Caring for a Sick Child at Home: The Complete Guide for Parents

Most childhood illnesses are caused by viruses, are mild, and get better on their own within a few days with rest, fluids and comfort at home. But a small number of children become seriously ill, sometimes quickly, and spotting the difference is one of the hardest and most important jobs a parent or carer has. Knowing what is normal, how to care for your child, and which warning signs mean “get help now” can save a life.

This guide covers fever, coughs and colds, vomiting and diarrhoea, dehydration, rashes, ear and throat infections, giving medicines safely, keeping your child comfortable, and when to seek urgent care.

How children get sick

Young children catch frequent infections as their immune systems learn to fight new germs. It is common for a child in nursery or school to have 6 to 10 colds a year, especially in the first years. Most are caused by viruses, which do not respond to antibiotics and get better on their own. Bacterial infections, such as some ear, throat, chest or urine infections, may need antibiotics.

Trust your instincts

You know your child best. If you feel something is seriously wrong, even if you cannot explain why, seek help. Healthcare professionals take a parent’s concern seriously, and it is one of the factors used to judge how unwell a child is.

Fever

Fever is a temperature of 38°C or higher. It is the body’s natural response to infection and helps fight it. Fever itself is rarely dangerous; what matters most is the cause and how your child looks and behaves.

Taking a temperature

• For babies and children under five, use an electronic thermometer under the armpit
• Older children can use an oral or ear (tympanic) thermometer
• Forehead strips are not reliable
• Do not rely on feeling the forehead with your hand

When fever needs urgent attention

• Any baby under three months with a temperature of 38°C or higher: seek medical help immediately, even if they seem well
• Babies aged three to six months with a temperature of 39°C or higher
• Fever with any of the red flag signs listed below
• Fever lasting five days or more
• A child who is getting worse rather than better

Caring for a child with fever

• Offer plenty of fluids; breastfed babies should be offered the breast more often
• Dress them in light clothing and keep the room at a comfortable temperature; do not over-wrap or bundle them up
• Do not sponge with cold water, which can make them shiver and uncomfortable
• Check on them regularly, including during the night
• Keep them home from nursery or school while unwell
• Fever medicines (paracetamol or ibuprofen) can be used if your child is distressed or uncomfortable, not simply to bring a number down

Febrile seizures

Some children aged six months to five years have a seizure (fit) during a fever. These febrile seizures are frightening but usually harmless and brief. Place your child on their side on a safe surface, stay with them, time it, and do not put anything in their mouth. Call emergency services if it is their first seizure, if it lasts longer than five minutes, or if they do not recover quickly afterwards. Fever medicines do not prevent febrile seizures.

Red flag signs: get urgent help now

Call emergency services or go to the nearest emergency department if your child:

• Is floppy, unresponsive, very drowsy or hard to wake
• Has a weak, high-pitched or continuous cry
• Has pale, mottled, blue or grey skin, lips or tongue
• Is struggling to breathe: breathing very fast, grunting, the skin sucking in between or under the ribs, nostrils flaring, or pauses in breathing
• Has a rash that does not fade when you press a glass against it
• Has a stiff neck or seems to dislike bright lights
• Has a seizure
• Has cold hands and feet with a high temperature
• Has not passed urine for 12 hours or more (or has very few wet nappies in a baby)
• Has green vomit, blood in vomit or blood in poo
• Has severe tummy pain
• Is a baby under three months with a temperature of 38°C or more
• Has a bulging soft spot on the head (in babies)

Sepsis and meningitis

Sepsis is a life-threatening reaction to an infection. Meningitis is an infection of the lining of the brain. Both can develop rapidly. Early signs can look like a common illness, so watch closely for red flag signs, especially a child who is getting worse quickly, a rash that does not fade, cold hands and feet, unusual drowsiness, fast breathing and pale or mottled skin. Ask directly: “Could this be sepsis?” Vaccines such as MenB, MenACWY, Hib and pneumococcal protect against many causes of meningitis.

Coughs and colds

Colds cause a runny or blocked nose, sneezing, cough, sore throat and mild fever. They usually last 7 to 10 days, and a cough can continue for up to three weeks.

• Offer plenty of fluids and rest
• Saline nose drops can help babies with blocked noses feed more easily
• Raising the head of an older child’s mattress slightly may help at night (do not use pillows for babies)
• Honey can soothe coughs in children over one year; never give honey to babies under one because of the risk of botulism
• Cough and cold medicines are not recommended for young children in many countries, as they have little benefit and can cause side effects. Check age restrictions on any product with a pharmacist
• Keep your child away from cigarette smoke

When a cough needs checking

• Fast or difficult breathing, or noisy breathing
• A cough lasting more than three weeks
• Coughing fits followed by a “whoop”, vomiting or turning red or blue (possible whooping cough)
• Barking cough with noisy breathing in (possible croup)
• High fever with a cough and appearing unwell (possible pneumonia)
• Coughing up blood

Croup

Croup causes a barking cough, hoarse voice and sometimes a harsh noise when breathing in (stridor), often at night. Keep your child calm, as crying makes it worse. Seek medical help if breathing is difficult or stridor occurs at rest. Steroid medicine is very effective.

