How to treat a runny nose in a child?

Treatment of a runny nose in a child is determined by the child’s age and the severity of the disease itself.

Non-drug treatment of a runny nose in a child

In moderate and severe cases of the disease, bed rest is indicated, which lasts from 3-4 to 5-7 days. The diet is normal. Warming procedures are widely used: a bandage on the throat, warming foot baths, etc.

Drug treatment of runny nose in children

Treatment of a runny nose in a child should be started in the first 2 days of the disease; the most effective therapy is started in the first hours of the disease. The volume and program of treatment are determined by the severity of the disease, the health condition and age of the child, the development of complications or the risk of their development. Therapy may be limited to the prescription of vasoconstrictor intranasal drops. In children who are often ill, or in severe cases of the disease, or in the development of complications, therapy can be quite extensive. When therapy is prescribed in the first 2 days of the disease, these measures have a therapeutic effect proven in placebo-controlled studies.

Therapy of acute rhinitis and nasopharyngitis in children

Features of the disease	Possible causative agent	Treatment
Mild, uncomplicated nasopharyngitis	Rhinoviruses Coronaviruses Parainfluenza viruses PC viruses	Vasoconstrictor intranasal drops Antipyretic drugs (as indicated) Anti-inflammatory drugs (as indicated) Antitussives (as indicated)
Mild, uncomplicated nasopharyngitis in frequently ill children, in children with chronic tonsillitis, adenoiditis, sinusitis Severe nasopharyngitis (with hyperthermia and intoxication)	Rhinoviruses Coronaviruses Parainfluenza viruses PC viruses Influenza viruses	Intranasal vasoconstrictor drugs Local antibacterial therapy Anti-inflammatory drugs Antiviral: Interferons intranasally, rectally Interferonogenesis inducers "Rimantadine" Antipyretic drugs Antitussives (as indicated)
Rhinopharyngitis with a protracted course and persistent cough	Mycoplasma pneumonia Chlamydia pneumonia	Local antibacterial therapy or systemic macrolide therapy Antitussives Antipyretic drugs (as indicated)

Characteristics of intranasal decongestants and features of their use in pediatrics

Preparations	Duration of action, h	Permitted age of use	Number of nasal drops per day
Naphazoline	4-6	From 2 years old in a concentration of 0.025%	4-6
Tetryzoline	4-6	From 5 years old in a concentration of 0.05%	4
Xylometazoline	8 10	From 2 years old	3-4
Oxymetazoline	10-12	From birth 0.01% solution From 1 year 0.025% solution From 5 years 0.05% solution	2

• Oxymetazoline is administered intranasally:
  • newborns: 1 drop of 0.01% solution in each nasal passage 2 times a day;
  • children over 5 months - 1-2 drops in each nasal passage 2 times a day:
  • children over 1 year old - 1-2 drops of 0.025% solution 2 times a day;
  • children over 5 years old - 1-2 drops of 0.05% solution 2 times a day.
• Naphazoline and tetryzoline are administered intranasally:
  • children over 2 years old - 1-2 drops of 0.025% solution in each nasal passage 4-6 times a day; children over 5 years old - 2 drops of 0.05% solution in each nasal passage 4-6 times a day.
• Xylometazoline is administered intranasally to children over 2 years of age, 1-2 drops in each nasal passage 3-4 times a day.

Anti-inflammatory therapy is indicated for severe inflammatory manifestations of acute respiratory infections. In these cases, fenspiride (erespal) is prescribed:

• for children under 12 years of age in solution orally at a rate of 4 mg/kg per day or
• newborns 1/2 teaspoon 2-3 times a day:
• children from 1 to 3 months - 1 teaspoon 2 times a day:
• children from 3 to 6 months - 1 teaspoon 3 times a day:
• children from 6 months to 2 years - 1 teaspoon 3-4 times a day:
• children 2-4 years old - 1 tablespoon 2 times a day;
• children 4-7 years old - 1 tablespoon 3 times a day;
• children 7-12 years old - 2 tablespoons 3 times a day:
• children and adolescents - 1 tablet 3 times a day.

