The 3 most common illnesses in kids and expert advice on how to manage them

Coughs, vomiting and fever are the three most common reasons parents contact children’s video conferencing healthcare service Cub Care, according to analysis of the latest video call data.

Paediatric Emergency Physician, Dr Dave Wood says that most of the time these ailments can be managed at home and a parent’s or carer’s best defence is knowing when to seek professional help.

“Parents should trust their gut instinct because they know their child best. It can feel like a big deal – making that call or getting in the car and heading to the emergency department – but you have to do what feels right and there is no such thing as an over-cautious parent when it comes to your child’s health.”

Here Dr Wood shares advice for parents on managing coughs, vomiting and fever at home and the warning signs that it’s time to seek further medical help.

When a child has a cough

A cough is very common health complaint in children and is usually caused by a cold. This can be caused by lots of different viruses including most commonly COVID-19, rhinovirus, influenza and RSV. It’s normal for children under five to have up to 12 viruses a year and most will recover within 10 days, although some children might have a dry cough for a few weeks following a virus.

“This persistent cough is normal as long as it’s a dry cough and children otherwise feel well and behave normally and continue to grow and develop normally. Most coughs are caused by viruses and don’t need or respond to antibiotics or cough syrups.”

Managing a cough at home

“Cough medicines should not be used in children under six, however a spoonful of honey before bedtime can help if a child is over one year old.

“Children should have plenty of rest and fluids such as milk, half strength apple juice or specifically designed oral rehydration solutions that you can get at your pharmacist.

“It is common to have an associated sore throat which may mean your child is reluctant to drink. Simple painkillers such as paracetamol and/or ibuprofen can be helpful to make your child feel more comfortable. Just make sure you follow the packet instructions for use as they come in different strengths.

“Importantly, make sure your child is not exposed to any cigarette smoke in the home, which can contribute to a more severe and persistent cough,” he adds.

When to seek help

Most coughs will get better at home by themselves, but Dr Wood said red flags that indicate you should seek medical advice include:

• Sucking in through the ribs or tummy area, grunting, wheeze (whistling when breathing out), stridor (high pitched noise when breathing in), or particularly fast breathing;
• Decreased fluid intake – generally drinking less than half the amount they usually would;
• Restlessness, drowsiness, or becoming agitated/confused;
• Difficulty talking (for older children);
• Pale or sweaty skin;
• Turning blue or having noticeable pauses in breathing;
• A wet cough that lasts more than four weeks;
• A new cough that immediately follows a choking episode.

When a child is vomiting

The majority of the time, vomiting in children is due to viral gastroenteritis (gastro), a contagious infection that affects the digestive system. In addition to vomiting, gastro can cause symptoms such as abdominal pain, nausea and diarrhoea.

While it can affect anyone, children are more susceptible to the infection and outbreaks often occur among children particularly in daycare centres and schools.

While gastro is a common cause of vomiting there are other causes too so vomiting children may still need medical assessment to assess for alternative causes and evaluate their degree of dehydration. Sometimes children need medication to help stop the vomiting.

Occasionally dehydrated children require hospital admission for fluids via an intravenous drip (straw in a vein) or a nasogastric tube (feeding tube from the nose to the stomach).

A service like Cub Care can help determine whether your child may need to go to hospital or whether they can be safely managed at home.

Managing gastroenteritis at home

The key in this situation is to ensure you are comfortable with the diagnosis and your child gets enough fluids to prevent dehydration, explains Dr Wood.

“Encourage your child to drink smaller but more frequent volumes of breastmilk, water, apple juice diluted 50:50 with water, or oral rehydration solutions like Hydralyte or Gastrolyte.

“The use of oral syringes to give your child small amounts of fluids very frequently can be very helpful to maintain their hydration.

“Water alone is not recommended as it does not replace the sugar and salts your child’s body is losing through the vomiting and diarrhoea.”

When to seek help

In most cases, the symptoms of gastroenteritis will clear up on their own within a few days. Sometimes however, medical review is required.

According to Dr Wood, signs to watch out for in your child include:

• An inability to tolerate any fluids orally;
• Taking less than half their normal fluid intake;
• Having significantly reduced wet nappies;
• Reporting feeling dizzy or lightheaded;
• Obvious drowsiness or lethargy;
• Cracked dry lips and coated tongue;
• Any episode of green coloured vomit;
• Blood in the poo;
• Severe abdominal pain not responding to paracetamol or ibuprofen;
• Pain/stinging when passing urine or passing urine more frequently than usual.

Fever in children

Fever itself is defined as a temperature of 38 degrees Celsius or above. Fever is very common in children and in most cases is due to the body’s innate response to a viral infection.

Sometimes, however, fever can be a sign of a more serious or treatable infection. This can make it very challenging for both parents and clinicians to be certain of the right course of action to take.

A clinician can help to decide if further tests or medications are needed. It is always important to note that your best protection from these serious or treatable infections is vaccination for those diseases that are vaccine preventable.

“Properly used ear thermometers are the most accurate way to measure fever in children over 6 months of age while under arm thermometers are best for children under six months of age,” says Dr Wood.

“Children under 5 years of age have many febrile illness due to their developing immune systems and lack of attention to handwashing.

“Teething is often blamed for a fever in young children but the cause is more likely to be an infection.”

Managing fever at home

When managing your child with a fever at home it is important to dress them in comfortable clothes that are appropriate for the weather, or one less layer of clothing than they would usually be wearing in that environment, advises Dr Wood.

“You should not attempt to actively cool your child using cold baths or showers however the soothing touch of a parent with a cool cloth to a warm forehead is never inappropriate.

“If your child is happy and interactive despite their fever then it is not necessary to treat them with anti-fever drugs such paracetamol or ibuprofen.

“If your child is miserable, not drinking or in pain then that should be treated by using paracetamol and/or ibuprofen. Just make sure you check the individual packaging for appropriate doses and dosing intervals as this can differ between different brands of these medications.

“Some children are prone to vomiting oral paracetamol. It is worth trying different brands or a rectal form of paracetamol in these cases.”

One of the most important supportive measures for children with febrile illness is to ensure they have sufficient fluids.

“You should encourage them to drink plenty of sugary fluids particularly if they are not eating. Use of oral syringes can be helpful to maintain their intake.”

When to seek help

These are the signs it’s time to seek further medical assistance:

• Fevers in a child less than 1 month of age should always have an in-person assessment with a clinician;
• Your child is drowsy, confused or difficult to wake;
• Despite your best efforts your child is not drinking and passing urine far less than usual;
• Your child is drooling profusely with difficulty swallowing;
• Your child has difficulty breathing including grunting, wheezing or has stridor (whistling sound when breathing in);
• Your child is in severe pain not responding to paracetamol and/or ibuprofen;
• Your child has a severe headache with neck pain and is sensitive to bright lights.
• Your child has purple spots or rash on the skin that looks like bruises and doesn’t go away when you push on them or roll a glass over them.
• Your child has a limp or is not using a limb despite not having any trauma to the limb.
• Your child has swelling and redness around the eye, or pain on moving their eye.
• Your child has pain when passing urine.
• Your child has more than 5 days of fever.

This information is provided as a guide only and is not designed to replace consultation with a doctor or healthcare professional. 

Dr Dave Woods is one of the co-founders of Cub Care, a video telehealth service connecting families with specialist and expert doctors for kids, and an experienced children’s emergency physician.