Bronchiolitis

A common chest infection in babies under one, usually caused by RSV. It causes a cough, fast breathing and difficulty feeding. Most babies recover at home, but seek help if your baby is feeding less than half the usual amount, has fewer wet nappies, is breathing very fast or struggling, or has pauses in breathing. Maternal RSV vaccination and infant antibody injections now offer protection in many countries.

Vomiting and diarrhoea

Gastroenteritis, usually caused by a virus such as rotavirus or norovirus, is common in children. Vomiting usually stops within one to two days and diarrhoea within five to seven days.

Preventing dehydration

The biggest risk is dehydration, particularly in babies and young children.

• Breastfed babies: continue breastfeeding, offering feeds more often
• Formula-fed babies: continue formula, offering small amounts often
• Oral rehydration solution (ORS): the best drink for replacing lost fluids and salts. Give small sips frequently, for example a spoonful every few minutes if vomiting. ORS is available from pharmacies and, in many countries, from health centres free of charge
• Zinc supplements: WHO recommends zinc for 10 to 14 days for children with diarrhoea in low- and middle-income countries; it shortens illness and reduces future episodes. Ask a health worker for the right dose
• Avoid fizzy drinks and fruit juices, which can make diarrhoea worse
• Offer normal food as soon as your child wants to eat

Signs of dehydration

• Fewer wet nappies or passing less urine
• Dry mouth and lips, no tears when crying
• Sunken eyes, or a sunken soft spot in babies
• Drowsiness or irritability
• Cold hands and feet
• Skin that stays pinched up when gently pinched

Seek urgent help if your child shows signs of dehydration, cannot keep fluids down, has blood in their poo, green vomit, severe tummy pain, or is a young baby with vomiting and diarrhoea.

Hygiene

Wash hands thoroughly with soap and water after nappy changes and before preparing food. Keep children off nursery or school until 48 hours after the last episode of vomiting or diarrhoea. The rotavirus vaccine protects babies against a major cause of severe diarrhoea.

Ear infections

Ear infections are common in young children, often after a cold. Signs include ear pain, pulling at the ear, fever, irritability and difficulty sleeping. Most improve within three days without antibiotics. Pain relief helps. Seek advice if symptoms last more than three days, your child is under two with infection in both ears, there is discharge from the ear, swelling or redness behind the ear, or they seem very unwell.

Sore throats and tonsillitis

Most sore throats are viral and get better within a week. Offer cool drinks, soft foods and pain relief. Seek advice if your child has difficulty swallowing saliva, drooling, difficulty breathing, a muffled voice, cannot open their mouth fully, or has a high fever and seems very unwell. Some bacterial throat infections, such as strep throat, need antibiotics; in some settings, untreated strep throat can lead to rheumatic fever, which damages the heart.

Rashes

Many viral illnesses cause rashes, and most are harmless. Always do the glass test: press the side of a clear glass firmly against the rash. If the rash does not fade, seek emergency help immediately, as it can be a sign of meningitis or sepsis. On darker skin, rashes can be harder to see; check paler areas such as the palms, soles, inside the eyelids and the roof of the mouth.

Common childhood rashes

• Chickenpox: itchy spots that become blisters then scab. Keep your child cool, use calamine or cooling gels, cut nails short, and keep them away from pregnant women and people with weakened immunity. Seek help if the skin around blisters becomes red, hot and painful, or your child seems very unwell.
• Hand, foot and mouth disease: mouth ulcers and spots on hands and feet; usually mild.
• Slapped cheek syndrome: bright red cheeks followed by a lacy rash; usually mild.
• Measles: high fever, cough, runny nose, red eyes, then a blotchy rash. Measles can be serious; contact a healthcare provider by phone first so you do not infect others in waiting rooms. Vaccination prevents it.
• Scarlet fever: a sandpaper-like rash, sore throat and “strawberry” tongue; needs antibiotics.
• Eczema flare-ups and hives are also common.

Urine infections

Urinary tract infections in young children can cause fever without other obvious signs, along with vomiting, irritability, poor feeding, pain passing urine, smelly urine or new bedwetting. A urine test is needed to diagnose, and antibiotics are usually required. Seek advice if a young child has an unexplained fever.

Giving medicines safely

• Always read the label and follow the dosing instructions for your child’s age and weight, using the measuring syringe or spoon provided
• Do not give paracetamol and ibuprofen at the same time routinely; if you are considering switching between them, ask a pharmacist or healthcare provider first
• Check combined cold remedies do not also contain paracetamol, to avoid accidental overdose
• Never give aspirin to children under 16 unless prescribed, because of the risk of Reye’s syndrome, a rare but serious condition
• Avoid ibuprofen if your child is dehydrated, has chickenpox, or has asthma that worsens with it
• Do not use leftover antibiotics or someone else’s medicine
• Finish a prescribed course of antibiotics as directed
• Keep all medicines out of reach and sight of children, ideally in a locked cupboard
• If your child might have taken too much medicine, seek urgent advice immediately, even if they seem well

If you are unsure about a dose, ask a pharmacist, nurse or healthcare provider. Dosing for children depends on their weight and the specific product.

