10/19/2023
Runny nose? Cough? Fever? Read this and call if you need us!
Back in my urgent care days, this was the "script" I used when seeing a child with the classic constellation of cough, congestion, runny nose, and fever: "It sounds like your little guy is battling a nasty virus, but let me ask some questions and do a good physical exam to make sure we aren't missing a bacterial infection that would require antibiotics."
I then primarily ask about a history of prolonged fever >4 days, notable ear pain or drainage, burning upon urination, eye redness with discharge, or a viral illness that seemed to subside and then got much worse with cough/rapid breathing/fever. Historical findings like this point me in the right direction as far as my physical exam and/or diagnostic testing.
The main indications for antibiotics in the setting of cough, congestion, runny nose, and fever include: True ear infections, secondary bacterial pneumonia, pink eye (with purulent discharge), and urinary tract infections. Sinusitis is something you could consider for persistent (>10 days) or worsening nasal discharge with daytime cough.
If there is no bacterial source of infection, I go on to explain that cold, flu, RSV, COVID, and other viral infections do not respond to antibiotics. Rather, the body has to do all of the hard work. The immune system does this over the course of several days by mounting fevers to fight off the infection. The parents' job is to keep their child HYDRATED and as comfortable as possible.
You know your child is staying hydrated if they are able to produce at LEAST 3 good urine outputs per day. They may not feel like eating solid foods for several days, and that's okay. Push age-appropriate fluids such as formula, breast milk, Pedialyte, water, or sports drinks.
For congestion, especially in infants, try nasal saline drops or spray to both nostrils. Let it sit for a few seconds before you suction it out with a bulb syringe or suction device such as NoseFrida. You can also run a humidifier near the child's bed or crib to help loosen up mucus.
The cough is the body's way of clearing mucus out of the lungs. It protects the body from developing pneumonia, so we don't go out of our way to suppress it, especially among children less than 6 years of age. If it's really bothersome, try half a teaspoon of honey for children ages 2-5 years or 1 teaspoon for kids ages 6 and above. Do not give honey to children less than 1 year old. Cough drops or lozenges are okay starting at 4 years and up.
Do your best to avoid falling victim to fever phobia. Several days of fever is natural and safe in babies 3 months and up. Babies less than 3 months need to be evaluated by a doctor for fever (defined as 100.4°F and above). Beyond this age, a fever is the body's way of ramping up the immune system to fight off infection. You only need to treat a fever if it’s making your child uncomfortable - Tylenol at any age, Motrin at 6 months old and up. You want to keep them comfortable enough to drink fluids in particular!
Seek rapid medical care for any of the following 🚩 RED FLAG signs: Bulging soft spot, inconsolable crying, confusion, disorientation, stiff neck, seizures, difficult or rapid breathing, blue lips or nails, refusal to move an arm or leg, severe abdominal pain/swelling, dehydration, or simply looking very ill. Touch base with your pediatrician if your child has any complex medical condition such as heart disease, diabetes, sickle cell disease, cystic fibrosis, or kidney problems.
You've got this! 💪
