Is it possible to protect your child from falling sick?

From fevers to fatigue, viral infections often leave parents wondering: Which virus is affecting my child? Is it respiratory syncytial virus (RSV), influenza, COVID-19, or something else? 

These common viruses each present differently - RSV typically causes breathing difficulties in infants, influenza brings high fevers, while adenovirus and enterovirus can trigger symptoms from pink eye to rashes. 

Although most children recover well, parents naturally question if frequent infections are normal and what preventive measures they can take.

While most viral infections in children cause mild symptoms that resolve on their own, a small number of children may develop serious complications that require immediate medical care - how can parents tell the difference? 

In this ‘Ask the Specialist’ Q&A, Dr Christopher Seow addresses your concerns about common childhood viral infections such as influenza, COVID-19, RSV.

Whether you have questions about the causes, symptoms and treatments for viral infections in children, or effective ways to prevent them, don't hesitate to post your questions. Submit them now!

Related articles:
When to Take Your Child to the A&E

Home Remedies for Fever and When is it an Emergency?

Dr Christopher Seow is an Associate Consultant from the Infectious Disease Service, Department of Paediatrics at KK Women's and Children's Hospital (KKH).  

His special interests include treating babies born with infection or develop them around birth, infection prevention and control, and caring for children who get infections more easily due to weaker immune systems.

1. Question by Stephanie

Hi Dr Christopher, 

My child has been contracting bronchiolitis multiple times over the span of a few months. 

Does the household environment such as dust and cleanliness play a factor in this recurrent illness or is it purely due to his poor immune system and infant care? 

How can we strengthen his immunity, and are there any supplements that u recommend? Does Tuina work in strengthening immunity? 

Thank you!

Answer by Dr Christopher Seow

Hi Stephanie, thank you for your excellent question. One of the most frequently asked questions I get from parents and caregivers is, ‘Why does my child keep falling sick?’ 

If your child has contracted bronchiolitis multiple times, these viruses may have affected him a bit more seriously.

Bronchiolitis - it means the lower deeper airways (bronchus, bronchioles, lung) are involved, as opposed to a milder upper respiratory tract infection of the nose/throat. 

Bronchiolitis caused by a viral infection is very common. The viral infection gets better on its own without treatment after a few days, although some children who have more severe symptoms might need support in the hospital, like oxygen or continuous positive airway pressure (CPAP). If your child has recurrent episodes of wheezing and needs nebulisers or puffs at each episode, then the question would be whether your child has more ‘sensitive’ airways. 

Sensitive airways (bronchial hyperreactivity or asthma) may be diagnosed if there are recurrent wheezing episodes, a strong family history of asthma, or if there are symptoms in between these episodes like night-time coughing or breathlessness caused by exertion. You can see a paediatrician for further advice on this. 

If your child does have bronchial hyperreactivity, asthma or allergic rhinitis, then environmental triggers do play a part. Dust mite allergy is common in our population. Soft toys, carpets, curtains, construction or passive smoking can trigger sensitive airways. 

However, it is important to distinguish environmental triggers from catching viruses. Viruses are all around in the community and transmit easily. Removing these environmental triggers does not mean that your child will not be exposed to viruses. Sensitive airways are also different from having a poor immune system. 

This leads me to my next point, catching recurrent viral infections is a normal part of childhood. In a child with a normal immune system, recovery will be good. In fact, the body’s immune system remembers each infection, and is more prepared to fight it the next time it comes on board. This is similar to how a vaccination works. A child’s immune system is going through training and learning for the future. 

Infant care as we know, is a hot spot for viruses. This does not mean we need to avoid sending children to school, or for play dates, or keep a child from going outdoors to experience the world.   

If there is a true problem with the immune system, these will be the ‘red flags’ that should prompt further evaluation:

1. Severe infections needing hospitalisation, the child can be very ill
   
   
2. Infections with bugs that are not so typical (e.g. fungus or mycobacteria)
   
   
3. Child not growing well, i.e. poor weight gain/losing weight 

If your child is generally active, growing well, recovers quickly from each illness (even if he/she catches another one shortly after – this is common), then it may not truly be a ‘poor immune system’. 

