Respiratory syncytial virus (RSV) and influenza account for most of the cold weather infections. Other important viruses responsible for respiratory infection in children include parainfluenza virus (peak in fall and spring), human metapneumovirus (peak in late winter and fall but activity is seen throughout the year), respiratory adenovirus (throughout the year), and rhinovirus (year-round with peak in cold weather). Based on strong clinical evidence, (5) RSV is the most common cause of bronchiolitis in infants and young children. Based on expert and consensus opinion, 2) clinicians should not routinely obtain radiologic or laboratory studies in cases of bronchiolitis. In addition, clinicians should not administer medications such as albuterol, epinephrine, and antibiotics in viral bronchiolitis. Based on analysis and interpretation of data, (19) palivizumab should be reserved for high-risk infants such as those born at or before 29 weeks of gestation, infants with chronic lung disease, and infants with congenital heart disease who continue to require treatment for their underlying condition until 24 months of age. Based on expert opinion, (24) influenza treatment should be considered in high-risk patients and in hospitalized children, ideally within 48 hours of symptom onset. The antiviral agent of choice is oral oseltamivir. Based on strong evidence, (35) parainfluenza 1 and 2 are a major cause of croup in the fall, and primary management is supportive care. Based on consensus, (41) the mainstay of treatment in adenoviral infections is supportive care. There is limited evidence (38) for use of cidofovir, even in immunocompromised hosts. Based on strong research evidence, (44) human metapneumovirus is a paramyxovirus causing bronchiolitis illness similar to RSV, and there is no antiviral drug therapy available. Based on strong evidence, (50) rhinovirus is the most common cause of the "common cold" in children and adults. Its detection in the multiplex polymerase chain reaction may represent infection or asymptomatic shedding. © 2019 by the American Academy of Pediatrics. All rights reserved.
