8, 2

Critical Pitfalls to Avoid

• Never prescribe antibiotics based on purulent nasal discharge alone—colored discharge reflects normal viral inflammation, not bacterial infection 1, 2, 3

• Do not use over-the-counter cough and cold medications in children under 4 years due to potential harm without benefit 3

• Avoid intranasal corticosteroids for acute cold symptoms (ineffective) 1

• Do not use non-sedating (newer generation) antihistamines—they are ineffective for cold symptoms 1

Red Flags Requiring Further Evaluation

• Persistent high fever >3 days 2
• Symptoms persisting beyond 10 days without improvement 1, 2
• Signs of respiratory distress 2
• Hemoptysis (warrants chest radiograph) 1
• Severe unilateral facial pain 1

Patient and Parent Education

• Cold symptoms typically last 7-10 days, with throat pain resolving by days 3-4 1, 2
• Nasal discharge normally changes from clear to thick/purulent, then back to clear before resolving 2
• The illness is self-limiting and viral—antibiotics will not help and may cause harm 1, 2, 3
• Teach proper cough/sneeze etiquette and hand hygiene to prevent transmission 2