New research suggests that toddlers and pre-schoolers are likely to get 15 illness in their first year of nursery, but they will be more resilient to bugs when they start school.
Experts from UCL – alongside colleagues from the University of Cambridge, Cornell University and North Middlesex University Hospital – examined immunology, infectious disease genomics, and epidemiology data, and found that during their first year of formal childcare, babies and children are expected to have 12 respiratory illnesses such as coughs and colds, two episodes of diarrhoea and/or vomiting illness, and at least one illness that involves a rash.
We got in touch with Doctify-rated consultant paediatrician Dr Arindam Das who has highlighted six common bugs that many children pick up at nursery, and shared some advice about when to let them have a sick day.
Is it normal for children to get sick frequently at nursery?
“It’s very normal, especially in the first year of nursery, for children to be unwell pretty frequently,” reassures Das. “When young children pick up these minor infections, their immune system is learning how to fight infections, so catching these bugs is a normal part of childhood.”
What are the most common illnesses that children pick up at nursery?
1. Coughs and cold
“The most common infections that children pick up at nursery are coughs, colds, and fever,” says Das.
Most colds in younger children get better within two weeks, according to the NHS website.
The NHS recommends making sure that your child drinks plenty of fluids and suggests asking a pharmacist or GP for saline nose drops to help loosen dried snot and relieve a stuffy nose.
“Good hand hygiene is the most effective measure to prevent lot of these infections because they spread via droplets and touch,” adds the paediatrician. “So, teaching children to wash their hands and to cover their mouth and nose when they’re coughing and sneezing is really important.”
2. Fever
“Parents are often worried about fever, but a fever in itself is not a red flag,” says Das. “You need to look at the whole picture. A fever is a sign or a symptom that the child is fighting a bug.”
What to do:
If your child or baby has a high temperature, you can usually look after them at home as a high temperature should return to normal within one to four days, according to the NHS website.
However, it recommends calling 111 or your GP surgery if your child has other signs of illness, such as a rash, as well as a high temperature, or if the high temperature has lasted for five days or more, or if they don’t want to eat or are dehydrated.
3. Tummy bugs
“We also see a lot of tummy bugs in nursery school-age children,” says Das. “For a tummy bug, the most common scenario is vomiting and then after a few days diarrhoea usually starts.
“This is a natural progression, and parents shouldn’t be alarmed.”
What to do:
“Tummy bugs can usually be managed at home safely if the child is otherwise well and is eating and drinking normally,” says the paediatrician. “Make sure that your child is well-hydrated, and Calpol and Brufen can make them feel more comfortable if needed.
“However, parents should seek help if their child is becoming very drowsy, or lethargic, or are not drinking enough, or are passing very little urine.”
The NHS recommends calling 111 if a child under five years has signs of dehydration (such as fewer wet nappies), if they keep being sick and cannot keep fluid down, if they have bloody diarrhoea or bleeding from the bottom, or if they have diarrhoea for more than seven days or vomiting for more than two days.
4. Conjunctivitis
“Conjunctivitis can be caused by viral infections, bacterial infections or allergies and is very common in young children,” says Das. “If your child has reddening of the eyes and has some watery discharge, then this is most likely to be a viral infection.
“With allergy conjunctivitis, the most predominant symptom will be itching, whereas with bacterial conjunctivitis, the discharge will be more purulent (pus-like), thick, yellowy, and the child will seem more unwell.”
What to do:
“If it’s minor or viral conjunctivitis, the main thing to do is to frequently water their eyes and if there is a mild temperature or the child is uncomfortable, you can always use Calpol,” advises the paediatrician. “You can also go to pharmacy for over-the-counter eye drops.”
The NHS website recommends seeing a GP if the conjunctivitis symptoms have not cleared up within seven days or if your baby has red, sticky eyes.
5. Hand, foot and mouth disease
“Normally, with something like hand, foot and mouth, the child will have a mild to moderate temperature,” says Das. “The other hallmark symptom is rashes on the hand, foot or mouth. There doesn’t necessarily have to be rashes on all three places, but is usually on at least two of these areas.
“The rashes will be blanching, so when you are pressing it should fade away and the child should be well in between the fever.”
According to the NHS website, mouth ulcers, not wanting to eat, and a sore throat are also common symptoms.
What to do:
The NHS website recommends drinking cool fluids to soothe the mouth and prevent dehydration, to eat soft foods like yoghurt and avoid hot, salty and spicy foods.
However, the NHS also advises parents to get in touch with their local GP if the symptoms do not improve after seven to 10 days.
6. Chickenpox
“Nowadays, we are seeing more and more younger children coming up in chickenpox,” observes Das.
The main symptom of chickenpox is an itchy, spotty rash.
“One typical character of a chickenpox rash is that they come out in different times and they look different – we call it ‘pleomorphic’, which means they come out in crops,” explains the paediatrician. “So, the rash usually starts on the face but by the time the rash on the body appears, the rash on the face will look different.”
What to do:
“Chickenpox is usually a self-resolving condition, but the rashes can be extremely itchy and distressing a child,” says Das. “You can use Calpol or some antihistamines in an age-appropriate dose if it is really itchy.
“However, if you feel that the rash is getting very yellowy, there’s pus or bleeding, the child needs to be seen by a GP.”
The NHS website also recommends calling 111 for advice if your child has chickenpox and is showing signs of dehydration, such as fewer wet nappies.
When should parents avoid taking their children into school?
“The standard guidelines for vomiting or diarrhoea advises parents to not send their child to school or nursery until 48 hours after the symptoms have stopped,” says Das.
“Also, if a child is coughing and sneezing actively, I would advise parents to keep them away from nursery. This is not only to protect the child, but to protect the other children as well, because in this age group bugs spread very quickly.”
The NHS website also states that if your child has a high temperature, keep them off school until it goes away.
“I fully understand that the logistics around keeping children at home, so I would just advise parents to use their common sense to judge whether the child is safe and whether they are following the official guidelines or school guidelines,” says Das.
