Stephen J. Schueler, M.D.

Overview Incidence Risk Factors Symptoms cold versus flu Evaluation Treatment questions for doctor specialist Home Care congestion cough diarrhea fever sore throat warning signs wheezing Prevention Complications Underlying Cause Transmission

Upper Respiratory Infections in Children Home Care

Home care for upper respiratory infections in children includes:

Upper Respiratory Infections in Children Congestion

Home treatment measures for congestion in children with an upper respiratory infection include general measures and medications. Medications include oral decongestants, decongestant nasal sprays and antihistamines.

General Measures

  • Ask your child to blow the nose gently. Forceful blowing can cause pain and bleeding.
  • Apply petroleum jelly to the nostrils if the skin becomes dry.
  • Drink plenty of liquids.
  • Use a humidifier, nebulizer, or vaporizer in the bedroom at night.
  • Use saline (saltwater) nose spray, such as Ocean Nasal Mist: saline helps to keep the lining of nasal passages moist.

Oral Decongestants
Oral decongestants, such as pseudoephedrine (Sudafed), help to thin the mucus responsible for the congestion. Decongestants are safe for children more than 6 years old. Talk to your doctor before providing a decongestant to a child less than 6 years old.

Decongestant Sprays
Decongestant nasal sprays, such as pseudoephedrine (Afrin), can relieve congestion faster than oral medications, but should not be used in children less than 12 years old.

Examples include:
  • Afrin Nasal Spray
  • Duration Nasal Spray
  • Four-Way Fast Nasal Spray
  • Neo-Synephrine Nasal Spray
  • Vicks Sinex Nasal Spray

Precautions include:
  • Do not use decongestant nasal sprays for longer than 3 days. After three days, the nasal tissues become dependent on the medication. When the medication is stopped, the nasal tissue swells and congestion worsens.

Antihistamines
Antihistamines, such as diphenhydramine (Benadryl) brompheniramine and chlorpheniramine, dry nasal tissue. Antihistamines are safe for children more than 5 years old. Talk to your doctor before providing an antihistamine to a child less than 5 years old.

Examples include:

Precautions include:

Diphenhydramine Dosing Chart
AgeDoseIntervalMax Daily Dose
2-5 years6.25 mg4-6 hours37.5 mg/day
6-11 years12.5-25 mg4-6 hours150 mg/day
12 and older25-50 mg4-6 hours300 mg/day

Chlorpheniramine Dosing Chart
AgeDoseIntervalMax Daily Dose
Under 6consult your physician
6-11 years2 mg4-6 hours12 mg/day
12 and up4 mg4-6 hours24 mg/day

Upper Respiratory Infections in Children Cough

Home treatment of a cough in children with an upper respiratory infection includes:

  • Avoid respiratory irritants, such as pollution, pollen, mold, dust and chemical fumes
  • Change A/C and furnace filters regularly.
  • Avoid exposure to secondary smoke.
  • Drink warm liquids to relieve coughing spasms.
  • Use throat lozenges, but do not use them in children under 5 years of age.
  • Use a humidifier, nebulizer, or vaporizer in the bedroom at night.

Cough medicines:

Dosing Dextromethorphan
Childs WeightDextromethorphan Dose
22 lb (10 kg)5 mg every 8 hrs
33 lb (15 kg)7.5 mg every 8 hrs
44 lb (20 kg)10 mg every 8 hrs
55 lb (25 kg)12.5 mg every 8 hrs
66 lb (30 kg)15 mg every 8 hrs
88 lb (40 kg)20 mg every 8 hrs
110 lb (50 kg)25 mg every 8 hrs
132 lb-adult (60 kg)30 mg every 8 hrs

Cough medication precautions:

Upper Respiratory Infections in Children Diarrhea

Home treatment of diarrhea with an upper respiratory infection includes hydration and dietary therapy.

Hydration
Those who are able to drink liquids can restore lost water and salt with oral rehydration therapy (ORT).

ORT fluids used in children include:

  • Infalyte
  • Lytren
  • Naturalyte
  • Pedialyte
  • Rehydralyte
  • ReVital
  • Generic drugstore brands

Additional ORT fluids for older children include:
  • Soft drinks without caffeine
  • Sports drinks (Gatorade)
  • Tea
  • Water

Strategies for breast-fed infants under 6 months include:
  • Continue breast feeding as much as your baby desires.
  • Provide additional ORT fluids to supplement breast milk.
  • If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes.
  • Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin.
  • Watch for symptoms of dehydration.