Antitussive treatment for a runny nose is mainly represented by expectorant and enveloping drugs. Drugs are prescribed for severe cough for 7-10 days.

Antitussive drugs with expectorant and combined (expectorant and enveloping) action

Preparation	Compound
Bronchipret drops, syrup and tablets	Drops and syrup - from 3 months; contain thyme and ivy, tablets - thyme and primrose
Bronchicum Elixir	Thyme, quebracho, primrose
Glycerams	Licorice
Breast collection #1	Marshmallow, oregano, coltsfoot
Breast collection #2	Coltsfoot, plantain, licorice
Breast collection #3	Sage, anise, pine buds, marshmallow, licorice, fennel
Breast Elixir	Licorice, anise oil, ammonia
Doctor Mom	Extracts of licorice, basil, elecampane, aloe, etc.
Lycorine	Licorice
Mucaltin	Marshmallow root
Pectusin	Mint, eucalyptus
Pertussin	Thyme or thyme herb extract

Antipyretic therapy for mild and uncomplicated rhinitis is rarely indicated. However, in severe cases, especially in young children, hyperthermia of the body up to 39.5 °C is often noted in the first days of the disease. Then antipyretics (paracetamol or ibuprofen) or a combination of antipyretics with first-generation antihistamines are prescribed.

• Paracetamol is prescribed orally or rectally at a rate of 10-15 mg/kg per day in 3-4 doses.
• Ibuprofen is also prescribed orally at a rate of 5-10 mg/kg per day in 3-4 doses.
• Promethazine (pipolfen) is prescribed orally 3 times a day:
  • children under 3 years old 0.005 g;
  • children under 5 years old 0.01 g;
  • children over 5 years old 0.03-0.05 g.
• Chloropyramine (suprastin) is prescribed orally 3 times a day:
  • children under 3 years old 0.005 g;
  • children under 5 years old 0.01 g;
  • children over 5 years old - 0.03-0.05 p.

At temperatures above 40 °C, a lytic mixture is used, which includes chlorpromazine (aminazine) 2.5% solution 0.5-1.0 ml, promethazine (pipolfen) in a solution of 0.5-1.0 ml. The lytic mixture is administered intramuscularly or intravenously, once. In severe cases, metamizole sodium (analgin) is included in the mixture in the form of a 10% solution at the rate of 0.2 ml per 10 kg.

It is advisable to include antiviral drugs in therapy along with the above drugs in severe illness with severe intoxication. hyperthermia (over 39.5 °C), general deterioration, as well as in frequently ill children. For this purpose, native leukocyte interferon alpha and/or, which is more effective, recombinant interferon alpha-2 (Viferon) can be used in the first 2-3 days of the disease.

Human leukocyte interferon intranasal is administered 1-3 drops in each half of the nose every 2 hours for 2-3 days. Interferon alpha-2 (Viferon) is administered rectally in suppositories of 150,000 IU (Viferon 1) for children under 5 years of age and 500,000 IU (Viferon 2) for children 5 years of age and older 2 times a day for 5 days. After 2-3 days, if necessary, Viferon is taken again, 1 suppository 2 times a day for 1 day and 4-6 such courses are carried out.

From 2.5 years of age, the endogenous interferon synthesis inducer arbidol can be used, which is prescribed at 0.05 g (children's arbidol) 2 times a day for children under 7 years of age, 0.25 g 2 times a day for children over 7 years of age. Arbidol is also used in the first 2-3 days of acute nasopharyngitis for 2 days, then a 3-day break is taken and the treatment is repeated for 1 day; 2-3 such repetitions are made.

