Respiratory tract infections are common childhood illnesses. They can spread easily through the air we breathe or via our hands. You can treat most symptoms at home while the body clears the infection.

Your upper respiratory (UR) tract is made up of your nose, mouth, sinuses, upper throat, and voice box (larynx). Your lower respiratory (LR) tract includes your windpipe (trachea), bronchial tubes, and lungs.

Children tend to get more respiratory tract infections than adults. This is because of their relative lack of immunity, close contacts in child care or school settings, and increased hand-to-mouth behavior that predisposes them to contagious illnesses.

This article reviews the more common childhood respiratory infections, their treatment, and prevention.

Here are the most common upper respiratory tract infections, which doctors may refer to as “URIs.”

Common cold

Common colds are by far the most common URIs in children. Typical young children catch 6 to 10 colds annually, possibly more if they attend day care or have older siblings at home.

Colds can cause sore throat, stuffy and runny nose, cough, intermittent fussiness, or low grade fever.

In children, cold symptoms last an average of 8 days but may linger for upward of 3 weeks. Treatment is usually with symptomatic care at home.

Because the common cold is typically caused by different viruses, antibiotics have not been shown to be helpful for treatment. Common cold viruses can include:

  • rhinovirus (causing up to 80% of colds during fall seasonal peak)
  • human metapneumovirus
  • parainfluenza
  • adenovirus
  • coronavirus

And many more respiratory viruses, like RSV, COVID-19, and influenza, commonly cause both upper and lower respiratory tract infections.

Sinusitis

Your sinuses are air-filled spaces adjacent to your nasal passage. In acute sinusitis, your sinuses become blocked and infected, usually after a viral cold.

In acute sinusitis, your child might have prolonged cold and cough symptoms that fail to improve after 10 or more days. They might have a two-phased illness, where typical cold symptoms improve, then suddenly worsen.

Or, you might notice sinusitis symptoms like headache, facial pain, swelling around the eyes upon waking, bad breath, high fever, or thick pus-like nasal discharge.

Bacteria often cause acute sinusitis. If sinusitis is suspected, your doctor may prescribe antibiotics in addition to the usual cold care.

Croup

Croupis a respiratory viral infection affecting the part of your airway where your throat meets your windpipe.

Croup is quite common in young children. It’s often caused by the same viruses that cause colds, particularly parainfluenza. Common cold symptoms often precede the classical croup symptoms of inspiratory stridor and a deep, barking cough.

More than 85% of affected children will have a mild illness course. Your child should improve within 3 to 7 days with care at home, such as breathing warm, humidified air.

But sometimes, difficulty breathing can become severe. In this case, your doctor or emergency room may treat croup with steroids (dexamethasone), nebulized racemic epinephrine, or oxygen.

Influenza

Influenzais a common upper respiratory tract infection. Symptoms include high fever and chills, aches, cold and cough, and sometimes vomiting or diarrhea.

Though most people will recover from the flu within about a week, the influenza virus still causes hundreds of thousands of global deaths annually. Young children, the elderly, and those with chronic health conditions are at highest risk.

Influenza can also cause lower respiratory tract infections, such as pneumonia.

The flu vaccine can help protect you and your child. If flu symptoms arise, talk with your doctor about the antiviral Tamiflu (oseltamivir). Influenza is estimated to account for at least 11.5% of annual LTRI among all ages.

Here are the most common lower respiratory tract infections, which doctors often refer to as “LRTIs.”

Bronchiolitis

Bronchiolitis is most common in children ages 0 to 2 years. In this viral infection of the small airways, you’ll see common cold symptoms along with crackling wheezes.

Most bronchiolitis can be safely treated at home with simple cold care measures. But sometimes, especially in young or premature infants, bronchiolitis can cause dangerous difficulty breathing. In this case, babies may need hospital care for respiratory support.

Respiratory syncytial virus (RSV), which usually causes a common cold in older kids and adults, is responsible for about three-quarters of bronchiolitis cases in young children. But bronchiolitis can also be caused by a variety of other cold and flu viruses.

