Management of Upper Respiratory Tract Infections in Infants

Diagnosis and Treatment

The American Academy of Pediatrics recommends that most upper respiratory tract infections in infants are viral and self-limited, typically lasting 5-7 days with symptoms peaking at days 3-6 3, 4, 5
Symptoms of viral upper respiratory tract infections include nasal congestion/discharge, cough, and low-grade fever in the first 24-48 hours 3, 4
The American Academy of Pediatrics advises against prescribing antibiotics for uncomplicated viral upper respiratory tract infections, as they provide no benefit and cause harm 1, 6, 7
Antibiotics should only be considered if the infant meets stringent diagnostic criteria for specific bacterial infections, such as acute otitis media or acute bacterial sinusitis 1, 7

Acute otitis media requires middle ear effusion and moderate/severe bulging tympanic membrane or mild bulging with ear pain/erythema, and first-line treatment is amoxicillin 90 mg/kg/day 2
Acute bacterial sinusitis requires symptoms that are persistent for more than 10 days without improvement, worsening after initial improvement, or severe (high fever ≥39°C with purulent discharge for 3-4 consecutive days) 3, 6, 4
Group A streptococcal pharyngitis is rare in children under 3 years and should not be tested or treated in this age group 6, 2

The American Academy of Pediatrics recommends providing supportive measures, including frequent small feeds to maintain hydration, antipyretics for fever, and nasal saline drops/spray to help clear nasal congestion and facilitate feeding 2
Humidified air may provide comfort, but chest physiotherapy provides no benefit and should not be performed 2

Parents should be instructed to return or call if the infant is deteriorating or not improving after 48 hours, signs of dehydration develop, high fever persists beyond 48-72 hours, breathing difficulty develops, or the infant refuses all feeds 2, 3, 4