Viral upper respiratory tract infection and the common cold — formative SAQs

SAQ 1 (10 marks)

A previously well 3-year-old is brought to the general paediatric clinic on day 4 of a viral cold. The nasal discharge has turned thick and yellow-green. The child is afebrile today, playing normally, drinking well, and has no respiratory distress. The parent asks for "an antibiotic to clear it up." [1] [4]

a) (3 marks) Explain why the change in discharge colour does not indicate bacterial infection. Purulent discharge reflects neutrophil myeloperoxidase staining sloughed epithelial cells and inflammatory debris; it is an expected part of the natural history, not evidence of bacterial infection, and antibiotics do not shorten the illness or prevent complications. [1] [4]

b) (3 marks) State the expected natural history of an uncomplicated cold, including the duration of nasal symptoms and the likely duration of cough. Symptoms peak on days 2 to 3 and resolve over 7 to 10 days; a post-viral cough may persist for 2 to 3 weeks and is normal; the well, drinking child with no red flags needs no follow-up for the cold itself. [1]

c) (4 marks) Outline the evidence-based symptomatic care you would recommend, naming two agents that help and one important age-restricted remedy to avoid. Give paracetamol 15 mg/kg/dose every 4 to 6 hours or ibuprofen 10 mg/kg/dose every 6 to 8 hours for fever and discomfort, and honey (2 to 5 mL) for cough in a child over 1 year, with saline drops or spray for the nose and fluids and rest. Avoid over-the-counter cough and cold mixtures (not recommended under 6 years) and remember honey is contraindicated under 1 year because of infant botulism. [3] [8] [6]

SAQ 2 (10 marks)

A 6-week-old infant presents with 2 days of coryza and a documented temperature of 38.3°C. The infant is mildly congested and feeding is slightly reduced. [1] [15]

a) (4 marks) What is the key principle guiding the investigation of this infant, and why is the fever not safely attributed to the cold? An infant under 3 months with any fever is investigated on the febrile-infant pathway for serious bacterial illness (blood and urine cultures, often cerebrospinal fluid) regardless of coryza, because the risk of invasive bacterial infection is high and clinical assessment is unreliable at this age; the cold may be incidental. [1] [15]

b) (4 marks) List four red flags that, in any child with a cold, would shift management from symptomatic care to escalation. Any four of: increased work of breathing (recession, grunting, nasal flaring, tracheal tug); stridor at rest or drooling; poor feeding or reduced urine output indicating dehydration; drowsiness or irritability; oxygen saturation below 92 to 94 per cent in air; fever beyond 5 days; symptoms worsening after initial improvement; any fever under 3 months. [1] [15]

c) (2 marks) Describe how you would conduct the antibiotic conversation with a parent who expects a prescription for their well older child's cold. Reframe the antibiotic as a medicine that will not help and may harm through side effects and resistance; name what will help instead (paracetamol or ibuprofen, honey, saline); give a clear written safety-net; this is antimicrobial stewardship delivered at the bedside and meets the parent's need for a concrete plan. [4] [8]