The American Academy of Paediatrics does not recommend routine multivitamins for healthy children eating a varied diet, and the first thing that should be addressed for nutritional issues is proper nutrition education and improving dietary habits, rather than adding supplements.

That being said, supplements like multivitamins and probiotics are generally not harmful, and might help especially if your child is fussy with food. Vitamin C and other micronutrients (which should be present in diet) does help your body fight off infections better.

Please do read the labels properly for over-the-counter supplements and run it by your friendly paediatrician. Also, these supplements can be costly - do be discerning of what you see on social media, advertising can be sensationalised and not evidence-based. 

We currently do not practice or prescribe paediatric Tuina at KK Women’s and Children’s Hospital (KKH). Combined data from several clinical trials indicates a reduction in recurrent respiratory infections among children.

However, there is insufficient evidence to establish its safety and efficacy currently. Hence if you are interested in this treatment, please consult a registered Traditional Chinese Medicine practitioner for advice. 

In summary,

1. There may not be a problem with your child’s immune system but you need to consider sensitive airways if there are recurrent episodes of wheezing.
   
   
2. Removing environmental triggers can help for sensitive airways but does not completely eliminate child’s exposure to viruses that are all around in the community.
   
   
3. Catching back-to-back viral infections at infant care is normal, and part of the journey of building your child’s immune system. Childhood vaccination also helps with this.
   
   
4. Look out for the red flags – poor growth, severity of infection, uncommon infections. See your doctor if you are concerned.
   
   
5. Balanced diet is best but not easily achieved. Most multivitamins are safe at the appropriate doses. Please check labels and run by the supplements by your paediatrician. 

2. Question by Benjamin

Hi Dr, how do you tell the difference between a viral and bacterial infections clinically? Thank you.

Answer by Dr Christopher Seow

Hi Benjamin, that is a very good question that needs more awareness.

Differentiating between viral and bacterial infections is important particularly for determining the need for antibiotics – antibiotics are only warranted for bacterial infections and are of no use in viral infections. 

Clinically, it can be very challenging to tell. They both cause high fevers. They both can have symptoms like cough, flu, body aches, diarrhoea, vomiting, abdominal pain, rashes, headache and nausea. They both have a spectrum of illness – infections can be mild or severe (and everything in between) for both viruses and bacteria. 

Viral infections are certainly more common and prevalent in the community. They do not require antibiotic treatment, and often we rely on the body’s immune system to fight and clear the infection. That being said, severe viral infections do occur, and supportive treatment in the hospital might be needed. 

Whether the infection is viral or bacterial, the red flags that parents should watch out for are:

• Being under the age of three months
• Poor feeding
• Lethargy
• Change in consciousness
• Shortness of breath
• Looking ‘off-colour’ 

These are reasons to seek medical attention immediately. If a child is very unwell, antibiotics may be started initially while waiting for further evaluation, as we cannot afford to leave a bacterial infection untreated in an unwell or unstable child.

We can stop the antibiotics if we confirm it is just a viral infection - this means there is no bacteria found in the tests and your child is improving. 

How high the fever is does not tell us whether it is a viral or bacterial infection, but a very high fever of >40˚C (hyperpyrexia) can suggest a serious bacterial infection, particularly in infants aged six months and below.

As children get older, the association between very high fevers and a serious bacterial infection becomes weaker, so it becomes less reliable in telling between a virus or a bacteria. However, you should still see a doctor if your child has a very high fever (above 40°C). 

The duration of the fever is another clue. Most viral fevers last three to five days. If fever lasts beyond five days, we then need to question if this is a prolonged viral illness, or if there is an untreated bacterial infection. Both can be true, as infections can co-exist together.

This is the reason your doctor might order a blood test for your child when the fever lasts more than five days. Blood tests looking at the markers of the body’s inflammation are helpful, but they do not replace good clinical assessment by the physician. 

The site of infection is another important consideration. Infections like pneumonia (lung infection), urinary tract infection, meningitis (brain lining infection) or bone/joint infections are commonly caused by bacteria.