Strategies for bottle-fed infants under 6 months:
  • Give your child normal amounts of formula.
  • Provide as much ORT fluids as your baby desires.
  • If vomiting occurs, provide small amounts of ORT fluids every 30-60 minutes.
  • If vomiting occurs, try a lactose-free formula.
  • Prevent diaper rash by changing diapers frequently and apply Vaseline to the skin.
  • Watch for symptoms of dehydration.

Strategies for children over 6 months:

Dietary Therapy
ORT is most important if you have vomiting with the diarrhea. Once vomiting and nausea resolves, provide bland foods first. If bland foods are tolerated, then you resume a normal diet.

Foods that may help diarrhea:
  • Applesauce
  • Bananas
  • Bread
  • Cereal
  • Crackers
  • Mashed potatoes
  • Noodles
  • Oatmeal
  • Potatoes
  • Rice
  • Strained carrots
  • Wheat
  • Yogurt

Items that may worsen diarrhea include:
  • Alcohol
  • Caffeine
  • Concentrated fruit juices
  • High-sugar foods junk food
  • Cow's milk
  • Spicy foods
  • Sugar substitutes

Upper Respiratory Infections in Children Fever

Common medications used at home for fever in children with an upper respiratory infection include:


Aspirin and most of the other nonsteroidal anti-inflammatory drugs (NSAIDS) are not used in children except under a doctor's care.

Acetaminophen
  • Acetaminophen decreases fever and pain, but does not help inflammation.
  • Dosing is 10-15 mg per kilogram (5-7 mg per pound) of body weight every 4-6 hours, up to the adult dose.
  • Do not exceed the maximum daily dose.
  • Acetaminophen products come in various strengths. Always follow the package instructions.
  • Avoid this drug in children with liver disease or an allergy to acetaminophen.
  • Common acetaminophen products include Tylenol, Panadol and many others.

Ibuprofen

Naproxen

Upper Respiratory Infections in Children Sore Throat

Home care for a sore throat in a child with an upper respiratory infection includes:

Upper Respiratory Infections in Children Warning Signs

Notify your doctor for upper respiratory infections in children and any of the following:

Upper Respiratory Infections in Children Wheezing

Some upper respiratory infections in children may cause mild wheezing. This is particularly common in children who suffer from asthma. A URI can make asthma more difficult to control.

Home care for mild wheezing includes:

  • Avoid exposure to smoke.
  • Avoid cough medicine.
  • Avoid sedative medications.
  • Avoid substances that trigger wheezing.
  • Drink plenty of liquids to remain hydrated.
  • Place a vaporizer or nebulizer in the bedroom at night.

Home care for children who take medication for wheezing includes:
  • Follow asthma home care instructions.
  • Learn to use prescribed inhalers correctly.
  • Use short-acting inhalers every 20 minutes, or as directed by your doctor.
  • Long-acting medications must be used regularly.
  • Learn to use a peak flow meter.
  • Know the peak flow danger zones.
  • Develop a strategy for using your inhaler based on your PEFR reading
  • Stay calm during a wheezing attack.

Peak Flow Zones:
  • Green Zone:
    • A PEFR reading that is 80-100% of personal best represents good control
  • Yellow Zone:
    • A PEFR reading that is 50-80% of personal best represents a moderate attack
  • Red Zone:
    • A PEFR reading that is less than 50% of personal best represents a severe attack and may identify the need for treatment in an emergency department.

Continue to Upper Respiratory Infections in Children Prevention

Last Updated: Jan 6, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Upper Respiratory Infections in Children References
  1. Autret-Leca E, Giraudeau B, Ployet MJ, Jonville-Bera AP. Amoxicillin/clavulanic acid is ineffective at preventing otitis media in children with presumed viral upper respiratory infection: a randomized, double-blind equivalence, placebo-controlled trial. Br J Clin Pharmacol. 2002 Dec;54(6):652-6. [12492614]
  2. Butler CC, Hood K, Kinnersley P, Robling M, Prout H, Houston H. Predicting the clinical course of suspected acute viral upper respiratory tract infection in children. Fam Pract. 2005 Feb;22(1):92-5. [15640294]
  3. Fahey T, Stocks N, Thomas T. Systematic review of the treatment of upper respiratory tract infection. Arch Dis Child. 1998 Sep;79(3):225-30. [9875017]
  4. Lam TP, Lam KF. Why do family doctors prescribe antibiotics for upper respiratory tract infection? Int J Clin Pract. 2003 Apr;57(3):167-9. [12723716]
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