The common cold in a young child generates a lot of parental worry and is one of the top reasons for GP appointments in the under-5s. In most cases, the treatment is the same regardless of which exact virus is responsible: supportive care, comfort, and time. Knowing what actually helps — and why antibiotics aren't the answer — saves an antibiotic that you'll want to work later, and saves you a frustrating consultation.
Healthbooq covers children's health and evidence-based approaches to common childhood illnesses.
What Is a URTI?
Upper respiratory tract infection (URTI) is the umbrella term for the common cold, pharyngitis (sore throat), and otitis media (middle ear infection) — all infections of the upper airway. The common cold, caused by rhinovirus in roughly 40–50% of cases, with coronaviruses, RSV, parainfluenza, adenovirus, and others making up the rest, gives the familiar picture: blocked or runny nose, sneezing, mild sore throat, mild cough, and sometimes a low-grade fever. Symptoms typically peak around days 2–4 and improve from there.
Young children average 8–10 respiratory infections per year in the first 2 years of life, and starting nursery or childcare reliably increases the count. This is normal — the immune system is being trained on the menu of common viruses, not failing.
Why Antibiotics Do Not Help
Viral respiratory infections don't respond to antibiotics. Antibiotics target bacteria, and a virus is not a bacterium. Side effects of unnecessary antibiotic prescribing in children include disruption of the gut microbiome, antibiotic-associated diarrhoea (in 10–15% of children on amoxicillin), and a contribution to wider antibiotic resistance. NICE guidance (NG116 on common infections and NG84 on respiratory tract infections) is clear: do not prescribe antibiotics for viral URTIs, and explain to parents why not.
Multiple Cochrane reviews and a body of work including studies by Tapiainen and colleagues at the University of Oulu have confirmed that antibiotics do not shorten an uncomplicated viral URTI in children.
Effective Supportive Care
Fluids. Hydration is the single most important thing. Fever increases water loss, and a stuffy nose makes feeding harder for young infants. Offer breastfed babies more frequent, shorter feeds. Older children should be offered water or diluted juice in small, frequent sips throughout the day. Watch for wet nappies — fewer than 4 wet nappies in 24 hours, no tears when crying, or a sunken fontanelle is a sign of dehydration that needs medical assessment.
Paracetamol and ibuprofen. Weight-based dosing of paracetamol (15 mg/kg every 4–6 hours, max 4 doses in 24 hours) or ibuprofen (5–10 mg/kg every 6–8 hours, from age 3 months and 5 kg) provides relief from fever, headache, and sore throat. They don't shorten the illness, but they meaningfully improve comfort and feeding. Don't combine them routinely; alternate only if a single agent isn't controlling discomfort and on advice from a clinician.
Nasal saline drops. For babies under 6 months whose feeding is impaired by congestion, isotonic saline drops (0.9% NaCl, available as Calpol Saline Nasal Drops, Sterimar, or generic) instilled into each nostril before feeds clear secretions and let feeding proceed. They're safe and effective for short-term use. A bulb syringe or a nasal aspirator (NoseFrida or similar) can follow.
Honey. From age 1 year, 2.5–5 ml of honey before bed has modest evidence for reducing cough severity and frequency. The Cochrane review by Oduwole and colleagues (2018) found honey better than no treatment and better than the antihistamine diphenhydramine for nocturnal cough in children. Never give honey to a child under 1 year due to the risk of infant botulism.
Sleep position. For older infants and toddlers (over 6 months), slightly elevating the head end of the cot or bed can help nocturnal congestion. Never use pillows or rolled blankets in cots for under-1s — that's a SIDS risk. A folded towel under the mattress at the head end is the safer way.
Run a humidifier or use steam. A cool-mist humidifier in the bedroom or 10 minutes in a steamy bathroom (with you, not unsupervised) can ease congestion. Avoid hot-steam vaporisers — burn risk.
What to Avoid
Over-the-counter cold and cough medicines (decongestants, antihistamines, cough suppressants) are not recommended for children under 6 years. The MHRA issued guidance in 2009 advising against them in this age group after reviewing evidence that they don't work and carry real risks — tachycardia, drowsiness, paradoxical agitation, and rare serious reactions. The same applies to combination products.
Aspirin should never be given to children under 16 because of the risk of Reye's syndrome — a rare but devastating condition causing brain swelling and liver failure.
Cough suppressants generally aren't useful — coughing clears secretions; suppressing the cough doesn't help and may extend symptoms.
Duration and Red Flags
Most uncomplicated colds resolve in 7–10 days, though the post-viral cough can persist for up to 3 weeks. A child whose cold isn't improving by day 7–10, or who initially improved and is now getting worse, deserves an assessment — secondary bacterial infections (otitis media, sinusitis, bacterial pneumonia) are possible, and they change management.
Red flags — get an urgent assessment:
- Any fever in a baby under 3 months (38°C or above is a 999/A&E call)
- Fever above 39°C in a 3–6 month old
- Respiratory distress: fast breathing (over 50 breaths/min in 1–5 year olds, over 60 in under-1s), chest indrawing, head bobbing, nasal flaring, grunting
- A child who is not drinking, has no wet nappies for over 12 hours, or has a sunken fontanelle
- A child who is very difficult to rouse, floppy, or unusually drowsy
- A non-blanching rash (does not fade when pressed with a glass)
- Persistent vomiting that prevents fluid intake
- Cough that is barking or stridor (high-pitched sound on breathing in)
Key Takeaways
Upper respiratory tract infections (URTIs) — colds — are the most common illness in young children. The average child has 8–10 episodes per year in the first 2 years of life. They are caused by viruses (most often rhinovirus) and don't respond to antibiotics. Management is supportive: fluids, weight-based paracetamol or ibuprofen for fever and discomfort, saline nose drops for congestion that interferes with feeding, and rest. Honey is helpful for cough in children over 1 year (never in under-1s, due to infant botulism risk). Over-the-counter cold medicines are not recommended for children under 6. Most colds resolve within 7–10 days, though the cough can hang around for 3 weeks.
