Children's health

NHS 111

If you need medical help fast, but it’s not a 999 emergency; or you want advice about treating your child's symptoms at home; or you need to access a local medical service but you're not sure which one, start with NHS 111.

NHS 111 is available 24 hours a day, 365 days a year. Visit the NHS 111 website or call 111 free from your landline or mobile phone.

Trained advisors will ask you a series of questions to assess your child’s symptoms and then if necessary, book an appointment for you to attend the local healthcare service that’s right for them. If the NHS 111 team think you need an ambulance, they will send one immediately.

Pharmacies

Pharmacists are trained medicine experts who can give you advice on treating a range of common childhood conditions and minor injuries such as:

sore throat
coughs
colds and flu
insect bites
earache
skin rashes

You don't need to make an appointment to visit your local pharmacist, and many pharmacies are open during the evening and at weekends. Find your nearest pharmacy.

Caring for children with coughs

The University of Bristol have created a leaflet on how to look after a child who has a cough (not due to asthma).

Not sure what to do?

Get instant access to expert advice via a free mobile app, called HANDi App.

Developed and approved by Paediatric Consultants at the Royal United Hospital (RUH), the HANDi App provides expert advice on how best to manage the six most common childhood illnesses; diarrhoea and vomiting, high temperature, chestiness, newborn problems and stomach pain.

It's easy to use as it takes you through a series of questions about the symptoms your child is experiencing and then advises on what to do, whether that's to treat at home, make a GP appointment or to go to A&E.

Bath or Wiltshire resident? Search for 'HANDi App' in your app store to download HANDi App now.

Find Out More

Respiratory illness in children

We see an increase in severe respiratory illness like broncholitis in children over the winter months. Many of these illnesses are caused by a virus called respiratory syncytial virus or RSV.

Parents are encouraged to look out for symptoms of severe respiratory infection in at-risk children, including a high temperature of 37.8°C or above (fever), a dry and persistent cough, difficulty feeding, rapid or noisy breathing (wheezing).

For the majority of children, these illnesses will not be serious and they will soon recover following rest and plenty of fluids.

Most cases of bronchiolitis are not serious and clear up within 2 to 3 weeks, but parents should contact their GP or call NHS 111 if:

Their child struggles to breathe.
Their child has taken less than half their usual amount during the last 2 or 3 feeds, or they have had a dry nappy for 12 hours or more.
The child has a persistent high temperature of 37.8C or above.

Some children under 2 years, especially those born prematurely or with a heart condition, can suffer more serious consequences from these common respiratory infections.

Find out more about RSV using the dropdown list of FAQs below

RSV FAQs

What should I do if my child has a respiratory illness?

How is RSV infection spread?

RSV can spread when an infected person coughs or sneezes and the virus droplets get in your eyes, nose or mouth. You can also get it from direct contact with the virus, e.g., from kissing the face of a child with RSV. If you do touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands, you can also get the virus.

Children are often exposed to and infected with RSV outside the home such as in school or childcare centres. RSV can survive for many hours on hard surfaces such as tables and cot rails. On soft surfaces such as tissues and hands, the virus lives for a shorter time.

What are the symptoms of RSV infection?

The symptoms of RSV infection are typical symptoms of a cold, such as a runny nose, coughing, sneezing, fever (high temperature), wheezing and not feeling like eating. These symptoms usually appear in stages and not all at once.

In very young infants with RSV, the only symptoms may be irritability, decreased activity and breathing difficulties. However, RSV can also cause serious illness, including bronchiolitis and pneumonia (infections in the lung).

Who is most at risk of RSV infection?

People of any age can get another RSV infection, but infections later in life are generally less serious. People at highest risk for severe symptoms include:

Premature babies
Young children with congenital (from birth) heart or chronic lung disease
Young children with compromised (weakened) immune systems due to a medical condition or medical treatment
Adults with compromised immune systems
Older adults, especially those with underlying heart or lung disease.

How is an RSV infection diagnosed?

Is there a vaccine against RSV infection?

When should you seek help for a child with RSV infection?

What remedies are available to relieve RSV symptoms?

Some home remedies can help relieve some signs and symptoms:

Create moist air to breathe. Keep the room warm but not overheated. If the air is dry, a cool-mist humidifier or vaporizer can moisten the air and help ease congestion and coughing.
Drink fluids. Continue breastfeeding or bottle-feeding your infant as you would normally. For older children and adults, keep a steady supply of cool water at the bedside. Offer warm fluids, such as soup, which may help loosen thickened secretions. Ice pops may be soothing as well.
Try saline nasal drops. Over-the-counter (OTC) drops are a safe, effective way to ease congestion. If you speak to the pharmacist, they will be able to provide advice on the correct way to use the drops.
Use over-the-counter pain relievers. OTC pain relievers such as paracetamol may help reduce fever and relieve a sore throat. Ask the local pharmacist for advice.

How is RSV infection treated?

Most RSV infections go away on their own in 1 to 2 weeks. There is no specific treatment for RSV infection. Care involves relieving symptoms, such as:

Manage fever and pain with Paracetamol
Drink enough fluids to prevent dehydration (loss of body fluids).

Talk to your healthcare provider before giving your child cold and cough medicines. Some medicines contain ingredients that are not good for children.

A medicine called palivizumab (pah-lih-VIH-zu-mahb) is available by injection to prevent severe RSV illness in infants and children who are at high risk of severe illness, such as babies born prematurely or with congenital heart disease or chronic lung disease. The medicine can help prevent serious RSV disease, but it cannot help cure or treat children already suffering from serious RSV, and it cannot prevent infection with RSV. This must be administered regularly to be effective.

