This information deals with common symptoms and infections of the ear, nose, throat and chest in children who are usually healthy.

It does not apply to:

• children who have ongoing health problems such as asthma, heart or kidney problems or 
  
• babies who are less than 3 months old. Young babies can respond differently to infections.
  

Talk to your doctor if your child fits any of these categories.

No guide can be complete. If you are still worried about your child after reading this information, then you should get advice. This could be telephone advice or a consultation with your GP. 

If you feel that it is an emergency, you should dial 000 for an ambulance. 

Fever (or raised body temperature) is a normal response that may help to fight infections. Fever does not harm your child, and is a common symptom of colds and related conditions.

Your child may feel hot to the touch, but this does not necessarily mean they have a fever.¹ A fever is defined as your child having a temperature over 38° C¹ (measured in the mouth or on the forehead).

Children with a very high temperature are more likely to have a more serious infection (though most will not).

What can I do about it?

Ibuprofen or paracetamol will bring a child’s temperature down, but these medicines are only needed if your child is distressed.

You can help your child feel better by:

• giving them paracetamol and/or ibuprofen if they are irritable or uncomfortable 
  
• taking off outer clothing.
  

Sponging a child with water can sometimes upset them or make them shiver (which can raise their temperature more).²

Find out more about giving medicines to children.

What about antibiotics?

Fever may be caused by a virus or bacteria. Antibiotics will not prevent or treat fever itself. They may be prescribed if the fever is caused by a bacterial infection.  

Seek help

• If your child aged 3-36 months has a temperature greater than 38.9° C.
  
• If your child aged 3-36 months has a temperature greater than 38 for 3 days or more, or seems sick.
  
• If your child has a fever of more than 39.9° C³
• If your child has a febrile convulsion or fit.⁴ Find out more about febrile convulsions.
  

See card 12 'When should I seek further help?' for more information.

References

1. National Institute for Health and Care Excellence (NICE). Fever in under 5s: assessment and initial management (CG160). 2013. [Online] (accessed 24 March 2013).

2. Mackowiak PA, Plaisacne KI. Benefits and risks of antipyretic therapy. Ann NY Acad Sci 1998;856:214-23. [PubMed].

3. Baraff LJ, Bass JW, Fleisher GR, et al. Practice guideline for the management of infants and children 0 to 36 months of age with fever without source. Agency for Health Care Policy and Research. Ann Emerg Med 1993; 22:1198. [PubMed].

4. Royal Children's Hospital Melbourne. Febrile convulsions. Kids Health Info. 2008. [Online] (accessed 22 March 2017).

What can I do about it?

You can help your child feel better by:

• giving them ice to suck
  
• giving them a warm drink
  
• if they are older than 6 years, helping them gargle with warm salty water (use 1/4 to 1/2 teaspoon of salt to 250 mL water)
  
• giving them paracetamol or ibuprofen if other measures don't help.

Find out more about giving medicines to children.

How long will it last?

• In 3 days, 6 out of 10 children will no longer have a sore throat.¹
  

What about antibiotics?

After one week, more than three quarters of those with a sore throat will be better whether they take antibiotics or not.²

13 out of 14 who take antibiotics will get better just as quickly as if they had not taken them.²

Antibiotics make little difference in most cases of sore throat.

If your child has a sore throat and comes from Aboriginal communities in northern or central Australia, or is of Maori or Pacific Islander descent, they may benefit from antibiotics. Take them to see your doctor.³

Seek help

• If your child seems very sick, or has a sore throat and fever for more than 3 days, but no cough, take them to see the doctor.
  

See card 12 'When should I seek further help?' for more information.

References

1. Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347;f7027. [PubMed].

2. Spinks A, Glasziou PP, Del Mar CB. Antibiotics for sore throat. Cochrane Database Syst Rev 2013. [PubMed].

3. Antibiotic Expert Group. Antibiotic Therapeutic Guidelines v15. Therapeutic Guidelines Pty Ltd. [eTG Online] (accessed 24 March 2017).

Colds are very common and are caused by viruses that are easily passed from person to person. 

Symptoms may include: sneezing, blocked or runny nose, sore throat, cough, low grade fever (38° C to 38.5° C), headache, and tiredness.

Healthy children can sometimes have more than 8 colds in a year.

What can I do about it?

You can help your child feel better by:

• making sure they get plenty of rest
• encouraging them to drink water to avoid dehydration
  
• making sure no one smokes around them.
  

If your child has a headache or fever and is irritable or uncomfortable, paracetamol or ibuprofen can help them feel better.

Find out more about giving medicines to children.

How long will it last?

• In 10 days, 5 out of 10 children will no longer have a cold.
  
• In 15 days, 9 out of 10 children will no longer have a cold.¹
  

What about antibiotics?

