Coughs, colds and how many is too many

Parents of a child in nursery frequently believe something must be wrong because the child is constantly ill, and the numbers say otherwise.

How many is normal

Preschool children commonly have somewhere between six and twelve respiratory infections a year, and more in the first year of group childcare.

Each cold lasts around a week to ten days, with a cough persisting for two to three weeks or occasionally longer.

Which means that in winter a child can appear continuously unwell while having a normal series of separate ordinary infections.

What matters is not the number but whether the child recovers fully between them, grows normally, and does not have severe or unusual infections.

What warrants concern about immunity

The features that suggest something other than ordinary childhood exposure.

Recurrent severe infections requiring hospital admission or intravenous antibiotics.

Infections with unusual organisms.

Failure to recover between infections.

Poor growth or weight loss.

Persistent thrush beyond infancy.

Recurrent deep abscesses.

Two or more episodes of pneumonia.

And a family history of immune deficiency or early unexplained deaths.

Bronchiolitis

The condition that most commonly frightens parents of infants.

A viral lower respiratory infection, usually RSV, affecting infants under a year, typically starting like a cold and progressing over two to three days to cough, rapid breathing and feeding difficulty.

It typically peaks around days three to five and then improves, with the cough lasting weeks.

There is no effective treatment for most cases — antibiotics, steroids, bronchodilators and nebulisers have all been studied and do not help typical bronchiolitis.

Management is supportive: small frequent feeds, and hospital care where feeding or oxygenation is inadequate.

Preventive immunisation against RSV has become available in several countries for infants and through maternal vaccination, which is a significant change.

Croup

Recognisable and usually manageable.

A barking, seal-like cough, a hoarse voice and a harsh sound on breathing in, typically worse at night.

A single dose of oral steroid is effective and is the standard treatment, which means it is worth seeking medical advice rather than only waiting it out.

Keeping the child calm matters, since distress worsens the obstruction.

Steam and cold air have traditional followings and limited evidence.

Severe croup, with stridor at rest, marked recession, drowsiness or agitation, is an emergency.

The signs requiring urgent help

Applicable to any respiratory illness.

Difficulty breathing: rapid breathing, grunting, nostril flaring, drawing in below the ribs or at the neck, or head bobbing in an infant.

Pauses in breathing, which in young infants can occur with bronchiolitis and whooping cough.

Blue lips or tongue, or pale, mottled or ashen skin.

Being unusually drowsy, floppy or difficult to wake.

Taking less than about half the usual feeds, or significantly fewer wet nappies.

A high temperature in a baby under three months.

Fits, a rash that does not fade under pressure, or a stiff neck.

And any deterioration or parental instinct that something is wrong.

Whooping cough

Worth knowing because it is dangerous in young infants and has resurged in several countries.

It begins like a cold and progresses to prolonged coughing fits, sometimes with a whoop on inspiration, vomiting after coughing, and exhaustion.

Young infants may not whoop and may present with apnoea instead.

Vaccination in pregnancy protects newborns before their own vaccinations take effect and is the main preventive measure.

Any infant with coughing fits, colour change or pauses in breathing needs urgent assessment.

What to do at home

For an ordinary cold.

Fluids, in small frequent amounts.

Paracetamol or ibuprofen for discomfort or fever, at the correct dose.

Saline drops and gentle nasal suction before feeds in infants who cannot breathe through a blocked nose.

Keeping the room comfortable rather than hot.

Honey for cough in children over one year, which has evidence and must not be given under a year because of botulism risk.

And not using over-the-counter cough and cold medicines in young children, which are not recommended under six years in most guidance and have caused harm.

Antibiotics

Worth stating plainly.

Most childhood respiratory infections are viral and antibiotics do not help, do not shorten them, and carry side effects and resistance costs.

Green nasal discharge is not an indication of bacterial infection.

Antibiotics are appropriate for specific bacterial infections diagnosed clinically, and a clinician declining to prescribe is generally following the evidence rather than being unhelpful.

General information only, not medical advice. Seek urgent care for breathing difficulty, colour change, poor feeding, drowsiness or a non-blanching rash in a child.