What to Do About Recurring Illnesses

Does it feel like your child is always sick? Here’s why they might be prone to repeated bouts of colds, ear infections, strep throat, pneumonia, or other ailments—and what you can about these recurring illnesses. 

Sick Boy with Mother Checking Temperature
Photo: Rido/Shutterstock

If you're a parent, you might notice that your child gets sick over and over again. What's the deal with these recurring illnesses?

"I get asked that question all the time," says David W. Kimberlin, M.D., a pediatric infectious disease specialist at the University of Alabama at Birmingham. "The answer is, it's normal for young kids to have quite a few colds, ear infections, or gastrointestinal upsets in a single year," he says. "Children have an immature immune system. And they're encountering all the viruses, bacteria, and other antigens in the world for the first time."

Dr. Kimberlin, who has three children of his own under the age of 6, has recently gained a new appreciation for the issue. "The number of normal sicknesses a child can have is astonishing," he says. "That doesn't make it any easier for the family, but it might reduce the worry."

But why does your kid get four ear infections, while the neighbor's toddler skates by with just one? Why does one child vomit regularly, while another barely spits up? We asked the experts to help us explore the mystery. Here's what we found out about seven common childhood conditions, and why some kids seemingly always get sick.

Common Colds

Sometimes it seems little ones have a never-ending runny nose during the cool-weather months. The common cold can be a near-constant companion for young children, with some studies indicating that some kids can catch as many as eight colds per year.

Although a cold is usually harmless, it's considered a viral infection of the nose and the throat, says Madathupalayam Madhankumar, MBBS., MS General Surgery and gastroenterologist. Symptoms include cough, congestion, runny nose, and sneezing. Colds are spread easily in school and daycare settings, and it's possible to catch one through direct or indirect contact with infected individuals.

What's Normal

Five or six colds per year is average; eight to 10 is still in the normal range.

What's Not Normal

A cold with a fever that lasts more than five days; difficulty breathing (beyond a stuffy nose); a cold that lasts more than 10 days.

Why Your Child Might Be Vulnerable to Colds

Since there are more than 100 viruses that trigger the common cold, it's no wonder young kids fall prey to continual rounds of sniffles, sneezes, and coughs, says Preeti Jaggi, M.D., an infectious disease specialist at Children's Memorial Hospital in Chicago. Plus, if your child is in daycare, they'll be exposed to more of these nasty cold bugs at an earlier age.

Some cold-prone kids may also have a genetically active immune system that reacts more strongly to viruses. Still others may have an immune system that's been coddled by a hyperclean home. "That's the hygiene hypothesis," says Dr. Kimberlin. "Children's immune systems are designed to learn from exposure to all sorts of things. But researchers increasingly believe that our modern environment may be too clean. As a result, kids aren't building the immunity needed to resist certain illnesses."

Kids with upper respiratory allergies may also get more colds than normal, he adds. The reason? An inflammation of the upper respiratory system can make a child more susceptible to cold germs, or make cold symptoms more pronounced.

Some endless rounds of runny noses may simply be a case of bad timing: Newborns inherit short-term common-cold immunity from their birthing parent, but it wears off after about six months. This leaves summer-born babies without protection just as the winter sneeze season kicks into gear.

Advice for Parents

Make sure kids get lots of sleep. If they're eating solid foods, include plenty of fruits and veggies in their diet. In adults, low levels of vitamin C have been linked to harsher colds.

Also, don't smoke in the house, or even better, try to quit. Exposure to secondhand smoke—even the burnt-tobacco by-products that cling to clothing and furniture—irritates airways and dulls immunity, raising the risk of a child's cold becoming something worse. According to the Centers for Disease Control and Prevention (CDC), secondhand smoke causes numerous health problems in infants and children, including more frequent and severe asthma attacks, respiratory infections, and ear infections.

It's important for parents to keep in mind that COVID-19 often mimics a cold, especially in young children. If your child is presenting with cold symptoms, it's a good idea to perform an at-home COVID test before sending them to school or daycare to avoid an outbreak.

Croup

Croup is a viral infection that leads to swollen airways and a scary-sounding "barking" cough. The characteristic cough is a result of constriction of the airways in the upper respiratory system. While croup sounds quite scary, it isn't typically a mild virus.

What's Normal

At least one bout of croup by age 3.

What's Not Normal

When breathing becomes a serious struggle for your child.

Why Your Child Might Be Vulnerable to Croup

Up to half of all kids who've had one episode of croup will go through it again, researchers estimate. Why? Reasons range from physical anatomy and gender to race, genetics, and prematurity. Croup is more likely to strike in the fall and early winter, and it's slightly more common in boys than in girls.

A better-understood risk: being born with a narrower-than-usual voice box (larynx) and windpipe (trachea). The tiniest portion of the windpipe, the subglottic trachea, swells during croup. Pediatricians are also realizing that the breathing tubes that premature infants often require may scar the delicate lining of the trachea, leading to more croup as they grow. Asthma and a family history of allergies also heighten a child's risk.

For some kids, a recurrent croupy cough isn't even prompted by a viral infection: Muscle spasms start the process.