Antibiotics: when they help and when they do not

Antibiotics only work against bacteria, not viruses. Most coughs, colds, sore throats and ear infections in children are viral and get better on their own. Using antibiotics when they are not needed can cause side effects such as diarrhoea and rashes, disrupt healthy gut bacteria, and contribute to antibiotic resistance, which makes future infections harder to treat. If your healthcare provider does not prescribe antibiotics, ask what to watch for and when to come back.

Keeping your child comfortable

• Let them rest, but do not force bed rest; quiet play on the sofa is fine
• Offer small, frequent drinks and favourite foods; appetite usually returns as they recover
• Ice lollies can help with fluids and sore throats
• Stay close, offer cuddles, stories and reassurance
• Keep a note of symptoms, temperatures, medicines given and times, especially if several people are caring for your child
• Look after yourself too; caring for a sick child, especially at night, is exhausting

Children with long-term conditions

Children with asthma, diabetes, sickle cell disease, heart conditions, epilepsy, weakened immunity or complex needs may become unwell more quickly. Follow their individual care plan and seek advice earlier. For example, children with sickle cell disease and a fever of 38°C or more need urgent assessment, and children with type 1 diabetes need extra blood sugar and ketone monitoring when unwell.

Preventing illness

• Keep vaccinations up to date
• Teach handwashing with soap, especially before eating and after the toilet
• Cover coughs and sneezes with tissues or elbows
• Breastfeed if possible; it protects against many infections
• Keep homes smoke-free
• Use bed nets in malaria areas
• Ensure safe drinking water and food hygiene
• Good nutrition, including vitamin A where recommended

When to keep children home

Keep your child off nursery or school if they have a fever, are vomiting or have diarrhoea (until 48 hours after the last episode), or have an infectious rash such as chickenpox (until spots have crusted). Children with a mild cold and no fever can usually attend. Check your local public health guidance for specific illnesses.

The nurse’s role

Children’s nurses, school nurses, health visitors and practice nurses support families to care for sick children at home, give advice by phone, assess children in clinics, deliver vaccinations and teach parents to recognise warning signs. Many countries have nurse-led telephone advice lines for out-of-hours worries.

Asthma and wheezing

Viral infections are a common trigger for wheezing and asthma attacks in children. If your child has asthma, follow their written asthma action plan and give their reliever inhaler through a spacer as instructed. Seek urgent help if the reliever is not helping, your child is too breathless to talk, eat or drink, is breathing very fast, has blue lips, or seems exhausted. Never wait to see if an asthma attack settles on its own when these signs are present.

Head injuries

Minor bumps to the head are very common in children and usually harmless. Comfort them, apply a cold compress wrapped in a cloth, and watch them for 24 hours. Seek urgent care if your child loses consciousness, vomits more than once, becomes very drowsy or confused, has a seizure, has clear fluid or blood coming from the nose or ears, has weakness, or develops a severe headache. Babies under one with a significant head injury should always be assessed.

Burns and scalds

Cool the burn immediately under cool or lukewarm running water for 20 minutes, remove clothing and jewellery near the area unless stuck to the skin, and cover loosely with cling film or a clean, non-fluffy cloth. Do not use ice, butter, toothpaste or creams. Seek medical help for any burn in a baby or young child, burns larger than the child’s palm, burns to the face, hands, feet, genitals or joints, and any burn that blisters or looks white or charred.

Frequently asked questions

Should I wake my child to give fever medicine?

No. If your child is sleeping comfortably, let them sleep, but check on them regularly.

Is a very high temperature dangerous in itself?

Not usually. How your child looks and behaves is more important than the number, but a very high temperature in a young baby needs urgent assessment.

Can teething cause a fever?

Teething may cause a slight rise in temperature but does not cause a high fever. Look for another cause.

How long should my child stay off school with a cold?

If they have no fever and feel well enough, they can usually go to school.

When should I call an ambulance rather than drive?

Call an ambulance if your child is struggling to breathe, unresponsive, having a prolonged seizure, or you cannot get to hospital quickly and safely.

But what if I overreact and it is nothing?

Every experienced nurse and healthcare provider would rather see a child who turns out to be fine than miss one who is seriously ill. Children can deteriorate quickly, and early treatment saves lives. If red flag signs are present, or your instinct tells you something is wrong, act. You will never be judged for trying to keep your child safe.

Related: Fever in children: when to worry · Baby fever · Childhood vaccines · Newborn care guide

Sources: World Health Organization and UNICEF (Integrated Management of Childhood Illness; diarrhoea and pneumonia guidance), National Institute for Health and Care Excellence (fever in under 5s NG143), American Academy of Pediatrics, UK Health Security Agency, Meningitis Research Foundation.