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Paeds Casesinfectious-diseases

Paeds Cases · infectious-diseases

Viral upper respiratory tract infection and the common cold — structured clinical encounter

Structured encounter testing the assessment and management of a child with an uncomplicated viral cold whose parents expect an antibiotic, and the recognition of an evolving complication in a younger sibling, with emphasis on red-flag assessment, antimicrobial stewardship and safety-netting.

structured clinical encounter2 min readVerification in progress

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
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Study tools

Target exams

RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
A previously well 3-year-old is brought to the general paediatric clinic on day 4 of a cold. He has congestion, clear-then-yellow-green nasal discharge, a low-grade fever that has settled, and a nocturnal cough. He is playing and drinking normally and has no respiratory distress. On examination the nasal mucosa is inflamed, the throat is mildly erythematous, the tympanic membranes are normal with preserved mobility, and the chest is clear. The parents request 'an antibiotic to clear it up' because the discharge has turned green and the cough persists. During the consultation the mother mentions that the child's 6-week-old sibling now has a snuffle and 'felt a bit warm' this morning.

Candidate tasks (12 minutes)

The candidate should take a focused, red-flag history from the parents of both children; explain the meaning of the purulent discharge and the expected natural history of the cold; counsel the parents on evidence-based symptomatic care and on why an antibiotic is not indicated; address the 6-week-old sibling's febrile illness and outline the appropriate next step; and provide a clear, specific safety-net for return. [1] [4]

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References6ShowHide
  1. [1]Heikkinen T, Järvinen A. The common cold. Lancet, 2003.PMID 12517470
  2. [4]Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane database of systematic reviews, 2013.PMID 23733381
  3. [3]Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. American family physician, 2012.PMID 22962927
  4. [6]Shefrin AE, Goldman RD. Use of over-the-counter cough and cold medications in children. Canadian family physician Medecin de famille canadien, 2009.PMID 19910592
  5. [8]Oduwole O, Udoh EE, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane database of systematic reviews, 2018.PMID 29633783
  6. [15]Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics, 2013.PMID 23439909
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