While viruses can cause pneumonia and meningitis too, since these infections are usually quite serious to start with, initial treatment with antibiotics whilst awaiting further tests is needed.

What if fever comes with no other symptoms and we do not know where the site of infection is? It can also be concerning when the fever has ‘no clear source’, particularly if this fever is high-grade and lasts beyond three days. This may prompt your doctor to ‘hunt’ harder for ‘hidden infections’ by performing blood tests, urine test and/or an X-ray. 

Apart from that, there are certain clinical syndromes that point towards different types of viral or bacteria infections. A clinical syndrome is a group or pattern of symptoms or signs that occur together. Some examples are:

• Fever, strawberry tongue, rash that feels like sandpaper. (Scarlet fever – caused by bacteria: group A Streptococcus)
  
  
• Fever, swollen glands, sore throat with enlarged tonsils (Infectious mononucleosis – caused by virus: Ebstein-Barr virus)
  
  
• High fever, body aches, rash, headache and eye pain, dizziness (Dengue fever – caused by Dengue virus)
  
  
• Fever and a rash all over the body that appears after the fever settles (Roseola – caused by virus: HHV-6) 

Rather than trying to diagnose your child's condition, it is more important to know when to seek medical help. Focus on recognising the warning signs we discussed above that indicate your child needs to see a doctor. 

You might then ask: why do we not just treat everyone with antibiotics? This is an important issue that involves a bigger perspective, and I will attempt to explain briefly why we must be stewards of antibiotics (use antibiotics wisely and only when needed). 

There is a huge crisis of antibiotic resistance that is growing in our world today due to the overuse of antibiotics. This may not feel important immediately to your child here and now, but it will definitely affect all of us in the long run.

The unnecessary use of antibiotics helps bacteria to evolve and eventually outsmart us. We do not want to be in a situation where we do not have antibiotic options when it is critically needed to save a life.

Apart from this, antibiotics also come with side effects which can do more harm than good. Each course of antibiotics should hence be prescribed with careful consideration. 

In summary,

1. Viruses and bacteria can both cause mild or severe infections (and everything in between). Bacteria infections are more likely to progress if left untreated without antibiotics, most viral infections get better on their own.
   
   
2. There are symptoms and signs that will give clues to your doctor towards suspecting a virus or a bacteria, but the most important thing for a parent to know is to recognise the red flags for a sick child and when to seek medical attention.
   
   
3. Antibiotics should be used wisely and only when needed.

3. Question by JY

Dear Dr Christopher Seow, I would like to submit a question. 

My child, was born in 2022, has been frequently unwell ever since he started preschool in July 2024. 

Over the past year, he has been in and out of medication and has unfortunately been hospitalised twice – once in Oct/Nov 2024 for RSV, pneumonia, and bronchiolitis, and more recently, May 2025 for a combination of Adenovirus, HMPV and RSV within a span of just six months. 

He has been prescribed Ventolin, Flixotide, Avamys (Fluticasone) nasal spray, and Sterimar. The Ventolin is used only during episodes of more severe coughing. 

Despite recovering well after each illness and completing his medication, he often falls ill again shortly after, typically with flu or persistent cough symptoms. 

My child has been attending specialist follow-ups, and his next review is scheduled in November 2025, where the team will also be conducting a skin prick test as part of ongoing monitoring for asthma if any. 

I would like to ask:

• Is there any long-term treatment or “cure” to help break this cycle of recurring infections?
  
  
• Are there any vaccines or preventive measures that could help reduce the severity or frequency of these viral infections in children like him? I understand there is an RSV vaccine, but I was told he is no longer eligible as he has passed 2 years old. 

Unfortunately, this vaccine was not recommended to us earlier, and it now seems we have missed the opportunity to protect him during that critical period. 

I would greatly appreciate your expert advice on what preventive steps or alternative options may be available for children like my child, who seem to fall into this high-risk group. Thank you for your advice.

Answer by Dr Christopher Seow

Hi JY, thank you for providing great details on your child’s illnesses and your concerns and questions are very valid. I am sorry to hear that he has been in and out of the hospital, and it must be so distressing for him and the whole family! I am glad to hear that he recovers well in between episodes, even though you mentioned that he often catches another one shortly after. 

