Colds and upper respiratory infections in children: what is normal and what is not

The NHS says cold symptoms come on gradually over 2 to 3 days and include a blocked or runny nose, sneezing, a sore throat, a hoarse voice, a cough and feeling tired and unwell. Other possible symptoms are a high temperature, aching muscles, loss of taste and smell and pressure in the ears and face. NHS inform says fever is usually about 37C to 39C and notes severe earache may be a sign of a middle ear infection.

In younger children the picture differs. The NHS says symptoms can last longer in young children and that they may also be irritable, have difficulty feeding and sleeping, breathe through their mouth and be sick after coughing. It adds that it is common for small children to lose their appetite for a few days.

Both are viral and the symptoms overlap, but the pattern differs. The NHS says cold symptoms appear gradually, mainly affect the nose and throat and let you carry on as normal, while flu appears quickly within a few hours, affects more than the nose and throat and makes you exhausted and too unwell to carry on. NHS inform similarly says flu usually includes headache, high temperature and sore muscles.

The NHS suggests several measures, noting some are not suitable for children.

• Rest, plenty of fluids such as water, and healthy food when they feel like eating.

• Paracetamol or ibuprofen to ease aches or lower a temperature, after a pharmacist's advice on what is suitable.

• Vapour rubs to help ease chesty coughs in babies and small children, as a pharmacist may suggest.

• Do not let children breathe in steam from a bowl of hot water because of the risk of scalding; the NHS says gargling salt water is not suitable for children.

• Do not give hot drinks to small children and do not give honey to children under 12 months.

• Do not give aspirin to children under 16.

The NHS says some cough and cold medicines are not suitable for babies, children and pregnant women, and that decongestants should not be used by children under 6. Nasal sprays should not be used for more than a week because it can make symptoms worse. It also warns not to combine other cough and cold medicines with paracetamol and ibuprofen tablets as you may take more than you should. NHS inform makes the same point that many cough and cold medicines contain paracetamol or ibuprofen.

The NHS says there is little evidence that vitamin C, echinacea or garlic prevent colds or speed recovery, and that the flu vaccine does not prevent colds. Antibiotics only work if you have a bacterial infection, and colds are caused by viruses.

The NHS says to see a GP if a high temperature lasts more than 3 days, cold symptoms get worse, the temperature is very high or the child feels hot, cold or shivery, there is shortness of breath or chest pain, you are worried about your child's cold symptoms, symptoms have not improved after 10 days, or there is a cough for more than 3 weeks. It adds that people with long-term conditions or weakened immunity should also seek advice.

NHS inform says to speak to the GP practice for someone who is more short of breath than usual, has pain when breathing in or coughing, is confused, dizzy or lightheaded, has a very high or low temperature, has had a fever for more than 3 days or whose symptoms are not improving, and to phone 111 if the GP is closed.

NHS inform says colds usually clear without further problems but the infection can sometimes spread to the chest, ears or sinuses. In small children noisy breathing, fast breathing or difficulty feeding after a cold may be a different illness such as bronchiolitis or croup, both of which have their own guides on this site, and the NHS bronchiolitis page lists worsening of a cold as a reason to ask for urgent advice.

The NHS says colds spread by germs from coughs and sneezes, which can live on hands and surfaces for 24 hours, and that a person can spread a cold from a few days before symptoms begin until symptoms have finished, usually 1 to 2 weeks and sometimes longer in babies and young children. Handwashing with warm water and soap, tissues and not sharing towels, cups or toys help. NHS inform notes that different viruses cause colds, so children can have one after another.

UKHSA says infected people should stay away from a setting if they have more than mild symptoms, for example a high temperature, for respiratory infections. The NHS says that with a high temperature or feeling too unwell for normal activities, stay at home until better.