Colds In Children: What Helps, And When To Worry

In 2011, the Health Ministry reported a staggering 20,702 of influenza cases, that's a 13% increase in patients being admitted to polyclinics for acute respiratory infections (ARI) and other related diseases. Read on to find out how you can immunize yourself and your family.

A young child in childcare will get somewhere between six and twelve colds a year, and more in the first year of attending. That’s normal, it isn’t a reflection on the centre or on their immune system, and almost none of it needs medicine.

Antibiotics don’t work on colds. Colds are viral. Antibiotics do nothing for them, cause diarrhoea and rashes, and contribute to resistance.

Green or yellow mucus doesn’t mean a bacterial infection. It’s a normal stage of an ordinary cold and isn’t a reason for antibiotics.

What helps

Fluids, frequently and in small amounts. This does more than anything else on the list.
Saline nose drops and gentle suction for a blocked-up baby who can’t feed: the single most useful intervention for infants, since they can’t breathe through their mouths well while feeding.
Honey for cough, in children over 12 months. It has reasonable evidence and works better than most syrups. Never under one, because of infant botulism.
Humid air: a few minutes in a steamy bathroom. Don’t use a bowl of hot water near a child.
Paracetamol or ibuprofen if they’re uncomfortable, dosed by weight.
Rest, and lowered expectations for a few days.

What doesn’t

Over-the-counter cough and cold medicines: not recommended under six, and not to be given at all under two.
Vitamin C doesn’t prevent colds, and taken after one starts it makes very little difference.
Most supplements marketed for children’s immunity.

What to do about fever

Fever is a defence mechanism, not the illness. Treat the child, not the number. A child with a temperature of 39°C who’s playing needs less intervention than one at 38°C who’s limp and refusing to drink.

Give paracetamol or ibuprofen for discomfort, not to chase a reading down
Don’t routinely alternate paracetamol and ibuprofen: it increases dosing errors, and that’s where the risk lies
Don’t sponge with cold water or use fans to force the temperature down
Dress them lightly, keep fluids going
Any fever in a baby under three months needs same-day medical attention, whatever else is going on

When to get help

Same day, or straight to A&E:

Difficulty breathing: fast breathing, the skin sucking in between or under the ribs, nostril flaring, grunting
Blue or grey lips or tongue: call 995
Any fever under three months of age
Very sleepy, floppy, or hard to wake
Dehydration: far fewer wet nappies, no tears, dry mouth, sunken eyes
A rash that doesn’t fade when pressed with a glass
Stiff neck, dislike of light, or a severe headache
A seizure
Fever lasting more than five days, or a child who was improving and has worsened

Also see a doctor for ear pain, a cough lasting more than three weeks, wheeze, or breathing that worries you even without the signs above.

Reducing how often it happens

Handwashing. By some distance the most effective thing available, for the child and for everyone handling them.
Teach coughing into the elbow instead of the hand.
Keep sick children at home: the thing everyone wants others to do.
Flu vaccination, which is available for children and something to ask about.
No sharing of cups, straws and utensils, which is a hard habit to change in most families here.
Don’t smoke around them. Second-hand smoke measurably increases chest and ear infections, and residue on clothing counts.

Beyond that, frequent colds in the first year of childcare are the immune system doing its job. Children who attend childcare early tend to get more infections then and fewer once they start school. The total tends to even out.

Frequently asked questions

How many colds is normal for a young child?

Six to twelve a year, and more in the first year of attending childcare. It’s normal and not a sign of a weak immune system or a poor centre. Children who start childcare early tend to get more infections then and fewer at school age.

Do antibiotics help a cold?

No. Colds are viral, so antibiotics do nothing for them while causing diarrhoea and rashes and contributing to resistance. Green or yellow mucus is a normal stage of an ordinary cold and isn’t a reason for antibiotics either.

What helps a child with a cold?

Fluids frequently and in small amounts; saline nose drops and gentle suction for a blocked baby who can’t feed; honey for cough in children over 12 months, which has reasonable evidence; a few minutes in a steamy bathroom; and paracetamol or ibuprofen by weight if they’re uncomfortable.

Should I treat a fever?

Treat the child, not the number: a child at 39°C who’s playing needs less than one at 38°C who’s limp and refusing to drink. Give medicine for discomfort rather than to chase a reading down, and don’t routinely alternate paracetamol and ibuprofen, which mainly increases dosing errors. Any fever under three months needs same-day attention.

When should I take my child to a doctor?

Difficulty breathing, blue lips, any fever under three months, unusual sleepiness, signs of dehydration, a rash that doesn’t fade under a glass, stiff neck or dislike of light, a seizure, fever beyond five days, or a child who was improving and has worsened.

How do I reduce how often they get sick?

Handwashing, by a wide margin, for the child and everyone handling them. Then coughing into the elbow, keeping sick children at home, flu vaccination, not sharing cups and utensils, and no smoking around them, including residue on clothing.

What to remember

Six to twelve colds a year is normal. Antibiotics do nothing, and green mucus doesn’t change that.

Fluids, saline drops for babies, honey over one, and medicine for discomfort, not for the number on the thermometer.

Handwashing prevents more than anything else. And know the red flags: breathing difficulty, any fever under three months, and a rash that doesn’t fade under a glass.