Written by Dr Nické Theron, Pediatrician.

When our son was 1 year old we moved to Belgium. That December we experienced our first European winter, and for about 6 weeks our son had a cold with a runny nose almost weekly! In that time he was cutting 8 teeth, meeting new friends and going from a heated (dry) indoor environment to an icy cold outdoor environment. Although these were all valid reasons for him to have a runny nose (see our previous article for more information), I started to wonder if I am doing something wrong? Was it allergies? How could I prevent the upper respiratory tract infections and how do you prevent a cold to turn into something worse?

Unfortunately I do not have a brand new miracle answer for you. Most of the things that you are about to read are very boring, general, every-day tips, however if you stick to it, research shows that it will make a difference. If all else fails, stay strong, this too shall pass as they will grow out of it…

“Have I not commanded you? Be strong and courageous. Do not be afraid; do not be discouraged, for the LORD your God will be with you wherever you go.”

Joshua 1:9

Remember that until 6 months your baby still has some of your antibodies in their system to help protect them. After that they have to start building their own stash of antibodies, and they can only do that when they are exposed to pathogens. Although it is horrible to have a sick baby or toddler, remember that it means that your little one’s immune system is learning and growing.

Prevention of upper respiratory tract infections (aka boosting the immune system):

  • Get enough sleep: chronic lack of sleep suppresses the immune system.
  • Exercise, outside play.
  • Eat healthy: make sure your child eats a good variety of fruits and vegetables to ensure they get all the vitamins and minerals they need to keep their immune system healthy.
  • Supplements: Vitamin C and Zinc boosts the immune system. It has been proven that certain probiotics (Lactobacillus rhamnosus, Bifidobacterium Lactis) if given daily, decreases the amount of respiratory tract infections. Echinacea has also been proven to be preventative.
  • Hand washing / sanitizing: we have all become pro’s at this since Covid 19 started. It really is the best way to prevent infections of all kinds! 
  • Do not smoke (not even second hand): cigarette smoke paralyses the brush border that expels the mucous, causing pooling of secretions and increases the possibility of infection.
  • Immunizations: Flu vaccines can be given from 6 months of age and should be given every year to all children under 5 years. This protects against the most prevalent Influenza virus strains of the season.
  • Keep allergies under control: “hay fever” and sinusitis creates the perfect environment for pathogens to slip into the cells and cause infections.

A quick note on “crèche syndrome”: When babies and toddlers start to attend a crèche, they may develop 12 – 14 (or even more) upper respiratory tract infections a year. It may seem like they have a runny nose, mild fever and cough from a post-nasal drip almost constantly. This is because of the high continuous viral load that the child is exposed to. By the time the virus has infected all the children, it often re-infects your child due to changes in the virus itself (mutations). This unrelenting cycle of illness does not allow the immune system time to strengthen itself. Often antibiotics are prescribed as parents get anxious for a solution, but because most infections are viral, it often just causes more harm. 

What can be done? Try to find a crèche with only 5 – 6 children in a group, try to only send your child to crèche/ school when they are older than 2.5 – 3 years (when they are bigger, their airways are bigger so they get less complications, they can also communicate and cope better), or try to get an air purifier for the crèche.

Photo by cottonbro on Pexels.com

Let us discuss some treatment options of colds and flu that are safe and proven to make a difference:

In general:

  • Humidifiers vs Nebulizers:

Both convert liquids into a fine mist that can be inhaled to treat respiratory symptoms. Humidifiers simply provide moisture to the air, nebulisers are used to deliver specific medications to the airways. 

Humidifiers can help to soothe a dry cough and a blocked/runny nose as it helps to moisten the airways and thus decreases the amount of secretions formed by the lining of the airways. 

Make sure to keep your humidifier safe by following these guidelines:

  1. Cold mist humidifiers are safer (hot water can burn curious toddlers if spilled).
  2. Monitor level of humidity (high humidity is perfect for mould and dustmites to thrive which can worsen allergies).
  3. Clean thoroughly every 1 – 3 days (bacteria and fungi can grow in the water and be dispersed into the room when the humidifier is switched on).
  4. Do not add any medication or essential oils as it can irritate the airways if the correct dose is not used.
  5. Do not use bleach or other strong chemicals to clean as this could also be dispersed into the air and irritate the airways.

Nebulizers are used when you need to get medication into the airways of the lungs. It is handy to use when your little one has bronchiolitis, croup, asthma or other causes of spastic narrowing or swelling of the airways. A doctor will then prescribe hypertonic saline, steroids or other medication to open the airways. Nebulizers used to be very bulky and noisy, but there are some lovely new mobile devices that use ultrasonic technology to vaporize the medication that is much easier and more child-friendly to use.

  • Make sure your baby/child stays hydrated by giving extra feeds, offering water/tea.
  • Cold, dry air can cause the linings of the airways to make more secretions.
  • Give them plenty of rest and TLC.

Treatment of a cold in BABIES up to 2 years:

  • Saline nasal spray: helps to flush excess mucous from the nostrils, soothes the lining.
  • Iliadin nasal spray (after 3 months), use for maximum 5 days or it may cause rebound nasal blocking.
  • Nasal suction bulb or other suction device: use just as necessary to remove excess mucous from nostrils. Some studies show that vigorous suctioning may cause irritation of the nasal lining causing more secretions, but if used carefully and only when really necessary (before a feed or a nap) it gives a big symptomatic relief.
  • Paracetamol for pain and fever.
  • Nurofen (after 6 months of age) to improve inflammation of the ear passages, teeth, the Eustachian tubes, for pain and fever.
  • Prospan is safe to give for coughing. It helps to loosen mucous and soothes the airways.
  • Honey (after 1 year of age) has been proven to soothe a scratchy throat and cough.
  • A warm drink such as warm water with lemon juice or rooibos tea is also safe and soothes the airways.
  • Zinc supplement: can be given while your baby is ill to boost the immunity. Do not give daily over the longterm as it competes with copper and iron to be absorbed from the gut and can lead to deficiencies.

Treatment of a cold in TODDLERS 2 – 4 years:

All the above mentioned medications should be given first. Extra medication that can be given for older children:

  • Mucospect: helps to thin mucous to make it easier to cough out.
  • ACC 200: helps to thin mucous to make it easier to get out.
  • Saline nasal rinses are also effective to remove excess mucous from the nasal and sinus passages.
  • Echinacea chewable tablets (proven to shorten duration of symptoms).
  • Antihistamines: decreases inflammation, helps with an itching nose.
  • Over-the-counter cold and flu medications can be used with caution, but mostly only gives some symptomatic relief and has not been proven to shorten the duration of symptoms.

Stay away from:

  • Any over-the-counter colds and flu medication for babies and children under 2 years. It mostly contains pseudo-ephedrine that can cause severe side effects.
  • Cough syrup that suppresses coughs. Coughing is a natural way for you to clear your airways from secretions. If suppressed the secretions can cause mucous plugs or become infected with bacteria, causing pneumonia.
  • Aspirin in children under 18 years.

Please let us know which symptomatic treatments help your little one when they are ill!


  1. https://www.allergyfoundation.co.za/battle-creche-syndrome/
  2. Cotton MF, Innes S et Al; “Management of upper respiratory tract infections in children”; S Afr Fam Pract (2004). 2008 MAR-APR; 50(2): 6–12.
  3.  Paul IM, Beiler J, McMonagle A, Shaffer ML, Duda L, Berlin CM., Jr Effect of honey, dextromethorphan, and no treatment on nocturnal cough and sleep quality for coughing children and their parents. Arch Pediatr Adolesc Med. 2007;161(12):1140–1146.

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