Upper Respiratory Infection (URI) or Chifuwa

The most common pediatric illness I see at the clinic is upper respiratory infections (URI), also called “the common cold”, “chifuwa” in Chichewa, or the “flu” in Malawian English.  (The flu or influenza virus can look similar to a cold, but is usually a more serious virus that often includes fever, chills, and body aches- looking a lot like malaria. We don’t have the ability to test for the flu in Malawi.  Since the flu is also a virus, uncomplicated flu is treated the same as a URI.)  You can expect a child to get anywhere from 3 to 12 (usually 6-8) URI’s a year from one of the 200 cold viruses. 

What are the Signs and Symptoms of a URI?


-stuffy nose

-runny nose

-sore throat


-watery eyes

-mild headache (The headache can be more intense with the flu.)

-body aches

-fever (While few URI’s come with a fever, most flu viruses do.) 

How do you catch a cold? 

Cold viruses are spread from one person to another through close contact. It’s quite common for kids to pass URI’s from person to person by coughing, sneezing, touching the same objects, shaking or holding hands, and playing together. Trying not to touch your nose or mouth, coughing into a tissue and throwing it away, staying home when sick, and washing hands are all ways to try to limit the spread of these viruses.

What happens in the body?

Once in the body, the virus travels to the mucus membranes lining the eyes, throat, and nasal passages. Within five days, the immune system recognizes this virus and starts fighting back.  The nasal passages and back of the throat become inflamed and swollen.  The body produces more mucus causing the nose to run.  The nasal drainage travels down the back of the throat making it sore and causing your child to cough.   

What is the typical pattern of cold viruses?  

Most cold viruses follow a typical pattern. The first symptoms to appear are a sore throat and runny nose.  If a child has a fever it is usually in the first few days.  The third day is typically the worst with nasal stuffiness, achiness, cough, and generally not feeling well.  After that, the symptoms improve a little each day.  By seven days from the start of symptoms, most people are improving significantly.  All the symptoms should be gone by day ten to fourteen. Some kids will experience a lingering dry cough for a couple of weeks as the swelling in the respiratory tract goes down.  As long as there is no trouble breathing or fever, it is not a concern. IF most of the symptoms last longer than ten days, then you should see your doctor. 

When should I bring my child to the clinic?

  • If your child is younger than 3 months and has the above symptoms (Because babies have such small airways, we like to watch them closer.)
  • Symptoms last longer than 7 to 10 days, seem severe, or get better then worsen
  • Ear pain
  • Throat pain without nasal discharge
  • Fever is high or lasts longer than 3 days (It’s best to do a malaria test to rule out malaria with a fever in Malawi)
  • Trouble breathing or wheezing: Lift up your child’s shirt to look directly at his ribs.  If you can see the skin suck in between the ribs when he breathes then you should bring your child in.  Also, watch for fast breathing. If your baby is breathing roughly a breath per second then he should definitely be seen.
  • Severe headache, neck pain or neck stiffness

How can I manage my child’s symptoms from home?

  1. Get plenty of rest.
  2. Drink plenty of fluids. Fluids such as water or juice help thin the mucus.
  3. Avoid smoke.
  4. Take parcetemol, Panadol, or Brufen for pain or fever: It’s best to wait before giving paracetamol or Brufen as the fever can help fight the virus, but it is okay to give it if your child is uncomfortable or has a high fever.
  5. Use saline nasal spray or drops: Mix half a teaspoon of salt with a cup of water. Using a dropper or cloth, drip a couple of drops in each nostril. Wait a couple of minutes, then suction out the nasal secretions. This can be done with a bulb suction that can be bought in most baby stores.  If a bulb suction is not available, moms have also sucked the secretions directly out of their child’s nose (note this can spread the virus to mom, but may be necessary in extreme cases when a bulb suction is not available).

Should my child take an antibiotic such as Amoxicillin?  

Antibiotics are made to fight bacterial infections. They don’t work against viruses, such as URI’s or the flu.  If child takes an antibiotic when he doesn’t need it, then antibiotic resistance can develop.  Antibiotic resistance happens when the bacteria change in order to not be killed by the antibiotic, making antibiotics no longer helpful.  This is becoming a problem all around the world. 

Should I give my child a cough syrup? If so, which one? 

The American Academy of Pediatrics advises NOT to give cough syrups to children under 4 years of age and only with a doctor’s supervision under age 6.

Honey works well to help reduce coughing for kids over the age of one. You can give 1 to 2 teaspoons of honey, especially at bedtime to help with nighttime coughs.

Children over 6 years of age can have cough syrups, but know that honey and tea with lemon could be more effective.  Be careful to read the active ingredients as some cough syrups come with paracetamol and you don’t want to overdose. If the cough syrup has paracetamol in it, then be sure to wait 4 hours before giving any paracetamol.  

In Malawi, some of the over the counter cough syrups contain salbutamol. Salbutamol is a bronchodilator that is in the inhaler for asthma. If taken by mouth it will also speed up the heart rate and can be harmful to an already sick child.  Avoid cough syrups with salbutamol unless prescribed by your doctor.  

Amoxicillin is not a cough syrup.  It is an antibiotic, used to treat bacterial infections.  Since URI’s are viruses it will not help.

Coldril pediatric syrup can help with the symptoms of a stuffy nose. It contains Paracetamol, Chlorpheniramine maleate, and Pseudoephedrine (a nasal decongestant).

Docoff pediatric’s active ingredient is diphenhydramine. This is a first generation, short acting antihistamine. It can help dry up a runny nose, but will also make your child sleepy.

Could my child have COVID?

Without testing, it’s difficult to tell if your child has cold, flu or COVID.

There are several sites in Malawi (Bwaila, KCH, and PIH) that are currently testing for COVID. Contact your doctor if you want your child to be tested. If your child has URI and/or flu symptoms, but you choose not to get tested, then it is best to stay home for 10 days from onset of symptoms so it doesn’t spread to others.

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