What is the treatment for a 18-month-old child with rhinorrhea (runny nose) and sneezing for one week?

From the Guidelines

The treatment for an 18-month-old child with rhinorrhea and sneezing for one week is likely supportive care, as the symptoms are consistent with a viral upper respiratory tract infection, which is the most common cause of acute sinusitis in children.

Key Points

• The American Academy of Pediatrics defines acute bacterial sinusitis as a persistent illness with nasal discharge of any quality and/or daytime cough lasting for >10 days without improvement, a worsening clinical course, a severe onset of symptoms with concurrent fever, and purulent nasal discharge for at least 3 consecutive days 1.
• The diagnosis of acute bacterial sinusitis is based on clinical presentation and physical examination findings, and imaging is not recommended in this context as it does not change management 1.
• Antibiotics are not recommended for acute viral rhinosinusitis, and the use of antibiotics for acute bacterial sinusitis should be based on the severity of symptoms and the presence of complications 1.
• Supportive care, such as nasal saline irrigation and humidification, can help alleviate symptoms of viral upper respiratory tract infections 1.
• Antihistamines and decongestants may not be effective in reducing symptoms of acute sinusitis, and their use should be based on individual patient needs and medical history 1.

Treatment Approach

• For an 18-month-old child with rhinorrhea and sneezing for one week, the treatment approach should focus on supportive care, including:
  • Nasal saline irrigation to help loosen and clear mucus
  • Humidification to help relieve congestion
  • Monitoring for signs of complications, such as fever, purulent nasal discharge, or worsening symptoms
• Antibiotics should not be prescribed unless there is evidence of acute bacterial sinusitis, such as a persistent illness with nasal discharge of any quality and/or daytime cough lasting for >10 days without improvement, a worsening clinical course, a severe onset of symptoms with concurrent fever, and purulent nasal discharge for at least 3 consecutive days 1.

From the Research

Treatment Options for Rhinorrhea and Sneezing in an 18-month-old Child

The treatment for an 18-month-old child with rhinorrhea (runny nose) and sneezing for one week may vary depending on the underlying cause of the symptoms.

• If the symptoms are due to allergic rhinitis, treatment options may include:
  • Avoiding triggering allergens 2, 3
  • Pharmacological treatments such as intranasal/oral antihistamines or/and nasal corticosteroids 2, 3
  • Nasal lavage, which is safe, cheap, and adequate for removing secretions, allergens, and mediators 2
• If the symptoms are due to nonallergic rhinitis, treatment options may include:
  • Avoiding irritants or allergens 4
  • Pharmacotherapy such as intranasal corticosteroids, oral and intranasal antihistamines, intranasal anticholinergic agents, oral decongestants, and leukotriene receptor antagonists 4
• If the symptoms are due to acute rhinosinusitis, treatment options may include:
  • Antibiotics as the mainstay of treatment 5
  • Ancillary therapy, although there is no strong evidence for its use 5

Considerations for Treatment

When selecting a treatment option, it is essential to consider the severity and frequency of symptoms, as well as patient preference 3.

• For mild intermittent or mild persistent allergic rhinitis, a second-generation H1 antihistamine or an intranasal antihistamine may be used as first-line treatment 3
• For persistent moderate to severe allergic rhinitis, an intranasal corticosteroid may be used as first-line treatment, either alone or in combination with an intranasal antihistamine 3
• For nonallergic rhinitis, an intranasal antihistamine may be used as monotherapy or in combination with an intranasal corticosteroid 3