What can you do to reduce the chance a child getting RSV infection?

Breastfeeding – Breastfeeding your baby protects them from getting RSV infection by boosting their infection-fighting (immune) system. Breastfeeding beyond 4 months of age offers the best protection.

Smoke-free environment – Make sure your child's environment is smoke-free.

Vaccinations – Make sure your child is up to date with all their vaccinations. There is currently no vaccine for RSV but vaccination can prevent bacterial infections following RSV infection.

A warm house – Keeping the house warm and well insulated will also decrease your baby's risk of developing RSV infection.

Stay away from people with coughs and colds – It is sensible to keep young babies away from people who have colds and coughs.

Parents of children at high risk for developing severe RSV disease should help their child when possible do the following:

Avoid close contact with sick people.
Wash their hands often with soap and water for at least 20 seconds.
Avoid touching their face with unwashed hands.
Avoid their sharing drink containers and toothbrushes.

Limit the time they spend in childcare centres or other potentially contagious settings, especially during autumn, winter and spring. This may help prevent infection and spread of the virus during the RSV season.

How can we prevent the spread of RSV?

If you have cold-like symptoms, you should:

Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands
Wash your hands often with soap and water for at least 20 seconds
Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with others
clean frequently touched surfaces such as doorknobs and mobile devices
Wash solid toys and consider getting rid of soft ones.
Ideally, people with colds should avoid close contact with new-born babies: infants born prematurely (before 37 weeks): children under 2 years born with heart or lung conditions and those with weakened immune systems.
Smoking around young children is also a risk factor for severe RSV infection

Who is most at risk of severe illness?

Children can be at higher risk of severe illness from common respiratory infections like RSV.

Most cases are not serious and clear up within 2 to 3 weeks, but the symptoms can be very worrying for parents.

For some infants and babies, such as those born prematurely or with a heart condition, respiratory infections can be more severe. NHS 111 or your GP can offer advice if any parent has concerns.

It is perfectly okay for parents to ask people with colds to keep away from new-born babies, particularly in the first two months, and for babies born prematurely.

How transmissible is RSV?

How soon after exposure do symptoms appear and when will I feel better?

How do you discern the difference in symptoms between RSV and other Childhood Respiratory viruses?

Many other viruses can cause RSV-like illness: acute viral respiratory infections include Influenza, COVID-19, Parainfluenza, Rhinovirus and Human metapneumovirus. When viruses invade cells of the respiratory tract, they trigger inflammation and production of mucus. This situation leads to nasal congestion, a runny nose, scratchy throat, high temperature and cough- these are usually the common symptoms among the respiratory viruses. Persistent cough and loss of taste and/smell usually develop with COVID-19.

Other typical symptoms in children with respiratory infections caused by viruses include decreased appetite, lethargy, and a general feeling of illness. Headaches and body aches develop, particularly with influenza.

Guidance for when to seek help is similar for most of the Respiratory viruses as they present with like symptoms: Please refer to the RSV traffic light guide (pdf, 164KB) for further guidance on when to seek help.

Where can I get more Information?

Group A Strep

What should parents look out for?

It’s always concerning when a child is unwell. GAS infections cause various symptoms such as sore throat, fever, chills and muscle aches.

As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement.

Contact NHS 111 or your GP if:

your child is getting worse
your child is feeding or eating much less than normal
your child has had a dry nappy for 12 hours or more or shows other signs of dehydration
your baby is under 3 months and has a temperature of 38C, or is older than 3 months and has a temperature of 39C or higher
your baby feels hotter than usual when you touch their back or chest, or feels sweaty
your child is very tired or irritable

Call 999 or go to A&E if:

your child is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs
there are pauses when your child breathes
your child’s skin, tongue or lips are blue
your child is floppy and will not wake up or stay awake

How is it spread?

Which infections does GAS cause?

GAS causes infections in the skin, soft tissue and respiratory tract. It’s responsible for infections such as tonsillitis, pharyngitis, scarlet fever, impetigo and cellulitis among others.

While infections like these can be unpleasant, they rarely become serious. When treated with antibiotics, an unwell person with a mild illness like tonsilitis stops being contagious around 24 hours after starting their medication.

We are currently seeing high numbers of scarlet fever cases.

The first signs of scarlet fever can be flu-like symptoms, including a high temperature, a sore throat and swollen neck glands (a large lump on the side of your neck).

A rash appears 12 to 48 hours later. It looks looks like small, raised bumps and starts on the chest and tummy, then spreads. The rash makes your skin feel rough, like sandpaper. The rash will be less visible on darker skin but will still feel like sandpaper. More information on scarlet fever can be found on the NHS website, including photos.

What is invasive group A strep?

The most serious infections linked to GAS come from invasive group A strep, known as iGAS.

This can happen when a person has sores or open wounds that allow the bacteria to get into the tissue, breaches in their respiratory tract after a viral illness, or in a person who has a health condition that decreases their immunity to infection. When the immune system is compromised, a person is more vulnerable to invasive disease.

Which infections does invasive group A strep cause?

What is being done to investigate the rise in cases in children?

Investigations are underway following reports of an increase in lower respiratory tract Group A Strep infections in children over the past few weeks, which have caused severe illness.

Currently, there is no evidence that a new strain is circulating. The increase is most likely related to high amounts of circulating bacteria.

It isn’t possible to say for certain what is causing higher than usual rates of these infections. There is likely a combination of factors, including increased social mixing compared to the previous years as well as increases in other respiratory viruses.

How can we stop infections from spreading?