What is happening, and how often

The NHS gives the number that reframes the whole first winter: "Children have 5 to 8 colds a year on average." The reason is simple — "there are hundreds of different cold viruses and young children have no immunity to any of them as they have never had them before. They gradually build up immunity and get fewer colds."

On duration: "Most colds in younger children get better within 2 weeks." A cough often outlasts everything else, because coughing is how mucus trickling down the back of the throat gets cleared.

What normally helps

The NHS's list for easing symptoms:

Fluids. Make sure your child drinks plenty. If your baby is breastfed, continue as normal; smaller, more frequent feeds often work better than usual ones.
Saline nose drops, which "can help loosen dried snot and relieve a stuffy nose". Ask a pharmacist, GP or health visitor about them.
Paracetamol or ibuprofen if your child has a high temperature and seems distressed or in discomfort. Check the packaging for suitability. Children with asthma may not be able to take ibuprofen.
Handwashing across the whole family, to slow the spread.

For a child over one, the NHS suggests a warm drink of lemon and honey for a cough — but honey is not safe under twelve months.

What not to do

The NHS is clear that "children under 6 should not have over-the-counter cough and cold remedies, including decongestants, unless advised to by a GP or pharmacist". For fever it adds: do not undress your child or sponge them down to cool them, because "a high temperature is a natural and healthy response to infection"; do not over-wrap them; do not give aspirin under sixteen; do not give paracetamol under two months or ibuprofen under three months; and "do not alternate ibuprofen and paracetamol, unless a health professional such as a doctor or nurse tells you to".

Fever: the numbers that matter

The NHS defines a high temperature as 38C or more, and says it usually settles within one to four days. The thresholds that trigger a call are age-dependent, and they are lower than most people expect:

a baby under 3 months with a temperature of 38C or higher
a baby 3 to 6 months with a temperature of 39C or higher
a high temperature that has lasted 5 days or more
a high temperature with other signs of illness, such as a rash
refusing food, not being their usual self, or signs of dehydration — nappies that are not very wet, sunken eyes, no tears when crying

Those are calls to 111 or your GP surgery now, not tomorrow.

When it is more than a cold

Bronchiolitis

The most common escalation in the first year has a name. The NHS describes bronchiolitis as "a common chest infection that affects babies and children under 2", usually caused by respiratory syncytial virus (RSV), which is "very common and spreads easily in coughs and sneezes. Almost all children get it at least once before they're 2 years old."

It starts looking exactly like a cold — sneezing, a runny or blocked nose, a slightly high temperature — then adds a cough, faster breathing, difficulty feeding, noisy breathing such as wheezing or crackling, and irritability. "Symptoms are usually worst between days 3 and 5, and the cough usually gets better in 3 weeks."

The breathing signs to know

The AAP describes what to look for: "Watch your child's rib cage as they inhale. If you see it 'caving in' and forming an upside-down 'V' shape under the neck, then they are working hard to breathe." Its list of lower-airway signs includes "fast breathing", "flaring of the nostrils and head bobbing with breathing", "rhythmic grunting during breathing", "belly breathing, tugging between the ribs and/or the lower neck", and wheezing.

The AAP also gives a usable dehydration marker: "fewer than 1 wet diaper every 8 hours". And it notes RSV is "the most common cause of hospitalization in children under age 1 year", which is why the bar for getting a young baby looked at is deliberately low.

Ear infections

The NHS notes ear infections "often follow a cold and sometimes cause a high temperature". A baby may pull or rub at an ear; other signs are irritability, crying, difficulty feeding, restlessness at night and a cough. Most get better by themselves, usually within about three days — see a GP if earache is not starting to improve after three days. Do not put oil, eardrops or cotton buds into the ear unless a GP advises it.

When to call, and who

Call 999 or go to A&E immediately if your baby: is having difficulty breathing — grunting noises, the tummy sucking under the ribs, or very fast breathing; has pauses in breathing; has skin, tongue or lips that look blue or grey (on brown or black skin this may be easier to see on the palms, soles, lips, gums and inside the eyelids); is floppy and will not wake or stay awake; has a stiff neck, a rash that does not fade when pressed with a glass, a first febrile seizure, unusually cold hands and feet, or is extremely agitated or confused.

Call 111 or your GP surgery now if: your child has had a cold and it is getting worse; they are feeding or eating much less than normal; they have had a dry nappy for 12 hours or more or other signs of dehydration; they meet the fever thresholds above; or they are very tired, irritable or not themselves. The NHS adds a line worth trusting: "As a parent, you may know if your child seems seriously unwell and should trust your own judgement."

Book a routine appointment if: a cough has lasted longer than three weeks, a sore throat lasts more than three days with a high temperature, earache is not improving after three days, or you think hearing has been affected.

Baby's First Cold