How many colds are too many?

My child is sick all the time. If you are a parent of a preschool child, have you ever thought that? And, if you have, did you worry all those frequent illnesses meant there was something seriously wrong, some significant, underlying illness? Pediatricians and family doctors often hear this worry from parents.

Preschool children have a lot of infections, especially upper respiratory ones, called URIs. Children under three average five to six URIs per year, although the range of normal is quite broad — as many as ten in a year is not necessarily abnormal. One large survey from the Centers for Disease Control polled nearly three thousand households and asked the parents if their children had experienced URI symptoms during the preceding two weeks — a third of children under three had, as did a quarter of children three to five years old.

Where children are during the day matters in determining how many URIs they get, and the youngest preschoolers spending their day with six or more other children of similar age, such as in a daycare setting, get the most. In the CDC sample, for example, about half the children spent time in daycare, and those children had, on average, a fifty percent higher rate of infection. Considering how toddlers share hugs, toys, and crackers with each other, this is not surprising. But for a parent whose child is in daycare, does this increased number of infections mean anything? Is it worse for your child?

Various studies help answer this key question, and the answer is reassuring. In fact, although children under three attending daycare have more URIs than do their stay-at-home compatriots, there is evidence they have less URIs later on, during their early grade-school years. So things appear to even out; the children who are not exposed to as many respiratory viruses as preschoolers meet those viruses later.

Can all these URIs lead to further problems? The answer is generally no, but once in a while they are a problem for certain children, especially those under two. The principal complication of a URI is a middle ear infection, termed otitis media. The inflammation from the URI blocks the normal function of the eustachian tube, the connection between the back of the nasal passages and the middle ear, allowing bacteria normally present in the area to infect the ear. Children vary in their propensity for this to happen. However, the younger they are when they have their first ear infection, the more likely they are to have more of them. Susceptibility to ear infections also runs in families. Another complication of URIs among some children is wheezing whenever they get one. If your child has problems with repeated bouts of either otitis or wheezing, reducing the number of URIs by reducing exposure to sick children is a good way to help control the situation.

Even though experiencing many URIs is common among preschoolers, there are times when a doctor worries about the situation. For example, if the child is having recurrent high fevers, severe rashes, or diarrhea, this could mean there are problems with the immune system. A key red flag is if the child is not thriving — failing to gain weight or even losing weight, or is not keeping up with normal developmental milestones.

If you are concerned your child is too sick too often, discuss the situation with your child’s doctor. But for nearly all preschoolers, having lots of URIs is just part of growing up.