URTI: Latest Recommendations - Nothing!

The Common Cold

The scourge of every kid and parents! Which moms wouldn't bring their kid to the nearest clinic asking for antibiotics and vitamin C?

However, evidence based reviews suggest 'wait and see' for most of these problems.

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Most URTIs are self limiting.

Persistent symptoms more than 14 days should raise suspicions of other possible diagnosis.

Latest reviews suggest supportive measures in treatment of the common cold.

• Adequate hydration
• Warm fluids (ie. hot soup, tea)
• Honey
• Saline nasal spray or irrigation
• COLD humidifier (not warm)

The above measures have no strong evidence but is safe and inexpensive for use.

Does not recommend:

• Over-the-counter cough and cold medications in children < 6 yo
• Using antibiotics in ABSENCE of secondary bacterial infections
• Antihistamines, ipratropium, decongestants in nasal congestion. Side-effects may bring more harm that benefits
• Antitussives, mucolytics or expectorants in treatment of coughs as there is no proven benefits and may cause adverse effects. WHO however recommend us of dextrometrophan in cases of severe symptoms but diagnosis needs to be reviewed and revised.
• Bronchodilators in non-asthmatic patients.
• Topical rubs containing aromatics for nasal obstruction
• Zinc and vitamin C

Symptomatic treatment initiated only even it is bothering the child or family members (ie. difficulty sleeping)

• Fever - in children > 3 mo, treated with acetaminophen or ibuprofen
• Nasal Congestion - as mentioned above.
• Cough - Ingestion of warm fluids or honey.

Prevention

• Education on hand hygiene and non-contact of affected individual.
• No immunization to prevent common cold.
• Zinc, vitamin C are not proven to prevent the common cold.

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There you have it, URTI treatment in a nutshell.

In our community I doubt parents would buy that. Perhaps placebo should do the trick?

Reference:

Pappas, D. E., et al., The Common Cold in Children, Treatment and Prevention, UpToDate Article, 2013.


Some Doses of Commonly used drugs:

Paracetamol - 15 mg/kg (max 4 g/day) oral
Dextromethorphan - 0.2 - 0.4 mg/kg 6 - 8 hourly oral
Bromhexine - 0.3 mg/kg tds oral 7 days
Actifed (Triprolidine HCl 1.25 mg, pseudoephedrine Hcl 30 mg) - > 12yo 10mL, 6 - 12 yo 5 mL, < 6yo 2.5 mL tds oral (syrup).
Benadryl (diphenhydramine Hcl 12.5mg, ammon Cl 125 mg) - > 1 yo 1/2 - 1 tsp 4 hourly (Max 6 tsp/24 hours)
Clarinase (Loratidine 5 mg, pseudoephedrine 60 mg) - > 30 kg 5 mL, < 30 kg 2.5 mL bd syrup.

Autism: DSM IV Criteria

A total of 6 (or more) from (1) , (2) , (3), with at least 2 from (1), and 1 from each (2) and (3).

1. Qualitative impairment in social interaction, as manifested by at least 2 of the following:

a. Marked impairment in use of multiple nonverbal behaviors, such as eye to eye gaze, facial expression, body postures, and gestures to regulate social interaction.
b. Marked failure to develop peer relationships appropriate to developmental level.
c. Lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (ie. lack or showing, bringing, pointing object of interest).
d. Lack of social or emotional reciprocity.

2. Qualitative impairments in communication, as manifested by at least 1 of the following:

a. Delay in or total lack of development of spoken language (not accompanied by an attempt to compensate through alternative modes of communications such as gesture or mimes).
b. In individual with adequate speech, marked impairment in ability to initiate or sustain conversation with others.
c. Stereotyped and repetitive use of language or idiosyncratic language.
d. Lack of varied, spontaneous make-believe play or social imitative play appropriate to developmental level.

3. Restricted, repetitive, and stereotyped patterns of behavior, interest and activities as manifested by at least 1 of the following:

a. Encompassing preoccupation with 1 or more stereotyped and restricted pattern of interest that is abnormal in either intensity or focus.
b. Apparently inflexible adherence to specific, nonfunctional routines or rituals.
c. Stereotyped and repetitive motor mannerism (ie. hand or finger flapping or twisting or complex body movements)
c. Persistent occupation with parts of objects.

B. Delay or abnormal functioning in at least 1 of the following areas with onset < 3 age year: (1) social interaction, (2) language as used in social communication, or (3) symbolic or imaginative play

C. The disturbance is not better accounted by Rett disorder or childhood degenerative disorder.

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This article may be a bit out-dates when DSM V comes out with new changes. Asperger's and Persistent Developmental Disorder - Not Otherwise Specified (PDD-NOS) will be grouped together with Autism under Autistic Spectrum Disorders with various levels.

Asperger's differ only in terms of language skills which is mostly intact.

Autism has no association with MMR vaccination.

Reference:

1. Kliegman, Robert M., et al., Nelson Textbook of Pediatrics, 18th ed., Elsevier Saunders.

Future Topics:

- Management

- DSM V!