Catching back-to-back viral infections is a normal part of childhood. You can read my reply to the above question posed by Stephanie (question 1).

In a child with a normal immune system and no other medical conditions, recovery will be good. In fact, the body’s immune system remembers each infection, and is more prepared to fight it the next time it comes on board. This is similar to how a vaccination works.

A child’s immune system is going through training and learning for the future. Childcare and pre-school as we know, is a hot spot for viruses. This does not mean we need to avoid sending children to school, or for play dates, or keep a child from going outdoors to experience the world.

As your child grows up, you might notice that these episodes happen less often and get more spaced apart (also gives you as a caregiver more breathing space!), and that is because his immune system is learning and getting stronger each day. 

But the fact that your child has been treated with Ventolin, Flixotide and Avamys, could mean that there is an element of ‘sensitive airways’. While it is very common that these episodes are triggered off by a virus, sensitive airways (bronchial hyperreactivity, asthma or allergic rhinitis) may cause your child to be more ill at each episode with breathlessness and needing puffs or nebulisers.

I am glad you are following up at the outpatient specialist clinic, and they will be able to assess if your child has sensitive airways especially if there are recurrent wheezing episodes, a strong family history of asthma, or if there are symptoms in between these episodes like night-time coughing or breathlessness caused by exertion. 

Preventer medications such as Flixotide, will not stop viral infections from happening (your child will still get fever/cough/flu), but can help to ‘prevent’ or reduce asthma attacks, i.e. less chance of progressing to breathlessness and wheezing with each viral infection. 

We may never be able to eliminate completely the spread of viruses in our community, but there are ways we can reduce the transmission.

General hygiene measures, such as hand sanitisation can help to reduce the spread of viruses. Taking precautions when your child is ill, such as keeping them at home, minimising sharing of food, and avoiding close contact with other children, is also effective in protecting those around you and reducing the overall spread.

Childcares do take certain precautions to prevent outbreaks, such as checking of hand, feet and mouth disease (for HFMD) and temperature during drop offs. This is a great measure to adopt, but no matter how well it is being enforced, viruses will still fall through the cracks. The principle is to do the best we can, but to also be prepared that viruses will come, and they will go. 

I have addressed the role of good nutrition and vitamins in giving an additional boost to the immune system in the previous post above. For any nutritional supplementation, please check the labels and run them by your paediatrician before use. 

Vaccination is another way to help with ‘herd immunity’ – i.e. protecting the whole community. Let me explain: A vaccine is like giving your body’s security team (immune system) a ‘most wanted poster’ of a dangerous germ so they can recognise and stop it quickly if it ever shows up.

When many people in the community are vaccinated, the germ has trouble finding a place to go (someone to infect). This wall of protection, called herd immunity, also shields those who cannot be vaccinated, or yet to be vaccinated. In this way, the vaccine protects both you and the people around you. 

I am glad you have brought up the topic of RSV (Respiratory Syncytial Virus) immunisation. RSV is a common respiratory virus, and it can cause severe illness particularly in young infants and the elderly. There are two forms of RSV immunisations that have emerged recently:

1. Maternal RSV vaccine – This trains the mother’s immune system to recognise RSV. Her body makes antibodies (fighters) against RSV and she passes them to her baby before birth. These antibodies then protect the baby in the first six months of their life (the riskiest period) against severe illness caused by RSV.
   
   
2. Monoclonal antibodies (ready-made antibodies for babies) – Not truly a vaccine, instead the antibodies are pre-made and delivered straight into the baby’s immune system, giving protection against severe RSV illness over a few months.

Maternal RSV vaccination has been approved for use at KKH since late 2024. It is now offered to pregnant women between 32 and 36 weeks of gestation. For pregnant mothers who might be reading this, do speak to your obstetrician to find out more. As for monoclonal antibodies, please check with your doctor about its availability and recommendations in the future. 

While these options were not available earlier for your son, it also appears that he has thankfully recovered well from his RSV illnesses. Children his age have a lower risk of suffering from a severe bout of RSV. Furthermore, having a ‘natural infection’ will also boost his immunity for the future. 