There is no evidence that antibiotics help with colds. Antibiotics do not work against the viruses that cause colds.

What about green snot or phlegm?

Some parents and doctors have long believed that the colour of snot or phlegm indicated the type or seriousness of an infection. Research suggests that this is not the case, and even a cold with green snot or phlegm does not need to be treated with antibiotics.^2,3

See card 12 'When should I seek further help?' for more information.

References

1. Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027. [PubMed].

2. Shields MD, Bush A, Everard ML, et al. Recommendations for the assessment and management of cough in children. Thorax 2008;63:iii1-iii15. [Online]. 

3. Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane Database Syst Rev 2013:Cd000247. [PubMed]. 

If your child has a cold, a ‘noisy chest’ or a ‘chesty cough’ is often one of the symptoms. This can be worrying for parents. 

In fact coughing helps the body fight against infection and normally takes a while to get better. 

A child with a chest infection will generally be more unwell than a child with a cold. 

What can I do about it?

There is little evidence cough syrups work in children. Current Australian guidelines state that:

• Cough and cold medicines should not be given to children younger than 6 years old¹
  
• You should ask a doctor, pharmacist or nurse practitioner for advice before giving cough and cold medicines to children aged 6 to 12 years.²
  

You can help your child feel better by:

• encouraging them to drink water. This loosens phlegm and lubricates the throat, so coughing should be less uncomfortable. Try to avoid sugary drinks.
  
• making sure no one smokes around your child.
  

Find out more about giving medicines to children.

How long will it last?

• In 10 days, 5 out of 10 children will no longer have a cough³
  
• In 25 days, 9 out of 10 children will no longer have a cough³
  

What about antibiotics?

Most children who take antibiotics do not get better any faster than children who do not take them. 

In adults and children with bronchitis (chesty cough) on average, people taking antibiotics may have a cough for only half a day less than those who don't take them.⁴

Seek help

• If your child has problems breathing – including rapid breathing and being short of breath or ‘working hard’ to breathe (it sometimes looks as though the skin between the ribs and below the ribs get sucked in each time they breathe).

See card 12 'When should I seek further help?' for more information.

References

1. Therapeutic Goods Administration. Cough and cold medicines for children - changes. 26 November 2012. [Online] (accessed 24 March 2017).

2. Respiratory Expert Group. Respiratory Therapeutic Guidelines v5. Therapeutic Guidelines Pty Ltd. [eTG Online] (accessed 24 March 2017).

3. Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027. [PubMed].

4. Smith SM, Fahey T, Smucny J, et al. Antibiotics for acute bronchitis. Cochrane Database Syst Rev 2014(3):Cd000245. [PubMed].

A painful ear may be a symptom of an ear infection. Often the ear infection comes after a child has had a cold. Your child may have a fever as well as a sore ear or ears.

What can I do about it?

Treating the pain with paracetamol or ibuprofen is now the recommended treatment for most ear infections.

You can help your child feel better by:

• giving them paracetamol and/or ibuprofen to relieve the pain and fever if they are irritable or uncomfortable
  
• making sure they get plenty of rest.
  

Find out more about giving medicines to children.

How long will it last?

• In 3 days, 5 out of 10 children will no longer have an earache.¹
  
• In 7 days, 9 out of 10 children will no longer have an earache.¹
  

What about antibiotics?

Ear infections usually do not need treatment with antibiotics. After one week, more than three quarters of children will be better whether they take antibiotics or not.

15 out of 16 children who take antibiotics get better just as quickly as if they had not taken them.²

Your child is more likely to benefit from antibiotics if they:

• are under the age of 2 years, with infections in both ears³
  
• have fluid coming out of their sore ear³
  
• are of Aboriginal or Torres Strait Islander descent.⁴

Seek help

• If the earache gets worse or does not get better after 2-3 days⁴
• If your child has persistent hearing problems.

See card 12 'When should I seek further help?' for more information.

References

1. Thompson M, Vodicka TA, Blair PS, et al. Duration of symptoms of respiratory tract infections in children: systematic review. BMJ 2013;347:f7027. [PubMed].

2. Venekamp RP, Sanders S, Glasziou PP, et al. Antibiotics for acute otitis media in children. Cochrane Database Syst Rev 2015(6):CD000219. [PubMed].

3. Rovers MM, Glasziou P, Appelman CL, et al. Antibiotics for acute otitis media: a meta-analysis with individual patient data. Lancet 2006;368(9545):1429-35. [PubMed].

4. Antibiotic Expert Group. Antibiotic Therapeutic Guidelines v15. Therapeutic Guidelines Pty Ltd. [eTG Online] (accessed 24 March 2017).

Croup is caused by a virus in the voice box and upper airway and results in an unusual cough that sounds like a seal bark. It can occur in children from 6 months to 12 years, but is most common in children under 3 years old. It is usually worse at night.

