Upper Respiratory Tract Infections (URTI) in Children

Upper Respiratory Tract Infections in Children

Your child has a runny nose, a cough and a sore throat, and after a few days the nasal discharge turns a darker color…

The question families ask is usually the same:

"Is this still a viral infection, or is an antibiotic needed now?"

Upper respiratory tract infections in children are one of the most common reasons for visits to the pediatrician, especially in the fall and winter months.

Most of these illnesses are caused by viruses and clear up on their own without needing an antibiotic. In some children, though, symptoms may last longer than expected, may get worse again after an initial improvement, or bacterial complications such as a middle ear infection or sinusitis may develop.

That is why what matters in upper respiratory tract infections is not only which symptoms are present, but how the symptoms began and how they change over the following days.

What Is an Upper Respiratory Tract Infection?

Upper respiratory tract infection is the general name for infections affecting the upper airways, mainly the nose, the nasal passages behind the nose, the throat and the sinuses.

In everyday speech they may be called different things, such as:

• Head cold
• Common cold
• Catching a chill
• Throat infection

The great majority of these infections are caused by viruses.

Many different viruses, including rhinoviruses, seasonal coronaviruses, adenoviruses, influenza, parainfluenza and RSV, can cause a respiratory tract infection.

For this reason, a child getting sick again soon after having one infection does not always mean that "the same illness never went away." The child may have come across a different virus.

Why Do Children Get Upper Respiratory Tract Infections So Often?

It is a common situation, especially in the preschool years, for children to have more than one upper respiratory tract infection over the course of a year.

This number may rise in children who start daycare or preschool.

That is because children:

• Come across a great many viruses for the first time
• Are in close contact with one another indoors
• Share toys and surfaces

They frequently put their hands in their mouths, noses and eyes.

So a child catching colds often does not on its own show that the immune system is weak.

What matters here is how severe the infections are, how long they last and whether any complications develop.

What Are the Symptoms of an Upper Respiratory Tract Infection in Children?

In upper respiratory tract infections, the following may be seen:

• Runny nose
• Stuffy nose
• Sneezing
• Sore throat
• Postnasal drip
• Cough
• Mild or moderate fever
• Fatigue
• Poor appetite
• Headache

In young children, a stuffy nose can also lead to problems with feeding and sleep.

The type and severity of the symptoms can vary according to the virus causing the infection and the child's age.

What Is the Common Cold in Children?

The common cold is one of the most frequent viral upper respiratory tract infections.

Despite its name, the main cause of the illness is not the child getting cold, but becoming infected with viruses.

In cold weather, children spend more time indoors and close contact increases, so infections can spread more easily. This can be perceived as "he got chilled and got sick."

In a common cold, what usually stands out is:

• Runny nose
• Stuffy nose
• Sneezing
• Discomfort in the throat
• Mild cough

There may be no fever at all, or fever may be seen, especially in young children.

How Many Days Does a Common Cold Last?

The symptoms of viral upper respiratory tract infections usually become more obvious within the first few days and then slowly begin to improve.

In a large share of children, clear improvement is seen within about 7 to 10 days.

However, a runny nose and especially a cough may last longer.

So a child still coughing mildly on the 7th or 8th day does not on its own mean that a bacterial infection has developed.

What really matters is whether the symptoms are gradually easing, staying the same, or getting worse again.

Does Yellow or Green Nasal Discharge Mean a Bacterial Infection?

No.

This is one of the most common misconceptions about childhood infections.

In the natural course of a viral upper respiratory tract infection, nasal discharge that is clear at first may turn yellow or green after a few days, and then become clear again and go away.

The color of the nasal discharge on its own does not show that an antibiotic needs to be started.

What matters more when it comes to sinusitis is how long the illness lasts and how the symptoms run their course.

How Are Viral and Bacterial Infections Told Apart?

It is not always possible for families to make this distinction with certainty by looking only at the symptoms.

That is because fever, cough, a runny nose and a sore throat can be seen in both viral and some bacterial infections.

The pediatrician evaluates the following together:

• How many days the illness has been going on
• How the symptoms have changed over time
• The level and duration of the fever
• The child's general condition
• The child's breathing
• The ear, nose and throat examination

In certain situations where it is considered necessary, additional tests may be used.

However, in a typical common cold, routine blood tests or imaging are not needed.

Are Antibiotics Used in Upper Respiratory Tract Infections?

Antibiotics are not used in viral upper respiratory tract infections.

Antibiotics are medicines effective against bacteria; they do not treat viruses.

Using an antibiotic unnecessarily:

• Does not make the child's illness pass any faster
• Can cause medication side effects

It can contribute to the development of antibiotic resistance.

An antibiotic should be used only when a bacterial infection is being considered and when a physician judges it necessary.

How Is an Upper Respiratory Tract Infection Treated in Children?

In most viral infections, the aim is not to get rid of the virus with a medicine, but to ease the symptoms and make sure the child takes in enough fluid until they recover.

The basis of treatment is:

• Taking in enough fluid
• Rest
• Relieving a stuffy nose with saline
• When needed, fever and pain control appropriate for the child's age and weight

Relieving a stuffy nose is especially important for feeding and sleep in babies.

