Colds (acute respiratory viral infections) in children: how they run and when an examination is needed

“ARVI” is not the name of one illness but a catch-all label for acute respiratory viral infections. Behind it stand dozens of different viruses that produce a similar picture: fever, runny nose, cough and sore throat in various combinations. What matters for a parent is something else: how the child is coping with the illness and whether there are signs with which waiting is not an option.

Which symptom combinations occur most often

Symptoms rarely arrive one at a time. A few stable combinations are typical, and each of them can be caused by different viruses:

• fever and general malaise, joined a day or two later by a runny nose and cough;
• a runny, blocked nose without a marked fever;
• a sore throat and fever with little nasal discharge;
• a cough that appears later than the other symptoms and outlasts them.

Each of these directions is covered separately and in more detail — follow the links below. What matters here is the general logic of the course.

How the illness usually unfolds

In most children, wellbeing is at its worst in the first days and then gradually improves. The fever usually goes before the runny nose, and the cough often remains last and can persist after the child has otherwise recovered. Such a “lingering” tail of a cough is common and does not in itself mean a complication.

More important than any timeframe is the direction of the trend. Gradual improvement, even if slow, looks different from a worsening after a period of improvement. The second scenario is a reason for an examination, even if formally “we have only been ill a few days”.

Age changes the assessment

• Babies in the first three months of life: a fever is assessed by a doctor without delay, whatever the other symptoms.
• Babies under one year: they cope worse with a blocked nose because they depend on nasal breathing while feeding; what matters is how much the baby takes and how they breathe while eating.
• Preschoolers: they fall ill often but usually mildly; duration and general condition come to the fore.
• Schoolchildren: they can more often complain in words, and the complaint can be discussed, not only observed.

What a parent can watch at home

• Breathing: calm or rapid, whether there is effort, drawing-in, a noisy out-breath.
• Drinking and urination: is the child drinking, how often are they passing urine.
• Activity and responsiveness: playing and responding as usual, or listless, drowsy, inconsolable.
• The trend day by day, not hour by hour: better, the same or worse than yesterday.

Why symptoms cannot name the specific virus

Different respiratory viruses produce an overlapping picture, and the same virus can look different in two children. So neither the height of the fever, nor the colour of the nasal discharge, nor the character of the cough allows a parent — and often a doctor without investigations — to say exactly which virus caused the illness.

The practical conclusion is not that identifying the virus is impossible, but that decisions are made differently: from the child's condition, from the trend, and from the findings of an examination. There is a separate article about the difference between a viral and a bacterial infection.

When an examination is genuinely needed

• A baby under 3 months with a raised temperature — without delay.
• Any signs of difficult breathing.
• The child is drinking little, passing little urine, or is hard to wake.
• The condition has worsened after an improvement.
• The illness is dragging on longer than you would expect with an ordinary cold.
• The child has a chronic illness that affects how infections run.

This page is for general information only and is not a substitute for a consultation with a doctor. A child's diagnosis and treatment are determined by a doctor during an examination.