Young children often get “sick” more than adults because their immune system is less strong. Most childhood illnesses are mild and caused by viruses, such as the common cold. Sometimes they are more serious and need medical attention.  If “infections” occur more commonly than expected, the symptoms may be actually caused by allergies or they may be caused by a problem with the child’s immune system. Below is a guide on the common cold, followed by a section on what is normal in terms of frequency/type of illnesses and what is no longer considered within normal limits.

What is the common cold and what are the symptoms?

The common cold is an upper respiratory tract infection caused by  one of many viruses. It affects mainly the nose, sinuses and throat. The common cold often occurs in the winter season in cold, wet weather.  It usually starts with tiredness (often “grumpiness” in children), sneezing and headache followed by a runny nose and cough (in at least 50% of children). Most children have a mild fever in a common cold, though fever is rare in adults. Most of the symptoms of a cold are due to the immune response of the body to the virus. The chest is not involved in the common cold, but a cold may in some cases progress into a bronchitis or pneumonia. Symptoms are worst 2-4 days after the start of the illness, and generally last 7-10 days, though may last up to 3 weeks!

When do I need to see a medical practitioner?

If a child has low fever (under 38ºC), has periods of playfulness (even if it is after a dose of paracetamol), is eating and drinking relatively well despite the illness, and is not too tired or irritable, then you can sit it out for a few days. Keep the child comfortable with saline nose drops, paracetamol if needed, frequent small feeds and lots of hugs. Adults can try saline nose drops, short courses of decongestant nasal sprays, paracetamol or ibuprofen. Alternative remedies such as vitamin C and zinc are frequently used but there is not much evidence to back them up. Antibiotics do not work for the common cold and if overused may lead to problems such as antibiotic resistance. There is no effective anti-viral medication for the common cold.

Not every snuffle needs a doctor’s opinion; however please see your doctor if the child:

• is feeding poorly
• has a high fever (> 38 degrees in the first 6 months and > 38.5 degrees after that)
• is unusually tired or irritable
• is breathing fast (more than one breath per second/60 breaths per minute; especially if you  have already controlled the fever)
•  has a wheeze when breathing out (often bronchitis or asthma) or a “whoop” when breathing in (usually croup)
• is not “getting better” after 5 days or (they may have developed a bacterial infection such as a middle ear infection or tonsillitis).

In adults, a persistent cough or a fever should prompt seeking medical attention to rule out complications of the common cold.

Could the “colds” be allergy-related?

The common cold can mimic hayfever (allergic rhinitis), and if there is any doubt, your doctor should be consulted. Generally hayfever lasts several weeks (though a cold can last 2-3 weeks too!), is associated with itching, sneezing, blockage of the nose and sinuses and a clear nasal discharge. A common cold may have similar symptoms but there may also be more generalised symptoms such as lethargy, mild fever and loss of appetite. Hayfever tends to be persistent over a few weeks to months or even all year round (depending on what one is allergic to), whereas one tends to get “better” in between colds. In common colds the nasal discharge changes from clear to opaque and even yellowish over time, whereas in allergic rhinitis it is generally clear.

What is “normal” for the number and type of illnesses in a child?

Most children get many minor illness within the first 2-3 years of life when their immune systems are immature and all the bugs they encounter are “new” to their systems. Babies in crèche / day-care and babies with older siblings are exposed to more bugs and tend to get sick more frequently. Do not be surprised if the child has 5-10 minor infections (e.g. common colds) per year in the first 2-3 years of life.   In addition, every cold may last 1-3 weeks so it can feel as if your baby is “always sick.”

However, it is not normal if infections are too great in number, last for too long, fail to resolve with standard treatment, or have severe or unusual complications. Examples of such cases are:

• The need for intravenous antibiotics to clear an infection when oral antibiotics have failed
• More than 2 serious sinus infections or pneumonia episodes in 1 year
• More than 4 ear infections in 1 year
• Use of more than 2 months of antibiotics in one year
• Two or more episodes of sepsis or meningitis in a lifetime
• Unusual organisms causing the infections
• Chronic diarrhoea
• Extensive, recurring skin infections.

These may indicate a problem with the immune system of the child and the child should be seen by a doctor to check whether any further tests are needed.