Cough and cold medicines should not be used carelessly in children. Any medicine to be used should be evaluated according to the child's age and clinical condition.

Is Vitamin C Necessary in Upper Respiratory Tract Infections?

Vitamin C, zinc, herbal products and many products marketed as "immune boosters" are often used by families.

However, there is no approach showing that a healthy child needs to be started on high-dose vitamins or supplements with every upper respiratory tract infection.

If a deficiency is suspected in the child's nutrition or in particular vitamin and mineral levels, that needs to be evaluated separately.

When Is a Cough Normal and When Should It Be Watched?

In upper respiratory tract infections, a cough may be seen, especially because of postnasal drip.

The cough may even continue for a while after the other symptoms have passed.

However, if:

• The cough is gradually getting worse
• Shortness of breath is present
• The child is breathing rapidly
• There is wheezing
• Chest pain develops
• The fever is rising again

the lower airways may also need to be evaluated.

When Does a Common Cold Turn into Sinusitis?

Not every long-lasting runny nose is sinusitis.

During a common cold in children, inflammation can develop in the mucosa lining the inside of both the nose and the sinuses. For this reason, it is normal for there to be changes in the sinuses during a viral infection as well.

Acute bacterial sinusitis, on the other hand, develops in a smaller share of viral upper respiratory tract infections.

In children, bacterial sinusitis is considered mainly in three different courses of illness.

1. If Symptoms Last Longer than 10 Days and Are Not Improving

If a runny nose or daytime cough has been going on for more than 10 days and shows no improvement at all, bacterial sinusitis may be considered.

The nasal discharge does not have to be yellow or green.

2. If the Child First Improves and Then Gets Worse Again

The child has a cold for a few days and the symptoms begin to ease.

Then:

• The fever returns
• The nasal discharge clearly increases

The cough becomes more severe again.

This picture of "improving first, then getting worse" is an important clue when it comes to bacterial sinusitis.

3. If the Illness Runs a Severe Course from the Start

A high fever of about 39°C or above continuing for at least three days together with purulent nasal discharge is also one of the pictures that suggests acute bacterial sinusitis.

These children need to be evaluated by a physician.

How Is Sinusitis Recognized in Children?

In sinusitis, the classic "facial pain" seen in adults is not always prominent in children.

Most often, the following may be seen:

• Long-lasting runny nose
• Stuffy nose
• Daytime cough
• A cough that may increase at night
• Postnasal drip
• Bad breath
• Headache or facial pain in some children

One of the most important points in the diagnosis is the duration and course of the symptoms.

Is an X-Ray Needed to Diagnose Sinusitis in Children?

In uncomplicated acute bacterial sinusitis, the diagnosis is usually made clinically.

Routine sinus X-rays, computed tomography or MRI are not used to tell a simple viral upper respiratory tract infection apart from bacterial sinusitis.

That is because changes in the sinuses can also be seen on imaging during viral infections.

Imaging comes into question particularly when complications spreading to the area around the eye or inside the skull are suspected, or in special clinical situations.

How Is Sinusitis Treated in Children?

Treatment of sinusitis is planned according to the clinical picture of the illness.

Antibiotic treatment is needed in acute bacterial sinusitis that begins severely or that improves first and then gets worse again.

In some cases where the symptoms have only continued without improving for more than 10 days but the child's general condition is good, the physician may consider the option of a short period of observation.

The decision about whether to start an antibiotic, which antibiotic to use and how long treatment should last should be made by evaluating the child's age, the severity of the illness, antibiotics used previously, any history of allergy and other clinical features.

Cleaning the inside of the nose with saline may also relieve a stuffy nose and thick secretions in some children.

If an Antibiotic Is Started for Sinusitis, When Is Improvement Expected?

In acute bacterial sinusitis, improvement in the child's symptoms is expected within a few days after appropriate treatment.

If improvement does not begin within 72 hours despite treatment, or if the symptoms get worse, the child needs to be evaluated again.

In that case, whether the diagnosis is correct, whether the treatment needs to be changed and whether a complication is present are all evaluated.

What Illnesses Can an Upper Respiratory Tract Infection Turn Into?

Most viral upper respiratory tract infections clear up without complications developing.

However, in some children, conditions such as:

• Middle ear infection
• Acute bacterial sinusitis
• Bronchiolitis
• Pneumonia
• A flare-up of asthma or airway sensitivity

may develop.

That is why a child who has been sick for a few days getting worse again, just when improvement is expected, is an important warning sign.

When Should I Take My Child to the Doctor for an Upper Respiratory Tract Infection?

A pediatrician's evaluation is needed particularly if there is:

• Difficulty breathing
• Rapid or labored breathing
• A bluish color of the lips
• A clear decline in the child's general condition
• Being unable to take in fluids
• A clear drop in the amount of urine
• Unusual sleepiness
• Severe headache or facial pain
• Swelling or redness around the eye
• A high, continuing fever
• Fever returning and a clear worsening while the illness is improving
• A runny nose or daytime cough that has not improved even after 10 days

Fever and signs of respiratory tract infection should be evaluated with particular care in young infants.