Initial Treatment of Pediatric Wheezing, Cough, and Upper Respiratory Infection

Critical Safety Warning: Avoid OTC Medications in Young Children

Over-the-counter cough and cold medications are contraindicated in children under 2 years of age due to lack of proven efficacy and potential for serious toxicity, including death 1
Between 1969-2006, there were 54 fatalities associated with decongestants in children under 6 years and 69 fatalities associated with antihistamines 1
Topical decongestants should not be used in children under 1 year due to narrow therapeutic margin and risk of cardiovascular and CNS side effects 1

Bronchiolitis is diagnosed by history and physical examination alone without routine laboratory or radiologic studies, and is characterized by viral lower respiratory infection with acute inflammation, edema, increased mucus production, and bronchospasm 2
Asthma is characterized by recurrent episodes of wheezing/cough triggered by viral URI, activity, or weather changes, with symptoms lasting longer than the typical week to recover 3, 4
Age less than 12 weeks, prematurity, underlying cardiopulmonary disease, or immunodeficiency increase risk for severe disease 2

Ensure adequate hydration to help thin secretions 1
Use antipyretics to manage fever and keep the child comfortable 1, 5
Gentle nasal suctioning may help improve breathing in children with nasal congestion 1
Maintain oxygen saturation above 92% using nasal cannulae, head box, or face mask if hypoxemic 1, 5
Chest physiotherapy is NOT beneficial and should NOT be performed 1, 5

Young children with mild symptoms of lower respiratory tract infection generally do not need antibiotics 1, 5
If bacterial infection is suspected, amoxicillin is first choice for children under 5 years 5

Consider daily controller therapy if the child meets specific criteria suggesting persistent asthma, including more than 3 episodes of wheezing in the past year 3, 4, 6
Low-dose inhaled corticosteroids are the preferred first-line controller therapy 3, 4, 6

Children managed at home should be reviewed if deteriorating or not improving after 48 hours 1, 5
If cough persists beyond 4 weeks, systematic evaluation using pediatric-specific algorithms is required 1, 7
Provide families with information on managing fever, preventing dehydration, and identifying signs of deterioration 1, 5