Pneumonia

In children, pneumonia is often caused by cold and flu viruses. Doctors often prescribe antibiotics to treat pneumonia, as it’s hard to determine whether the cause is a virus or bacteria.

Most people with pneumonia improve within a few days of starting medication. But in some cases, progressive pneumonia symptoms like high fevers, difficulty breathing, or low oxygen levels may require hospital care.

Although pneumonia often improves within a few days, coughing can linger for weeks.

Typical symptoms of childhood respiratory infections include:

  • runny nose (often clear at first, though yellow or greenish mucus may appear)
  • congestion
  • sneezing
  • sore throat
  • cough
  • decreased appetite
  • occasionally, vomiting or diarrhea
  • fever

In children, cold symptoms usually peak around day 3 to 6 of illness and begin improving by 10 days. In about 90% of children, symptoms resolve by day 23.

When to call your doctor or pediatrician

Call your doctor if your child:

  • seems very ill
  • is in severe pain (such as ear, facial, or chest pain)
  • has a headache and stiff neck
  • has difficulty swallowing or signs of dehydration
  • is wheezing or has signs of difficulty breathing
  • has excessive sleepiness or crankiness
  • has congestion, runny nose, or cough lasting over 2 weeks
  • has fever or cold symptoms (for infants under 3 months)

When to call 911

Always call 911 if your child is having a medical emergency, including unresponsiveness, severe trouble breathing, or turning blue.

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In most respiratory infections, you can treat symptoms at home while your body fights the infection. For common cold symptoms, the American Academy of Pediatrics (AAP) recommends:

For children ages 5 and under:

  • rest
  • drinking fluids
  • a humidifier
  • saline nasal rinses/suction
  • pain or fever reducers
  • honey (starting at age 12 months)
  • mentholated chest rub (starting at age 24 months)

For ages 6 and up:

Over-the-counter cough and cold medications may be safely added to the tips above. However, these medications have not been shown to consistently improve symptoms or shorten illness duration.

Specific prescription treatment is recommended only for select respiratory infections:

  • Influenza: when started within 48 hours of symptom onset, Tamiflu (oseltamivir) can reduce symptom duration and risk of complications
  • COVID-19: Paxlovid (nirmatrelvir/ritonavir) or antibody infusion may be recommended for some intermediate or high risk children ages 12 and up.
  • Acute sinusitis or pneumonia: antibiotic therapy may be recommended

If your child has other medical conditions, such as asthma, cystic fibrosis, immunodeficiency, or chronic lung disease (CLD), additional treatment may be needed. Contact your doctor to discuss recommended care.

Immunizations

The good news is that immunizations can protect against some of the most common childhood respiratory infections. The Centers for Disease Control and Prevention (CDC) recommends:

Additional preventive measures

  • Hand hygiene: Soap and water or hand sanitizer containing at least 60% alcohol can kill most respiratory viruses. Teach children the proper handwashing technique.
  • Cover your cough: Sneeze or cough into a tissue if you have one, then wash your hands. If you don’t have a tissue handy, cough into your elbow and away from others. Masking is also an option (for children over 2 years old).
  • Disinfect: You can make or purchase a bleach-based disinfectant solution to use on high-touch surfaces, such as countertops, knobs, handles and switches, and remote controls. Be sure to disinfect your high-touch tech devices.

Childhood respiratory infections are a common cause of illness, causing many missed school and child care days. The most frequent childhood respiratory infection is the common cold.

Although the symptoms of respiratory infections are bothersome, they are rarely dangerous, and most children will recover fully within 1 to 2 weeks. Contact your child’s doctor if you notice more severe respiratory symptoms, such as difficulty breathing or wheezing.

Routine immunizations and hygiene measures can help protect your family from some childhood respiratory infections. As cold and flu season approaches, be sure to talk with your child’s doctor about preventive care.