Viral respiratory tract infections affect the nose, throat, and airways and may be caused by any of several different viruses.
Common respiratory tract infections include the common cold and influenza (flu).
Typical symptoms include nasal congestion, a runny nose, scratchy throat, cough, and irritability.
The diagnosis is based on symptoms.
Treatment is aimed at relieving symptoms.
Careful handwashing, avoiding contact with others when ill, and wearing a mask when coughing or sneezing, are the best ways to prevent the spread of these infections.
Vaccination can help prevent some of these infections.
Children through age 14 develop on average up to 6 viral respiratory tract infections each year, and the highest number of infections occurs in children under 1 year old.
Viral respiratory tract infections are typically divided into:
Upper respiratory tract infections: Symptoms occur mainly in the nose and throat. Viral upper respiratory tract infections may occur at any age and include the common cold and influenza (flu).
Lower respiratory tract infections: Symptoms occur in the windpipe, airways, and lungs. Viral lower respiratory tract infections are more common among children and include bronchiolitis and pneumonia.
Children sometimes have an infection that involves both the upper and lower respiratory tracts, such as croup.
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Causes of Viral Respiratory Infections
Many different viruses infect the respiratory tract. In children, rhinoviruses, influenza viruses (during annual winter epidemics), parainfluenza viruses, respiratory syncytial virus (RSV), enteroviruses, coronaviruses, and certain strains of adenovirus are the main causes of viral respiratory infections.
Most often, viral respiratory tract infections spread when children's hands come into contact with nasal secretions from an infected person. These secretions contain viruses. When the children touch their nose, mouth, or eyes, the viruses gain entry and produce a new infection. Less often, infections spread when children breathe air containing droplets that were coughed or sneezed out by an infected person.
For various reasons, nasal or respiratory secretions from children with viral respiratory tract infections contain more viruses than those from infected adults. This increased output of viruses, along with typically lesser attention to hygiene, makes children more likely to spread their infection to others. The possibility of transmission is further enhanced when many children are gathered together, such as in child care centers and schools. Contrary to what people may think, becoming chilled or wet does not cause colds.
Symptoms of Viral Respiratory Infections
When viruses invade cells of the respiratory tract, they trigger inflammation and production of mucus. This situation leads to nasal congestion, a runny nose, scratchy throat, and cough, which may last up to 14 days. Some children may continue to cough for weeks after the upper respiratory infection has resolved. Fever, with a temperature as high as 101 to 102° F (about 38.3 to 38.9° C), is common among young children or those with influenza. The child's temperature may even rise to 104° F (40° C).
Other typical symptoms in children include decreased appetite, lethargy, and a general feeling of illness (malaise). Headaches and body aches develop, particularly with influenza. Infants and young children are usually not able to communicate their specific symptoms and just appear cranky and uncomfortable.
Complications of viral respiratory tract infections
Because newborns and young infants prefer to breathe through their nose, even moderate nasal congestion can create difficulty breathing. Nasal congestion leads to feeding problems as well because infants cannot breathe while breastfeeding or bottle-feeding. Because infants are unable to spit out mucus that they cough up, they often gag and choke.
The small airways of young children can be significantly narrowed by inflammation and mucus, making breathing difficult. Children breathe rapidly and may develop a high-pitched noise heard on breathing out (wheezing) or a similar noise heard on breathing in (stridor). Severe airway narrowing may cause children to gasp for breath and turn blue (cyanosis). Such airway problems are most common with infection caused by parainfluenza viruses, RSV, and human metapneumovirus infection. Children who are gasping or have cyanosis (bluish or sometimes purplish discoloration of the skin, lips, inside of the mouth, or nail beds) need to be seen urgently by a doctor.
Some children with a viral respiratory tract infection also develop an infection of the middle ear (otitis media) or the lung tissue (pneumonia). Otitis media and pneumonia may be caused by the virus itself or by a bacterial infection that develops because the inflammation caused by the virus makes tissue more susceptible to invasion by other germs. In children with asthma, respiratory tract infections often lead to an asthma attack.
Diagnosis of Viral Respiratory Infections
A doctor's evaluation
Sometimes nasal swabs or other tests
Doctors and parents recognize respiratory tract infections by their typical symptoms. Generally, otherwise healthy children with mild upper respiratory tract symptoms do not need to see a doctor unless they have trouble breathing, are not drinking, or have a fever for more than a day or two.
When necessary, samples of fluid from the nose or saliva are taken and tested. When nasal swabs are taken in a hospital, they are often checked for a variety of organisms that cause respiratory infections, including viruses and bacteria.
X-rays of the neck and chest may be taken in children who have difficulty breathing, stridor, or wheezing or if the doctor can hear congestion in the lungs.
Treatment of Viral Respiratory Infections
Rest and fluids
Medications for fever and pain
Sometimes antiviral medications
Antibiotics are not given because they cannot cure viral respiratory tract infections.
Children with respiratory tract infections need additional rest and adequate fluid intake. Acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can be given for fever and aches.
In infants and young children, congestion may be relieved somewhat by using a cool-mist vaporizer to humidify the air and by suctioning the mucus from the nose with a rubber suction bulb.
There are antiviral medications (oseltamivir, zanamivir, peramivir, and baloxavir) for influenza that can be used in children. However, these medications work only if taken within the first day or two after symptoms begin, and they shorten the duration of fever and symptoms only by a day or so.
Ribavirin, an antiviral medication, is given to children who have RSV and whose immune system is severely weakened.
COVID-19 infection can be treated with nirmatrelvir/ritonavir in children 12 years old and older. It can be treated with remdesivir in some hospitalized children.
School-aged children may take nonprescription (over-the-counter) decongestants for bothersome nasal congestion, but they often do not help, especially in children under 5 years old. Infants and children 4 years old and younger are also particularly sensitive to the side effects of decongestants and may develop agitation, confusion, hallucinations, lethargy, and a rapid heart rate, so they should not be given decongestants.
Prevention of Viral Respiratory Infections
Good hygiene
Vaccination
Sometimes medications
The best preventive measure is practicing good hygiene. An ill child and the people in the household should wash their hands frequently. In general, the more intimate physical contact (such as hugging, snuggling, or bed sharing) that takes place with an ill child, the greater the risk of spreading the infection to other family members. Parents must balance this risk with the need to comfort an ill child. Children should stay home from school or child care facilities until the fever is gone and they feel well enough to attend.
Influenza and COVID-19 are preventable by vaccination. The number of doses a person receives depends on their age, on whether they have a weakened immune system, and on whether they ever received any doses of vaccine. Guidance on influenza and COVID-19 vaccinations evolves over time, and various expert organizations publish recommendations for who may be given these vaccines, and these recommendations may vary. See the All About the American Academy of Pediatrics (AAP) Recommended Immunization Schedule, the American Academy of Family Physicians (AAFP), and the Centers for Disease Control and Prevention (CDC) Vaccines for Your Children.
Respiratory syncytial virus (RSV) is preventable by vaccination. The RSV vaccine can be given to pregnant people to prevent RSV in their infant after birth. A medication that contains RSV antibodies can be given to infants whose mother did not receive an RSV vaccine during pregnancy. Nirsevimab and clesrovimab are medications that contain antibodies against RSV. These medications are available in the United States for the prevention of RSV infection in infants and young children. They are effective and safe and help reduce the number of infants who are hospitalized because of RSV infection.
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