In summary,

1. Catching back-to-back viral infections is a normal part of childhood, and part of the journey of building your child’s immune system.
   
   
2. There may not be a problem with your child’s immune system but you need to consider the need to treat extra sensitive airways if there are recurrent episodes of wheezing.
   
   
3. General hygiene measures, reducing contact during illness and childhood vaccination are all good ways to reduce (though not eliminate) the transmission of viruses.
   
   
4. RSV immunisation: Maternal RSV vaccination is available to pregnant mothers at 32 to 36 weeks of pregnancy, giving protection to the infant from severe RSV illness in the first six months of life.

4. Question by June

Hi Dr Christopher, 

My kid who is 9, frequently wakes up with what seems as a sinus blocked nose. Sometimes there is mucus which he will blow out. 

How do I know if it is viral infection versus a sinus nose. Some days are worse than other days.

Does washing hair in early morning causes worsening of the blocked nose? 

Thank you for taking the time to answer my questions.

Answer by Dr Christopher Seow

Hi June, thank you for your question! It can be frustrating trying to tell if your child has a viral infection or a ‘sinus nose’, especially when it is happening so frequently! 

They are indeed two distinct issues, but can be related. What is commonly referred to as ‘sinus’ is actually allergic rhinitis.

Allergic rhinitis is when your nose gets irritated because your body reacts to allergens in the environment such as dust or pollen. This can result in frequent sneezing, drippy nose, constant scratching or nose-rubbing, and sometimes can be associated with itchy eyes. 

Sometimes symptoms are worse in the morning (though not always the case). 

It can get worse with environmental triggers - most commonly bedding, pillows, mattresses, carpets, curtains and soft toys, which can all contain house dust mites.

To make things more confusing, allergic rhinitis can also lead to frequent coughing. This is related to a post-nasal drip (mucus dripping from the nose passage to the back of the throat), triggering the coughing reflex. 

Viral infections also often cause runny nose/blocked nose. The mucus might be thicker or be yellow/greenish in colour. Usually there can be other associated symptoms like fever, a chesty cough, muscle aches, malaise (feeling unwell). It might affect your child’s appetite and activity levels more significantly. Your child may have been in contact with someone who is sick, such as a family member with similar symptoms. The viral course lasts a few days then gets better on its own (if mild). 

Viral infections can worsen allergic rhinitis too. Think of it as viruses coming in waves (up and then down), and allergic rhinitis is something in the background that is more long term.

I suspect that if your child is getting blocked nose very frequently, and to the point of waking up at night, and even when he is otherwise ‘well’, then there is very likely an element of allergic rhinitis. 

One good way would be to seek treatment for allergic rhinitis and see if there is a good response to treatment. Treatment for allergic rhinitis involves a nightly steroidal nasal spray, that reduces the swelling inside the nose, making it less ‘sensitive’ to allergens. This is given regularly over a long course (can be months) until there is a clear improvement in symptoms for a good period of time. 

Reducing environmental triggers will also help a lot. Wash bedding at least once a week with hot water ≥60˚C (this temperature kills the dust mites). Use dust-mite-proof covers for pillows, mattresses and duvets. Avoid heavy curtains and stuffed toys in the bedroom.

If you have pets, keep them out of the bedroom (ideally off the furniture), bathe and groom them regularly (by someone who is not allergic), and vacuum furniture with a HEPA (high-efficiency particulate air) vacuum. 

Your child's blocked nose can disturb his sleep by making it hard to breathe, so it is important to treat these symptoms. Sleep is the time that children’s bodies and brains do some of the most critical work for growth, learning and overall health. 

If your child gets better with these measures, then he might still catch a viral infection every now and then, but his symptoms should resolve after each episode. The virus should not cause long term damage to the nasal passages. 

Hope this answers your question, and your child gets better soon!

5. Question by Neme

Hi Dr Seow,

My 10-year-son has allergy rhinitis and has been on a steroidal nasal spray since he was six months old. It is sprayed into both nostrils, before bedtime. 

