Childhood Infections

Fever, cough, a runny nose, a sore throat, vomiting, diarrhea, fatigue or a rash appearing on the body…

Infectious diseases make up an important share of childhood visits to the doctor. Children who have just started daycare or school often fall ill one after another, and this can leave families asking, "Why is my child sick all the time?"

In reality, a child's immune system meets a great many viruses and other infectious agents for the first time during the early years of life. For this reason, several infections in a single year, especially in young children, do not on their own mean that there is a problem with the immune system.

What matters is not only how often a child gets sick, but how the infections run their course, how long they last, whether they keep coming back and whether any complications develop.

Why Are Infections So Common in Children?

Children may come across certain infections more often than adults do.

In settings such as daycare centers and schools, where many children spend time together, close contact and shared toys and surfaces make it easier for respiratory and contact-borne infections to spread.

The fact that children frequently put their hands in their mouths, noses and eyes also matters when it comes to transmission.

That is why it is a common situation for a child in the preschool years to have several upper respiratory tract infections over the course of a year.

However, if infections run a very severe course, keep coming back, take longer than expected to clear or if serious infections such as pneumonia recur, the child should be evaluated in more detail.

What Are the Signs of Infection in Children?

Symptoms can vary according to the part of the body involved and the agent causing the illness.

Common signs of infection in children include:

• Fever
• Runny and stuffy nose
• Cough
• Sore throat
• Wheezing or shortness of breath
• Fatigue
• Poor appetite
• Vomiting or diarrhea
• Headache and muscle aches
• A rash on the body
• Sores inside the mouth

A single symptom is usually not enough to say what is causing the illness.

Fever, for example, can appear with a simple viral infection, and it can also accompany a bacterial infection that needs closer follow-up.

For this reason, especially in young children, it is important to evaluate the symptoms together with the child's general condition.

Upper Respiratory Tract Infections in Children

Upper respiratory tract infections are among the most common infections in children.

A large share of these illnesses, which affect the nose, the sinuses, the throat and the upper airways, are caused by viruses.

A runny nose, a stuffy nose, sneezing, a sore throat, mild fever and cough are common symptoms.

In young children in particular, upper respiratory tract infections may come back several times over the course of a year.

The Common Cold in Children

Despite what its name may suggest, the common cold is not an illness that appears simply because a child has gotten cold.

Many different viruses can cause a common cold.

A runny nose, a stuffy nose, sneezing, a sore throat and cough are among the most common symptoms.

Because the common cold is usually viral, it does not require antibiotic treatment.

What matters here is following the natural course of the viral infection and evaluating whether a complication such as a middle ear infection, sinusitis or a lower respiratory tract infection has developed.

Sinusitis in Children

Not every long-lasting runny nose is sinusitis.

During upper respiratory tract infections, a runny nose and cough may continue for a while. However, if the symptoms last longer than expected, if they get worse again while the child is recovering, or if findings such as a high fever are added to the picture, an evaluation for sinusitis may be needed.

Looking only at the color of the nasal discharge is not enough to diagnose sinusitis in children.

The duration and course of the child's symptoms and the examination findings should be evaluated together.

Infectious Diseases with a Rash in Children

In childhood, some viral infections can run their course with characteristic rashes that appear together with fever or after the fever subsides.

Although a large share of these illnesses can clear on their own, the appearance of the rash, when it shows up and the symptoms that go along with it are important in telling them apart.

Hand, Foot and Mouth Disease

Hand, foot and mouth disease is a viral infection seen especially in young children.

The illness may begin with symptoms such as fever, poor appetite and a sore throat. Painful sores inside the mouth and a rash on the hands and feet may then develop.

The full set of rashes does not have to appear at the same time in every child.

In young children who cannot take in enough fluid because of the painful sores in the mouth, particular care should be taken to prevent dehydration.

The illness can spread through close contact, respiratory secretions, stool and contact with the fluid in the skin lesions.

Fifth Disease

Fifth disease is a rash-causing infection seen especially in childhood and caused by a virus called Parvovirus B19.

