Respiratory Infections in Children

Upper vs lower respiratory infections

Common infections

Common cold

Runny or blocked nose, sneezing, cough and mild fever, lasting 7 to 10 days; a cough can linger for up to 3 weeks. See common cold.

Bronchiolitis

Inflammation of the small airways, mostly in babies under 1 year, usually caused by RSV. Starts like a cold, then causes cough, wheeze, fast breathing and feeding difficulty, peaking around days 3 to 5. Most babies recover at home, but some need hospital oxygen or feeding support. See bronchiolitis.

Croup

A viral infection causing swelling around the voice box in children aged 6 months to 3 years. Causes a seal-like barking cough, hoarse voice and sometimes noisy breathing (stridor), typically worse at night. A single steroid dose from a doctor helps. See croup.

Influenza and COVID-19

Sudden fever, cough, sore throat, aches and tiredness. Children under 5 and those with health conditions are at higher risk of complications. Antivirals may be used for high-risk children.

Pneumonia

Infection in the lungs, caused by viruses or bacteria. Signs include fever, cough, fast breathing, chest pulling in, and sometimes chest or belly pain. Bacterial pneumonia is treated with antibiotics. See pneumonia.

Whooping cough (pertussis)

Bacterial infection with severe coughing fits, sometimes followed by a "whoop" or vomiting, lasting weeks. Very dangerous for babies, who may have pauses in breathing instead of a whoop. See whooping cough.

Ear infections and sore throats

Often follow colds. See middle ear infections. Strep throat is a bacterial cause of sore throat in school-age children that needs antibiotics.

Signs of breathing difficulty

• breathing faster than normal for age (for example, more than about 50 breaths a minute in babies 2 to 12 months, or more than 40 in children 1 to 5 years, counted when calm)
• skin pulling in between or under the ribs, or above the collarbone
• nostrils flaring
• grunting with each breath
• head bobbing in babies
• wheezing or stridor
• pauses in breathing
• blue or gray color around the lips

Home care

• Fluids: offer breast milk, formula or drinks often, in small amounts if needed.
• Fever and discomfort: acetaminophen (paracetamol) or ibuprofen (ibuprofen from 6 months) at the correct dose for age and weight, following the label. Do not give aspirin to children or teenagers.
• Blocked nose: saline drops and gentle suction before feeds for babies.
• Cough: honey for children over 1 year; never give honey to babies under 12 months. Avoid over-the-counter cough and cold medicines in young children; they are not recommended under age 4 and have little benefit up to 6.
• Rest and a smoke-free home.
• Check on your child regularly, including at night, for breathing changes.

Antibiotics do not work for colds, flu, bronchiolitis or croup, which are viral.

Who is at higher risk

• babies under 6 months, especially premature babies
• children with heart or lung disease, including asthma
• children with weakened immune systems or neuromuscular conditions
• children exposed to tobacco smoke
• children in crowded settings such as child care

Prevention

• Wash hands often and teach children to cough into their elbow.
• Keep sick children home from child care and school.
• Avoid smoking around children.
• Breastfeed if possible.
• Keep vaccines up to date: flu (from 6 months), COVID-19, whooping cough (DTaP and maternal Tdap in pregnancy), pneumococcal and Hib.
• RSV protection for infants: either an RSV vaccine during pregnancy or a long-acting antibody (nirsevimab) for babies entering their first RSV season, and for some high-risk toddlers.

Frequently asked questions

How many respiratory infections are normal for a child?

Young children commonly have 6 to 8 colds a year, more if they attend child care, with each lasting 1 to 2 weeks. This is normal as the immune system develops. Frequent severe infections, pneumonia or poor growth should be discussed with a doctor.

How can I tell if my child's breathing is a problem?

Watch for fast breathing, skin pulling in between the ribs or at the neck, nostril flaring, grunting, wheezing, pauses in breathing or blue lips. A child who cannot speak, feed or drink because of breathing needs urgent care.

When does a child with a cough need a doctor?

See a doctor if your child has breathing difficulty, a fever over 5 days, a cough lasting more than 3 to 4 weeks, coughing fits with whooping or vomiting, poor feeding or fewer wet diapers, or any fever in a baby under 3 months.

Do children need antibiotics for respiratory infections?

Usually not. Most childhood respiratory infections are viral, and antibiotics do not help. They are used for bacterial infections such as strep throat, some ear infections, bacterial pneumonia and whooping cough, after assessment by a clinician.

How long does RSV last in babies?

RSV symptoms usually peak around days 3 to 5 and improve over 1 to 2 weeks, though a cough can last up to 4 weeks. Watch for breathing difficulty and poor feeding, especially in babies under 6 months, and seek care if they appear.