What can I do about it?

You can help your child feel better by:

• comforting and holding your child to keep them calm – anxiety seems to make croup worse
  
• giving them sips of water to drink to prevent dehydration
  
• sitting them up, which may help them with the cough.
  

Humidity can also help make your child more comfortable. Try using a humidifier in your child’s bedroom, or sitting with your child in the bathroom with the hot water running in the shower. 

Most croup will improve with simple measures like this. If your child is having difficulty breathing you should call an ambulance.

How long will it last?

• For most children, croup will last for 2 days, although it can last as long as a week.¹ 
  

What about antibiotics?

Antibiotics do not help with croup, as it is caused by a virus.^2,3

Seek help

Your child should see a doctor urgently if:

• their breathing is rapid
  
• the skin around the neck or below the ribs are pulled in when they breathe
  
• they are becoming agitated, exhausted, bluish-grey or pale, or
  
• they cannot swallow or are drooling more than usual.

See card 12 'When should I seek further help?' for more information.

References

1. Johnson DW. Croup. BMJ Clinical Evidence 2014;2014:0321. [PubMed].

2. Alberta Clinical Practice Guidelines Working Group. Guidelines to the diagnosis and management of croup. 2008. [Online] (accessed 13 February 2017).

3. Russell KF, Liang Y, O'Gorman K, et al. Glucocorticoids for croup. Cochrane Database Syst Rev 2011:Cd001955. [PubMed].

Bronchiolitis is an infection of the bronchioles (the small airways in the lung), and is usually caused by a virus.

Viral bronchiolitis is the most common chest infection in children under two years of age. It is also the most common reason for hospitalisation in children younger than 6 months.

Most children will have a mild infection, and will recover from bronchiolitis with symptom relief to make them comfortable.

What can I do about it?

You can help your child feel better by:

• keeping your child at home from day care
  
• making sure your child rests, and is breastfed (or given formula or water) in small amounts frequently
  
• checking on your child regularly, including during the night.
  

These medicines can help you manage the symptoms of bronchiolitis for your child.

• paracetamol or ibuprofen to bring down their temperature if the fever is upsetting them
  
• saline nasal drops for relieving a blocked nose.
  

How long will it last?

Bronchiolitis may worsen on the second or third day and your child might be sick for 7 to 10 days. Their cough may continue for 2-4 weeks.¹ 

What about antibiotics?

Bronchiolitis is most often caused by a virus, so antibiotics — which work against bacteria, not viruses — will not help your child recover from the illness. 

Seek help

Your child should see a doctor urgently if:

• their breathing is rapid
  
• the skin around the neck or below the ribs are pulled in when they breathe
  
• they are becoming agitated, exhausted, bluish-grey or pale, or
  
• they cannot swallow or are drooling more than usual.
  

See card 12 'When should I seek further help?' for more information.

If you are concerned, or your child’s symptoms get worse very quickly, seek medical advice.

References

1. Royal Children's Hospital Melbourne. Brochiolitis. Kids Health Info. 2008. [Online] (accessed 23 May 2017).

Whooping cough (pertussis) is a respiratory tract infection that is very easily spread. Whooping cough usually starts off with cold-like symptoms, and develops into a cough. A bout of coughing is often followed by a deep intake of breath making the characteristic ‘whoop’ sound suggested by the name.

If you suspect your child has whooping cough, see your doctor.

What can I do about it?

You can help your child feel better by:

• giving them small frequent meals and fluids often (such as sips of water or smaller feeds but more often).¹
  
• keeping your home free of irritants such as cigarette smoke.¹
  
• keeping your child at home for 3 weeks from the start of the cough (if no antibiotics are given) or until they have had at least 5 days of their course of antibiotics.²

Taking care of a child with whooping cough can be stressful. Ask for help from family and friends so that you can catch up with sleep.¹

How long will it last?

Whooping cough can last up to 6 weeks, with an ongoing cough lasting another 2 to 6 weeks.³ 

What about antibiotics?

Antibiotics may be prescribed during the first 3 weeks of infection. This helps stop the spread of infection to others, but may not reduce symptoms. If the cough has been present for longer than 3 weeks, antibiotics are unlikely to help.²

Seek help

• If your child is having difficulty breathing.
• If your child has problems catching their breath after a coughing spasm.

See card 12 'When should I seek further help?' for more information.

Preventing whooping cough

Whooping cough can be prevented by vaccination. If you have whooping cough and you have been in close contact with anyone in the first 3 weeks of your infection, you must let them know that you have whooping cough and that they might be at risk of catching the infection including:

• all household and family members
  
• children and teachers at childcare or school
  
• friends, especially pregnant women
  
• work colleagues.