In addition, homeopathic preparations are used. For acute nasopharyngitis, viburkol, aflubin, children's anaferon, children's agri (homeopathic antigrippin for children), influcid, etc. are indicated. Homeopathic preparations are prescribed to children starting from 6 months, with the exception of children's agri, prescribed from the age of 3, and influcid, prescribed from the age of 6. Children under 3 years are given 1/2 tablet 2-3 times a day. Children over 3 years old - one tablet 3-4 times a day. The exception is viburkol, which is prescribed in suppositories. Children under 3 years of age - 1 suppository rectally. Children over 3 years - 2 suppositories rectally per day. The duration of the course of therapy with homeopathic preparations is 3-5 days.

Antiviral drugs such as rimantadine and rimantadine/alginate (algirem) are active against the influenza A virus. The indication for prescribing rimantadine is an established or highly probable influenza etiology of the disease (appropriate epidemiological situation, severe, progressive symptoms, a “delay” in the catarrhal symptoms of acute respiratory infections by several hours or 1-2 days).

• Rimantadine is prescribed to children over one year of age orally at 5 mg/kg per day (but not more than 15 mg/kg) in 2 doses for 5 days.
• Rimantadine/alginate syrup 2% is prescribed orally to children over one year old:
  • on the 1st day - 10 mg 3 times a day;
  • on the 2nd and 3rd days - 10 mg 2 times a day;
  • on the 4th and 5th day - 10 mg once a day.

Inclusion of local antibacterial therapy with fusafungine (bioparox) in the treatment regimen is recommended for severe acute nasopharyngitis, as well as for frequently ill children and children over 2.5 years of age with chronic tonsillitis, adenoiditis, sinusitis. Bioparox, along with local antibacterial action, also has a pronounced anti-inflammatory effect. Bioparox is recommended for children over 2.5 years of age because it is prescribed by inhalation. Do 2-4 inhalations in each nasal passage and oral cavity every 6 hours, i.e. 3-4 times a day. The duration of therapy is 5-7-10 days.

Systemic macrolide antibiotics are used when local antibacterial therapy with fusafungine is ineffective in acute nasopharyngitis of mycoplasmal or chlamydial etiology. Macrolide antibiotics are characterized by almost identical antibacterial activity against Chlamydofila pneumoniae and M. pneumoniae, so their choice is determined by individual tolerance and convenience of the dosage form used.

Doses, route and frequency of administration of macrolide antibiotics

Antibiotic	Doses	Routes of administration	Frequency of administration
Erythromycin	Children under 12 years 40 mg/kg Children over 12 years old 0.25-0.5 g every 6 hours	Orally	4 times a day
Spiramycin	Children under 12 years old 15,000 U/kg Children over 12 years old 500,000 IU every 12 hours	Orally	2 times a day
Roxithromycin	Children under 12 years 5-8 mg/kg Children over 12 years old 0.25-0.5 g every 12 hours	Orally	2 times a day
Azithromycin	Children under 12 years of age: 10 mg/kg per day, then 5 mg/kg per day for 3-5 days Children over 12 years old: 0.5 g once a day every day for 3-5 days	Orally	1 time per day
Clarithromycin	Children under 12 years 7.5-15 mg/kg Children over 12 years old 0.5 g every 12 hours -	Orally	2 times a day

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Surgical treatment of runny nose in children

They don't.

Indications for consultation with other specialists

In case of complications (acute otitis media, acute sinusitis, etc.), as well as a protracted or severe course, a consultation with an otolaryngologist is indicated.

Indications for hospitalization

Hospitalization is carried out in the following cases:

• body temperature 40 °C and above;
• severe respiratory and pulmonary-cardiac insufficiency;
• disturbance of consciousness;
• convulsive syndrome;
• development of purulent complications.

Hospitalization is best done in a boxed ward of a hospital, in cases of seizures - in an intensive care unit or resuscitation department, in case of complications (otitis, sinusitis, etc.) - in a specialized ENT department. Special attention should be paid to children in the first six months of life, who should be hospitalized if possible, preferably in a boxed ward.

The prognosis for runny nose in children is favorable.