Respiratory Infections in Kids: Signs, Care and When to Worry

Runny noses, coughs and sore throats are a normal part of childhood. KidsHealth says colds are the top reason kids visit the doctor and miss school. The American Academy of Pediatrics says it is normal for healthy children to get at least 6 colds a year.

Most of these illnesses are respiratory tract infections. That means they affect the nose, throat, airways or lungs. Most are mild and get better at home. But some can become serious. Here is how to tell the difference and how to help your child feel better.

Upper and lower respiratory infections

Doctors divide respiratory infections into two groups:

• Upper respiratory infections affect the nose, sinuses and throat. The common cold is the most common one. Others include sore throats, sinus infections and laryngitis, which is swelling of the voice box that can make your child's voice hoarse.
• Lower respiratory infections affect the airways and lungs. These include bronchitis (infection of the large airways), bronchiolitis (infection of the small airways) and pneumonia (infection of the lungs), says the CDC.

The flu can affect both the upper and lower parts. Lower infections are usually more serious.

Why do kids get sick so often?

• Their immune system is still learning to fight germs.
• They are around lots of other kids at daycare, school and play.
• They touch everything and then touch their eyes, nose and mouth.

The CDC says most respiratory viruses spread through droplets when a sick person coughs or sneezes. Germs can also spread when a child touches a dirty surface or a sick person's hand and then touches their face.

Common signs

The CDC says cold symptoms usually peak 2 to 3 days after a child gets sick. Common signs include:

• Runny or stuffy nose
• Sneezing
• Sore throat
• Cough
• Headache or mild body aches
• Low fever

Mucus often starts clear and can turn yellow or green. The AAP says this is normal for a cold and does not always mean your child needs antibiotics.

Lower respiratory infections may cause a deeper cough, fever, wheezing or fast breathing. These signs need a call to the doctor.

What is RSV?

RSV is a common virus. The CDC says it usually causes mild, cold like symptoms. But it is the most common cause of bronchiolitis and pneumonia in babies under 1 year old. Babies younger than 6 months are most at risk of getting very sick. RSV spreads most in fall and winter. The CDC now recommends immunizations to protect babies from severe RSV. Ask your doctor what is right for your baby.

How long do colds last?

The AAP says a normal cold can last about 2 weeks:

• Fever can last 2 to 3 days.
• A runny nose can last 7 to 14 days.
• A cough can last 2 to 3 weeks.

How to help your child feel better

Most respiratory infections are caused by viruses. The AAP says antibiotics do not help colds. Your doctor may only use them if your child gets a bacterial infection, like an ear or sinus infection. Here is what does help:

• Fluids. Offer lots of fluids. The AAP says this thins mucus and makes it easier to cough up.
• Rest. Let your child rest as much as they need.
• Saline nose drops. These loosen mucus so your child can breathe easier.
• A cool mist humidifier. KidsHealth says this adds moisture to the air.
• Honey for cough. For children over 1 year, the AAP suggests ½ to 1 teaspoon of honey. Never give honey to babies under 1 year.
• Fever or pain medicine. You can give acetaminophen or ibuprofen based on the package directions for your child's age or weight. Do not give ibuprofen to babies under 6 months unless your doctor says to.

What to avoid

• Cough and cold medicines. The AAP says drugstore cough and cold medicines are not approved by the FDA for children under 6. They are not helpful and can cause serious side effects.
• Aspirin. KidsHealth says never give aspirin to children or teens. It is linked to Reye syndrome, a rare but serious illness.
• Cough drops. KidsHealth says hard candy and cough drops are only for kids older than 6.

A sick day is a good time for cuddles and quiet songs. Our Honey Don't You Cry Lullaby is about a mommy penguin caring for her sick baby. You can find more calm children's music on our music page.

When to call the doctor

The AAP says to call 911 if your child:

• Has severe trouble breathing, is struggling for each breath or can barely speak or cry

Go to the ER if your child:

• Is not alert when awake
• Has ribs that pull in with each breath

Call the doctor now if your child has:

• Trouble breathing that does not go away after cleaning out the nose
• Wheezing or breathing that is much faster than normal
• Trouble swallowing or new drooling
• A fever higher than 104°F (40°C)
• Any fever in a baby younger than 12 weeks. Do not give fever medicine before the baby is seen.
• A look of being very sick

Call the doctor within 24 hours if:

• Your child is younger than 6 months
• Your child has an earache or ear drainage
• A fever lasts more than 3 days, or comes back after being gone for more than 24 hours
• There is sinus pain around the cheeks or eyes

Colds can lead to ear infections. Read our post on ear infections in children to learn the signs. For more warning signs, see our post on when to call a doctor. If your child feels nervous about a visit, our Going To The Doctor song walks kids through a checkup, from the doctor checking their heartbeat to getting medicine that helps them feel great.

How to help prevent respiratory infections

KidsHealth and the CDC suggest these steps:

• Wash hands well and often, especially after blowing the nose and before eating.
• Cough or sneeze into a tissue or elbow, not into the hands.
• Don't share cups, towels or spoons with someone who is sick.
• Stay away from smoke. Keep your child away from secondhand smoke.
• Get vaccines. The CDC says everyone 6 months and older should get a flu vaccine every season, with rare exceptions.

Make hand washing fun with our Don't Splash Water On Your Shirt song. The little penguins show kids how to use soap, scrub between their fingers and send "all the germs" down the drain. For more tips, read our post on common health problems in toddlers.

Questions Parents Ask About Respiratory Infections

How many colds a year is normal for a child?

The AAP says it is normal for healthy children to get at least 6 colds a year. KidsHealth says some kids get 8 or more. Kids in daycare or school often get more.

Does green mucus mean my child needs antibiotics?

No. The AAP says mucus often turns yellow or green during a normal cold. Antibiotics do not help colds. Call your doctor if the runny nose lasts more than 2 weeks or your child has sinus pain.

Can I give my toddler cough medicine?

No. The AAP says drugstore cough and cold medicines are not approved for children under 6. For kids over 1 year, a little honey can help with cough. Never give honey to babies under 1.

When is a cough serious?

Call your doctor if your child is breathing fast, wheezing, or working hard to breathe. Call 911 if your child is struggling for each breath or can barely speak or cry.

How long is a cold contagious?

KidsHealth says colds are most contagious in the first 2 to 4 days after symptoms start. They can spread for a couple of weeks. Your child can go back to school when the fever is gone and they feel well enough to join in normal activities.

Is RSV dangerous for babies?

RSV is usually mild, but it can be serious for babies, especially those younger than 6 months. It is the most common cause of bronchiolitis and pneumonia in babies under 1. Ask your doctor about RSV immunizations for your baby.

Should my child get a flu shot?

The CDC says everyone 6 months and older should get a flu vaccine every season, with rare exceptions. Talk to your child's doctor if you have questions.

This post is for general information only. It is not medical advice. If you have questions about your child's health, please talk to your child's doctor.