Chapter 4.4 Cough or cold

These are common, self-limited viral infections that require only supportive care.  Antibiotics should not be given. Wheeze or stridor may occur in some children, especially infants. Most episodes end within 14 days. Cough lasting 14 days or more may be caused by TB, asthma, pertussis or symptomatic HIV infection (see Chapter 8).

Diagnosis

Common features:

  • cough
  • nasal discharge
  • mouth breathing
  • fever

The following are absent:

  • general danger signs.
  • signs of severe pneumonia or pneumonia
  • stridor when the child is calm

Wheezing may occur in young children (see below).

Treatment

  • Treat the child as an outpatient.
  • Soothe the throat and relieve the cough with a safe remedy, such as a warm, sweet drink.
  • Relieve high fever (> 39 °C or > 102.2 °F) with paracetamol if the fever is causing distress to the child.
  • Clear secretions from the child’s nose before feeds with a cloth soaked in water that has been twisted to form a pointed wick.

Give normal fluid requirements plus extra breast milk or fluids if there is fever. Small frequent drinks are more likely to be taken and less likely to be vomited.

Do not give any of the following:

  • an antibiotic (they are not effective and do not prevent pneumonia)
  • remedies containing atropine, codeine or codeine derivatives, or alcohol (these may be harmful) or mucolytics
  • medicated nose drops.

Follow-up

Advise the mother to:
• feed the child
• watch for fast or difficult breathing and return if either develops
• return if the child becomes sicker or is unable to drink or breastfeed.