Upper Respiratory Infection (URI) in Children

Background

• URIs are acute, self-limiting infections of the upper airway that are usually viral in origin.
• Viral causes may include rhinoviruses (common), adenoviruses, picornavirus, coronaviruses, parainfluenza viruses, respiratory syncytial virus, human metapneumovirus, and influenza viruses.
• Bacterial causes are rare, but bacterial infection may occur as a complication of viral URI.

Evaluation

• The diagnosis is usually made clinically based on an acute onset of nasal congestion, rhinorrhea, cough, and/or sore throat. Other symptoms may include fever, headache, malaise, and myalgias.
• Perform history and physical exam to assess for symptoms or signs suggestive of
  • alternative diagnoses, such as streptococcal pharyngitis, allergic rhinitis, or pertussis.
  • complications such as otitis media, sinusitis, asthma exacerbation, or lower respiratory tract disease.
• Testing is usually not needed unless an alternative diagnosis is suspected.

Management

• Consider comfort measures such as nasal suction for infants, mist inhalation, and nasal irrigation.
• Antipyretics may be used for reducing discomfort associated with fever.
• For URI due to confirmed or suspected influenza, start antiviral medication as soon as possible in children who have severe, complicated, or progressive illness, require hospitalization, or are at higher risk for influenza complications, and consider antivirals in any outpatient if treatment can be started within 48 hours of illness onset.
• Other treatments such as vapor rub and honey (avoid in children < 1 year old due to risk of infant botulism) may also be considered to reduce symptom severity.
• Nonprescription cough and cold products should not be used in children < 4 years old, and prescription opioid cough and cold medicines should not be used in children < 18 years old.