The common cold is the most frequently occurring childhood illness. It is caused by any one of a large number of viruses, with rhinoviruses being particularly common. Children are especially vulnerable to colds because their immune systems are still building defenses and they tend to have close contact with other children in shared spaces.

A cold typically begins with a runny nose, sneezing, and mild congestion. A low-grade fever may or may not be present. Sore throat, cough, and general tiredness are also common in the early days. Most colds resolve within seven to ten days, though a lingering cough can sometimes last a bit longer.

Young children, especially those in their first years of life in group care settings, can experience several colds per year. While this can feel relentless for families, it is a normal part of how the immune system matures.

There is no need to seek care for most colds. However, it is worth contacting a provider if:

• A baby under three months old has a fever
• Symptoms worsen significantly after initially improving
• The child develops difficulty breathing or a very high fever
• Symptoms last significantly longer than expected without improvement

Influenza, commonly known as the flu, is a respiratory illness caused by influenza viruses. Although it shares some symptoms with a cold, the flu typically comes on more suddenly and is more intense.

Key characteristics of the flu in children include:

• Sudden Onset of symptoms that arrive quickly rather than gradually, which is one of the ways parents can sometimes distinguish flu from a cold.
• High Fever that can climb rapidly and may reach higher temperatures than a typical cold-related fever.
• Body Aches and Chills that are uncomfortable and unusual in a simple cold.
• Headache is common with the flu, especially in older children.
• Fatigue that is often significant, leaving children feeling genuinely worn down rather than just slightly under the weather.

Children under five, and especially those under two, are at higher risk for serious complications from flu. Flu can sometimes lead to pneumonia, dehydration, or other complications that require medical care.

Annual influenza vaccination is recommended for children beginning at six months of age because flu strains change each year.

Respiratory syncytial virus, or RSV, is a common respiratory virus that most children encounter before the age of two. For older children and healthy adults, RSV typically causes cold-like symptoms. For infants and young children, particularly those under six months of age or those born prematurely, RSV can cause more serious illness.

When RSV affects the smaller airways deep in the lungs, it can cause a condition called bronchiolitis. Bronchiolitis involves swelling and mucus buildup in the tiny airways and can make breathing significantly harder for young babies.

Signs of more serious RSV illness in infants include:

• Rapid or labored breathing
• Flaring of the nostrils with each breath
• A pulling-in or sucking-in appearance at the ribcage or neck when breathing
• Poor feeding or significant decrease in wet diapers
• Unusual sleepiness or difficulty staying awake

Parents of young infants should contact a provider if any of these signs appear during what seems like a cold.

Ear infections, medically called otitis media, are among the most common reasons young children visit a pediatric provider. They occur when fluid becomes trapped behind the eardrum, often following a cold or upper respiratory infection, and bacteria or viruses grow in that fluid.

Children are more prone to ear infections than adults because of the structure and angle of the tube that connects the middle ear to the back of the throat. In young children, this tube is shorter, more horizontal, and more easily blocked.

Signs that a child may have an ear infection include:

• Ear Pulling or Tugging particularly in infants who cannot yet communicate where it hurts.
• Fussiness or Crying that is unusual or more intense than normal, especially at nighttime.
• Difficulty Sleeping as pressure in the ear can worsen when lying flat.
• Fever that may accompany the infection.
• Hearing Difficulty or seeming not to respond clearly to sounds or voices.

Not all ear infections require intervention, and some resolve on their own. A provider can examine the ear and make an individualized recommendation based on the child's age, symptoms, and the appearance of the eardrum.

Strep throat is a bacterial infection caused by group A Streptococcus. Unlike many common childhood illnesses, which are viral, strep throat requires medical evaluation and treatment with antibiotics.

Strep throat most often affects school-aged children and tends to spread in group settings like classrooms and daycare. It is passed through respiratory droplets when an infected person coughs or sneezes, or through shared items like utensils or cups.

Symptoms of strep throat can include:

• Sudden Sore Throat that can make swallowing painful
• Fever that often develops quickly
• Red and Swollen Tonsils, sometimes with white patches or streaks of pus
• Swollen Lymph Nodes in the neck
• Headache or Stomach Pain, which can be more common in children than adults
• Absence of Cough, which can help distinguish strep from a typical cold

Not every sore throat is strep throat. Viral infections are still the most common cause of sore throat in children. Because symptoms can overlap, a provider may perform a rapid strep test or throat culture to confirm the diagnosis.

Treatment with antibiotics helps reduce the length of illness, prevents complications, and lowers the risk of spreading the infection to others. Children are usually no longer contagious after 24 hours of antibiotics.

Prompt treatment is important because untreated strep throat can lead to complications, though this is less common when care is received in a timely manner.

Viral gastroenteritis, often called the stomach flu, is a common childhood illness characterized by nausea, vomiting, diarrhea, and sometimes stomach cramping. Despite being called "stomach flu," it has nothing to do with influenza. It is caused by different viruses, with norovirus and rotavirus being among the most common.

Gastroenteritis spreads easily through direct contact with an infected person, contaminated surfaces, or contaminated food and water. It spreads rapidly in group settings like daycare and schools.

The biggest concern with gastroenteritis in young children is dehydration. Vomiting and diarrhea cause the body to lose fluids quickly. Signs of dehydration to watch for include:

• Fewer wet diapers or less frequent urination
• A dry mouth or tongue
• No tears when crying
• Sunken appearance around the eyes
• Unusual lethargy or decrease in activity

Most stomach illnesses in healthy older children resolve within one to three days. In infants and young children, dehydration can develop quickly and warrants earlier medical attention.

Many childhood illnesses involve some form of rash or skin change. Some are mild, while others signal something that requires prompt evaluation. Common childhood rash-associated illnesses include:

• Chickenpox (Varicella) causes an itchy rash with red spots that develop into fluid-filled blisters across the body. It is preventable through vaccination.
• Hand-Foot-and-Mouth Disease produces small sores or blisters in the mouth and on the hands, feet, and sometimes the diaper area. It is caused by a virus and typically resolves on its own in a week or so.
• Roseola often begins with several days of high fever followed by a pink rash that appears as the fever breaks. It is common in young children and typically resolves without complication.
• Fifth Disease causes a distinctive red rash on the cheeks that looks like a slap mark, followed by a lacy rash on the arms and trunk. It is caused by parvovirus B19 and is usually mild.
• Impetigo is a bacterial skin infection that produces honey-colored, crusty sores, often around the nose and mouth. It is contagious through direct contact and requires evaluation.

A fever combined with a rash should always be assessed, especially if the child seems very ill, has difficulty breathing, or shows other concerning symptoms.

Most common childhood illnesses do not require an emergency visit, but some situations call for prompt attention.

Seek emergency care immediately if your child:

• Has difficulty breathing or is breathing very rapidly
• Develops a rash of small, pinpoint red or purple spots that do not fade when pressed
• Has a seizure
• Becomes unresponsive or extremely difficult to rouse
• Shows signs of severe dehydration
• Is a newborn (under three months) with any fever

Contact a pediatric provider soon if your child:

• Has a high fever that is not improving or returns after improving
• Has symptoms that worsen significantly after a few days rather than improving
• Complains of severe pain, including headache, ear pain, or abdominal pain
• Has been exposed to a serious infectious illness and you have questions
• Is not drinking fluids or has not urinated in many hours

When in doubt, calling the pediatric office is always a reasonable first step. Providers expect these calls and can help you decide whether an in-person visit is needed.