One of its most striking findings is the marked redness that appears on the cheeks, commonly described as a "slapped cheek" appearance.

A lace-like rash may then develop on the trunk, arms and legs.

Although the illness runs a mild course in most children, contact with Parvovirus B19 needs separate evaluation in certain health conditions and in pregnancy.

Sixth Disease

Sixth disease is a viral infection seen especially in infancy and early childhood.

The characteristic course of the illness is usually a high fever appearing first, the fever coming down after a few days, and a rash then starting on the body.

The high fever can worry families because of the possibility of a febrile seizure in young children.

Because sixth disease is a viral infection, antibiotic treatment has no role in treating it.

Middle and Lower Respiratory Tract Infections in Children

An infection may not stay limited to the nose and throat.

In infections that affect the lower parts of the airways, cough may become more prominent, and symptoms such as rapid breathing, wheezing, difficulty breathing or chest pain may appear.

A clear change in the way a baby or child is breathing should be evaluated carefully.

Pneumonia in Children

Pneumonia is an infection that affects the lung tissue.

In children:

• High fever
• Cough
• Rapid breathing
• Shortness of breath
• Chest pain
• Abdominal pain in some children
• A clear decline in general condition

may call for an evaluation for pneumonia.

A diagnosis of pneumonia is not made based on the presence of a cough alone. The child's complaints and the examination findings are evaluated together, and when needed, a chest X-ray or laboratory tests may be used.

In pneumonia that keeps coming back or does not clear within the expected time, it may be necessary to look into whether another underlying health problem is present.

Viral Infection or Bacterial Infection?

This is one of the questions families ask most often.

Viruses and bacteria are different infectious agents, and their treatments are not the same either.

In childhood, the great majority of upper respiratory tract infections in particular are viral in origin.

Antibiotics have no effect on viruses.

For this reason, starting an antibiotic for every fever, cough, runny nose or sore throat is not the right approach.

On the other hand, antibiotic treatment may be necessary in some bacterial infections.

It is not always possible to make this distinction by looking only at the level of the fever, the color of the nasal discharge or the presence of a cough. The child's history of illness, the examination and, when needed, further tests should be evaluated together.

When Should Antibiotics Be Used in Children?

An antibiotic is not "the medicine given when a child gets sick."

Antibiotic treatment is used to treat bacterial infections and should be started by a physician when it is needed.

In viral infections, unnecessary antibiotic use does not help a child get better any faster, and it can also contribute to the development of antibiotic resistance.

For this reason, sensible antibiotic use is especially important in childhood.

My Child Is Sick All the Time — Is Their Immune System Weak?

This is one of the questions asked most often by families whose child has just started daycare or school.

A child having several infections over the course of a year does not on its own mean that the immune system is weak.

What matters here is not so much the number of illnesses as how they run their course.

If infections run a very severe course, if infections caused by unusual microorganisms appear, if growth and development are affected, if serious infections keep coming back or if illnesses do not clear despite treatment, a more detailed evaluation may be needed.

What Can Be Done to Protect Children from Infections?

It is not possible to protect children completely from all infections.

However, to lower the risk of transmission and the likelihood that some infections will run a severe course, it is important to:

• Help children build the habit of washing their hands regularly
• Complete the vaccines appropriate for their age
• Reduce close contact with sick people as much as possible
• Pay attention to cleaning shared toys and surfaces
• Ventilate indoor spaces regularly
• Keep children away from cigarette smoke
• Make sure they have a balanced diet appropriate for their age

When Should You See a Doctor for an Infection in Children?

Not every infection runs the same course.

A child should be evaluated by a physician in situations such as:

• Difficulty breathing
• Very rapid or labored breathing
• A bluish color of the lips or the skin
• A clear decline in the child's general condition
• Difficulty waking the child or a clear change in alertness
• Being unable to take in fluids
• A clear drop in the amount of urine
• A fever that lasts a long time or that is worrying given the child's condition
• An unusual rash together with fever
• Severe pain
• A clear worsening again while recovering

Fever and signs of infection should be evaluated with particular care in young infants.