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Is Johnny too sick for nursery? Doctor tips for the winter cold and flu season

Parents beware; ‘sickness season’ is upon us. With children back at school and in nursery, and with winter around the corner, it’s the perfect setting for the escalation of colds, coughs, sniffles and more. Parents around the country are gearing up to manage the germ onslaught as we call it. Here are some handy tips from Dr. Ben Smith. Consult with Dr. Smith or indeed any of our WellVine GPs, by simply booking a WellVine video call, anytime anywhere.

Please note that there are a small proportion of children who suffer with already diagnosed underlying illnesses, that mean that even common viruses can be more serious (e.g. premature babies, children who have reduced immune systems due to other illnesses, children with severe asthma, diabetes etc.). The advice here does not generally apply to them, and more specific advice should be sought.

What are the most common health issues you see children experiencing around this time?

Children at school and nursery, especially if they are starting for the first time, are susceptible to illnesses as they come in contact with each other in large number, and in contact with more bugs.

The most common illnesses are viral infections such as colds, sore throats, coughs and tummy bugs. I will focus here on the mixture of symptoms, which are referred to as “viral upper respiratory tract infections” as these are very common, usually mild and self-limiting (i.e. the body fights them of itself) and can be managed at home with sensible approaches.

What are the signs and symptoms?

At this time of year, children very commonly develop runny noses, coughs, sore throats, sore ears and sometimes associated temperatures and rashes. Often children are irritable and do not want to eat much. Viruses usually cause these symptoms. Children typically get a number of these infections every year, and it is part of them building up their natural immunity to viruses.

Other symptoms that viruses can cause include diarrhoea, vomiting and general aches and pains (although the latter two can obviously be less easy to detect in younger children). It is helpful to have a thermometer at home (that works in the child’s ear). It is quite common to get a rash with a viral illness. However, if your child is unwell and getting worse, seek medical help immediately. In rare cases for certain rashes, meningitis may be suspected. Every suspected case of meningitis should be treated as a medical emergency. Read further.

What are your best tips to avoid common infections?

It is difficult to avoid children picking up common viral infections, and it is part of them developing their immune systems to protect them in later life.

Sensible approaches include having a healthy balanced diet, rich in fruit and vegetables, taking regular exercise and managing good amounts of sleep. Children, as with adults, should be encouraged to wash their hands regularly and avoid lots of direct contact with other children (and adults) who are unwell. Ensure that your children have all their immunisations on time, and that they are up to date. 

When is a child too sick for nursery? And when should parents consult a doctor?

There are guidelines around when you should see a doctor. For example, medical advice should always be obtained for a baby under three months old with a temperature of over 38C or above, or is between three and six month with a temperature of over 39C or above. Read here for the NHS guidelines for when to see a doctor.

If children are unwell with temperatures, consider keeping them at home (away from school or nursery) until they are better. However, it is not practical, or appropriate, for children to be away from other children all the time; so children with a runny nose or a mild cough (but otherwise well, and without a temperature) are generally ok to be at school or nursery.

What is the best course of action if children do fall sick?

If the child does not need to see a doctor as per the guidelines above, then the following actions can be taken.

Give your child frequent cool drinks, (little and often) to prevent dehydration and soothe a sore throat. Don’t be alarmed if your child’s appetite is reduced, as they may not feel like eating whilst they are unwell, as long as they are drinking. Ensure they are passing urine, which indicates they are adequately hydrated. If you are breastfeeding the child, then continue to breastfeed as close to normally as you can.

A high temperature in a child is above 37.5C. However, temperatures may reach as high as 40 degrees Celsius in response to an infection. If your child has a temperature, remove any excess clothes (cover with a lightweight sheet, or clothing) and keep the room cool (about 18 degrees is the aim). A temperature that is making a child miserable can also be treated with either paracetamol (Calpol) or ibuprofen. Use the dose as stated on the packet for your child’s age. Do no exceed these doses. If your child is not distressed by the fever or underlying illness, there is no need to use these medicines to reduce a fever.

If you are worried that your child is very unwell, consult a doctor.

What other precautions should parents take?

Ensure that all children are fully immunised. Please note that even minor illnesses, if passed on to someone who is unwell for other reasons, can be dangerous. So take care not to pass viruses on to very young babies, elderly people, pregnant women, people who are having treatment for cancer with chemotherapy. Generally, it is best not to visit patients in hospital if you have a virus, or to attend A&E unless you are very worried. The same can apply to GP surgeries. A lot of medical assessment and advice can be done online over video call/over the phone first


Mild viruses cause the vast numbers of illnesses in children. Some of the more concerning features to look out for have been discussed in this Q&A and could, in rare cases, indicate an infection that requires treatment (e.g. meningitis, pneumonia or septicaemia (infection in the blood). You should also seek medical advice if your child has persistent vomiting, loses weight, has abnormal or unexpected bruising or bleeding, or is unusually drowsy.

Being a parent (particularly for the first time) can be an anxious time. The above advice is designed to give parents some tips to help cope with common illnesses. But remember, if you are worried, ask a doctor. The vast majority of the time they will be able to reassure you that your child is not facing a serious health issue.

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