If you have been in close contact with someone with whooping cough, see your doctor as soon as possible.

References

1. Royal Children's Hospital Melbourne. Whooping cough. Kids Health Info. 2008. [Online] (accessed 23 May 2017).

2. Antibiotic Expert Group. Antibiotic Therapeutic Guidelines v15. Therapeutic Guidelines Pty Ltd. [eTG Online] (accessed 24 March 2017).

3. Centers for Disease Control and Prevention. Pertussis (whooping cough).  National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases 2015. [Online] (accessed 12 May 2017).

Most of these types of symptoms and infections are self-limiting –they will go away without any treatment. A child's immune system is very powerful and will clear up most common infections by itself. Colds and most coughs are caused by viruses, and antibiotics do not work against viruses.

There are several reasons why it is not a good idea to take antibiotics unless they are really needed.

• Using antibiotics can make bacteria resistant to antibiotics. In other words, the antibiotics will no longer work against the bacteria. Someone who has recently taken antibiotics is more likely to have resistant bacteria in their body. Some bacteria have become resistant to almost all antibiotics.
  
• Using antibiotics when not needed may mean that they won't work when they are needed in the future, eg, for a serious or life-threatening infection.
• Most antibiotics have side effects, eg, diarrhoea, rashes and stomach upsets.
  
• Antibiotics kill our natural bacteria that help to protect us. This can result in infections such as thrush (candida).
  
• Antibiotics can also cause allergic reactions. These are often just annoying rashes, but can, in some cases, be severe reactions.
  

If your child gets an antibiotic-resistant bacterial infection:

• they will have the infection for longer
  
• they may be more likely to have complications of the infection
  
• they could remain infectious for longer, and pass the infection to other people, which increases the problem.
  

Find out more about antibiotic resistance

Children rarely need antibiotics for coughs, cold, earache and sore throats. These types of infection are usually caused by viruses, which cannot be treated with antibiotics.

However, there are uncommon situations where your doctor may decide your child may need to take antibiotics. Examples include:

• an earache with fluid coming from a sore ear¹
• an earache in a child of Aboriginal or Torres Strait Islander descent, who may be at increased risk of complications²
  
• a sore throat in a child from an Aboriginal community in central or northern Australia, or of Maori or Pacific Islander descent, who may be at increased risk of complications²
  
• a cough that is suspected or found to be whooping cough (pertussis) or bacterial pneumonia.²
  

If you think any of these situations might apply to your child, take them to see your doctor.

See card 12 'When should I seek further help?' for more information.

References

1. Hersh AL, Jackson MA, Hicks LA, et al. Principles of judicious antibiotic prescribing for upper respiratory tract infections in pediatrics. Pediatrics 2013;132:1146-54. [PubMed].

2. Antibiotic Expert Group. Antibiotic Therapeutic Guidelines v15. Therapeutic Guidelines Pty Ltd. [eTG Online] (accessed 24 March 2017).

No guide is complete. If you are still worried about your child after reading this information, then you should get advice. This could be telephone advice or a consultation with your GP.

If you feel that it is an emergency, dial 000 for an ambulance.

Signs of possible serious illness

• Your child is drowsy or irritable and does not improve after treatment with paracetamol and/or ibuprofen. If they are very drowsy, they should see a doctor urgently.
  
• Your child has problems breathing – including rapid breathing and being short of breath or ‘working hard’ to breathe (it sometimes looks as though the tissues between the ribs and below the ribs get sucked in each time they breathe). Any child who has a lot of difficulty breathing needs to see a doctor urgently.
  
• You notice cold or discoloured hands or feet with a warm body
  
• Your child has a convulsion.¹
  
• You notice unusual skin colour (pale, blue or dusky around lips)
  
• A temperature of 39° C or more in a child aged 3–6 months of age (an infant who is less than 3 months of age should be assessed if they have a temperature of 38° C or more).¹
  
• Most children can go a few days without eating much. However an infant who is not feeding or any child that is showing signs of dehydration, such as dry mouth, sunken eyes, no tears or weeing less, should be assessed. This is especially true for young children (under 1 year) and those who are vomiting.
  
• Your child is unable to swallow, is drooling more than usual and looking generally unwell.
  
• Your child shows symptoms related to meningitis: unusually severe headache, a stiff neck (difficulty putting chin to chest), dislike of bright lights, a rash that does not fade with pressure.
  

Other symptoms that mean you should take your child to a GP

• A cough that hasn't improved in 3 weeks (or sooner if becoming breathless easily or there is a family history of asthma).
  
• Any fever lasting 5 days or more.¹
• Persistent hearing problems.

References

1. National Institute for Health and Care Excellence (NICE). Fever in under 5s: assessment and initial management (CG160). 2013. [Online] (accessed 24 March 2013).