Parents commonly report that their child is always sick, and worry that something is wrong with the immune system. In the majority of cases the child is entirely normal and is simply doing what young children do.
The important skill is distinguishing normal frequency from the patterns that suggest asthma, allergy or an underlying problem.
How Many Infections Are Normal
A preschool child typically has six to twelve viral upper respiratory infections a year, and more once they start creche or school.
Each episode can last seven to ten days, with cough persisting up to three weeks. Six infections lasting ten days each, clustered in the cooler months, means a child who seems perpetually unwell from October to February. That is normal.
This frequency reflects an immune system encountering hundreds of viruses for the first time, and it declines steadily as the child accumulates immunity. By primary school most children have far fewer episodes.
What Is Not Normal
Certain patterns suggest a genuine immune problem rather than ordinary exposure.
- Recurrent severe infections needing intravenous antibiotics or admission
- Two or more episodes of pneumonia in a year
- Recurrent deep abscesses of skin or organs
- Persistent thrush in the mouth beyond infancy
- Failure to gain weight alongside recurrent infection
- Infections with unusual organisms
- A family history of immune deficiency or unexplained infant deaths
Frequent ordinary colds in a thriving, growing child are not on this list and do not indicate low immunity.
When It Is Actually Asthma
Asthma is frequently mislabelled as recurrent bronchitis or repeated chest infections, and children are given course after course of antibiotics for a condition antibiotics do not treat.
Features suggesting asthma include cough that is worse at night or in the early morning, cough or wheeze triggered by exercise, cold air, dust or laughing, audible wheeze, symptoms recurring without fever, a personal or family history of eczema or allergic rhinitis, and clear improvement with an inhaled bronchodilator.
The absence of fever is the most useful discriminator. Repeated chest symptoms without fever are far more likely to be asthma than infection. Our pulmonology department assesses children with this pattern.
Allergic Rhinitis Is Common and Missed
Persistent nasal symptoms without fever are frequently allergic rather than infective, and Chennai's dust levels make this common.
Clues include clear watery discharge rather than coloured, sneezing in bouts, itchy nose and eyes, a horizontal crease across the nose from repeated rubbing, dark circles under the eyes, and mouth breathing or snoring.
Untreated allergic rhinitis affects sleep, concentration and school performance, and it is a risk factor for developing asthma. It responds well to nasal steroid sprays used correctly. Our ENT department assesses persistent nasal symptoms.
Adenoids and Persistent Mouth Breathing
Enlarged adenoids are a common and under recognised cause of chronic symptoms in young children.
Suggestive features are persistent mouth breathing, snoring most nights, pauses in breathing during sleep, a nasal quality to the voice, recurrent ear infections, and daytime tiredness or behavioural difficulty.
Obstructive sleep apnoea in children presents differently from adults, often as hyperactivity and poor concentration rather than sleepiness. It is a genuine reason to investigate, and adenoidectomy can be transformative where symptoms are significant.
Why Antibiotics Are Usually Wrong
Most childhood respiratory infections are viral. Green nasal discharge is a normal stage of a viral cold and does not indicate bacterial infection, contrary to widespread belief.
Repeated antibiotic courses disturb gut bacteria, cause diarrhoea and rashes, and drive resistance. They do not reduce the frequency of future colds.
Antibiotics are appropriate for specific situations: ear infection with pus and significant pain in a young child, tonsillitis with confirmed streptococcal infection, pneumonia, and urinary infection. A doctor examining the child makes that distinction.
Reducing the Frequency
Several measures genuinely reduce how often a child gets ill.
- Hand washing, the single most effective measure, taught properly and repeated
- Complete elimination of household smoking, which markedly increases respiratory infections and asthma in children
- Annual influenza vaccination from six months of age
- Ensuring pneumococcal vaccination is complete
- Reducing dust exposure, with regular damp dusting and mattress covers where allergy is present
- Keeping the child home when unwell rather than sending them back too early
- Adequate sleep and iron sufficiency, since anaemia is associated with frequent infection
Immune boosting supplements and tonics have little evidence. Vitamin D correction where deficient does have reasonable support.
When to Bring Them In
Seek medical assessment if you observe any of these.
- Difficulty breathing, fast breathing, or ribs drawing in
- Wheeze, or an audible whistling sound
- Fever lasting beyond five days
- Cough persisting beyond three to four weeks
- Coughing that causes vomiting repeatedly, or a whooping sound
- Poor feeding, reduced urine output, or unusual drowsiness
- Ear pain, or discharge from the ear
- Weight loss or poor weight gain alongside recurrent illness
Breathing difficulty is the one that needs same day attention. Our paediatric emergency service is available around the clock.
A preschool child with frequent colds who is growing well, feeding normally and recovering fully between episodes almost always has a normal immune system. The patterns worth investigating are symptoms without fever, wheeze, night cough and persistent mouth breathing.
Our paediatrics department at T. Nagar assesses recurrent respiratory symptoms in children.
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