I am worried about the long-term effects of this medication. 

I have tried to wean him off before but every time I do so, his runny nose prevails. 

Can you explain if it is safe for prolong use and your recommendation? Thank you.

Answer by Dr Christopher Seow

Hi Neme, thank you for your question.

It sounds like your son has had a tough and prolonged journey dealing with allergic rhinitis, and you are understandably concerned with what seems like an inability to be weaned off his steroidal nasal spray. 

While allergic rhinitis and viral infections are two distinct issues, they can sometimes affect each other, with viral infections usually making the symptoms even worse than it already is on a regular day.

You may refer to a reply posted by June (above, question 4) to note some of the differences.

I suspect that since you have been going through this with your son since he was very young, the diagnosis is probably pretty clear - especially since he responds well to the steroidal nasal sprays and then gets the symptoms back when it is taken off.  

When allergic rhinitis is ‘stubborn’ despite proper treatment, here are some considerations (some of them might be things you have already done):

1. Is there ongoing exposure to environmental allergens?
   (Dust mites, pets, pollen). Wash bedding at least once a week with hot water >/= 60 degrees Celsius. Use dust-mite-proof covers for pillows, mattresses and duvets. Avoid heavy curtains and stuffed toys in the bedroom. If you have pets, keep them out of the bedroom (ideally off the furniture), bathe and groom them regularly (by someone who is not allergic), and vacuum furniture with a HEPA (high-efficiency particulate air) vacuum.
   
   
2. Are there issues with adherence or proper use of nasal steroidal sprays?
   When a child dislikes or resists using a nasal spray, there can be issues such as physical resistance (especially younger children), or missing of doses (both intentionally or unintentionally) for the older children.
   
   Frequent stopping and starting of treatment can make treatment less effective compared to regular, consistent use with good technique, ensuring proper delivery of the topical steroids to inside the nose.
   
   This can be a difficult problem to tackle, but may require more adult supervision, use of routines and positive reinforcement in encouraging the child to use the sprays regularly.
   
   
3. Are there other ways to treat allergic rhinitis?
   There are some other treatments to be considered, but this has to be done after consultation with your doctor and proper counselling:
   
   a) Adding regular oral antihistamines, saline irrigation
   
   b) Leukotriene receptor antagonist like Montelukast
   
   c) Allergen immunotherapy - exposure to small amounts of allergen extracts under the tongue [sublingual immunotherapy (SLIT)] to build ‘tolerance’ within your child’s immune system 

Given this has been such a prolonged journey for your son, I would recommend that you consult a paediatric allergist for the consideration of the above measures and if you are interested to find out more about SLIT.  

Regarding the long-term use of nasal steroids, a common misconception is that the child is ‘dependent’ on it. This suggests some kind of ‘addiction’ or a bad effect once he comes off it. There is no evidence that topical steroids (creams, nasal sprays) given at the right dose, strength and quantity can cause ‘dependence’.

The bad effects when coming off is more to do with the recurrence of the underlying condition that is not under control. Hence it is important to deal with the root of the problem with the above-mentioned measures.

Steroids actually occur naturally in our body and control inflammation. For topical steroids, they are applied directly to the target areas where they are needed (inside the nose for nasal steroids). They are hardly any steroids that are absorbed into the bloodstream and carried around the body - making it different from anabolic steroids taken by athletes or high dose oral/intravenous steroids needed for certain medical conditions.

The body is thus spared from the long-term effects of systemic steroids (i.e. carried around the whole-body system) such as poor bone growth, Cushing’s syndrome, etc. 

Regarding growth and a child’s height - there have been trials that show that the long-term use of nasal steroids can cause a very small, usually reversible reduction in the growth velocity (how fast height increases over time). This effect was very small (<0.5cm/year) and the effects on the final adult height remains uncertain.

This also has to be considered along with the many other things that can affect a child’s growth - such as poor sleep or poor disease control. You can speak to your paediatrician regarding monitoring of your child’s growth.

For more specific guidance about your son’s condition, please speak with his paediatrician or an allergy specialist who can provide a more in-depth understanding and assessment.

Ref: G25