Advice for Parents

Skip the cough syrup, since it won't reach the larynx or trachea. And never try to open your child's airways with your finger. The best home treatment? Time in a steamy bathroom (turn on the shower). Or if that doesn't work, try moist, cold air. Call your pediatrician—or 911—if your child's breathing worries you.

Ear Infections

These are infections of the part of the ear that's behind the eardrum, caused by bacteria or viruses. Ear infections don't spread from one person to another, says Dr. Madhankumar. Rather, they're mostly triggered by other issues, like a cold, flu, or allergy. "An ear infection occurs as a result of swelling in the middle ear cavity and is usually caused by a blocked eustachian tube. But a swimmer's ear is an infection in the outer ear canal, typically caused by water that pools in the ear canal for a long time."

What's Normal

Two infections a year in children from birth to age 3.

What's Not Normal

Fever and ear pain that persist for more than two days.

Why Your Child Might Be Vulnerable to Ear Infections

Little kids are more prone to middle-ear infections—also known as acute otitis media (AOM)—than are older kids and adults because their eustachian tubes (which drain the ears) are shorter, thinner, and more horizontal. During a cold, these tubes swell, trapping fluid in the middle ear, which becomes a perfect breeding ground for bacteria and viruses.

Children who have extra-short or extra-slim tubes are at even greater risk of getting AOM, says Margaret Fisher, M.D., chair of Monmouth Medical Center's pediatric department in Long Branch, New Jersey. Kids with a certain type of bone structure may have problems as well. "The flatter the middle of a child's face, the less the eustachian tube will be angled," says Dr. Fisher.

Living with a smoker and inhaling secondhand smoke raises a child's risk of ear infection. And lying flat while drinking a bottle or inheriting low levels of maternal antibodies to pneumococcal bacteria also increase the odds.

There's yet another reason for the uptick in AOM: "One of the most worrisome trends of the past few decades has been the emergence of antibiotic resistance among the 'big three' bacteria that cause most cases of AOM," says Ali Andalibi, Ph.D., a researcher in the department of cell and molecular biology at the House Ear Institute in Los Angeles. Researchers have found that between 25 and 95% of these germs are currently resistant to penicillin, and some are resistant to other antibiotics as well.

Advice for Parents

If your pediatrician suggests watchful waiting—a pain-and-fever reliever but no antibiotics for 48 to 72 hours—consider this approach. "Most kids get better with or without antibiotics," Dr. Kimberlin says. "Some kids need them. But antibiotic overuse is leading to serious problems."

If your child has had three ear infections in a six-month period, or four in one year (with the most recent in the past month), talk to your doctor about whether they should get ear tubes, says Anthony Magit, M.D., associate clinical professor of pediatrics and otolaryngology at the University of California, San Diego School of Medicine.

Diarrhea

Diarrhea in children is quite common, and it can be prompted by a host of issues. According to Dr. Madhankumar, the following are common causes of diarrhea: bacteria, viruses like rotavirus, parasites, certain medications like laxatives or antibiotics, or food poisoning. Less common causes can include irritable bowel disease, Crohn's disease, ulcerative colitis, food allergies, and celiac disease.

What's Normal

One or two cases a year is average; up to three episodes is within the normal range.

What's Not Normal

Diarrhea that lasts more than five days; dehydration.

Why Your Child Might Be Vulnerable to Diarrhea

The loose bowels of babyhood and early toddlerhood can be impressive both in their number and explosive power. Most are caused by the highly contagious rotavirus. This feisty misery-spreader can live for up to seven hours on a countertop and survive for nearly half an hour on your hands if you touch an infected surface. A smidgen of diarrhea contains 100 billion rotavirus particles, while it takes just 10 to pass the infection along. So imagine the yucky probabilities. It's all too easy for rotavirus to be passed around in your own home, and far easier at daycare. (Fortunately, washing hands with soap deactivates the virus.)

But don't blame all loose bowels on viral invaders. "Some antibiotics, such as Augmentin, Biaxin, and Zithromax, can speed up transit time in the bowels," Dr. Fisher notes. "And for young toddlers, the most common cause of frequent diarrhea is diet. Too much fruit juice makes the bowels pull in extra water." Other dietary causes include lactose or soy intolerance.

Advice for Parents

Limit fruit juice, since it has little nutritional value, says Dr. Fisher. Also, go easy on milk; if your child has had a bout of diarrhea, their gastrointestinal system may be hypersensitive for a while.

Vomiting

Vomiting: the childhood illness that parents dread more than just about anything else. And for good reason! It's no fun for anyone, but if there's any good news in this, it's that most bouts of vomiting aren't serious, and they'll self-resolve in short order.

What's Normal

Two or three episodes of vomiting per year is average. Babies may spit up once a day.

What's Not Normal

Repeated vomiting on any given day.

Why Your Child Might Be Vulnerable to Vomiting

True vomiting—usually a reaction to infection, food poisoning, or stress—is different from a baby's everyday spit-up, says Dr. Fisher. The gastrointestinal system of some babies takes extra time to mature, and they'll experience wet burps or gastroesophageal reflux. "This is normal," she notes.

But if your baby or toddler vomits fiercely after each feeding, they may have a condition known as pyloric stenosis, a thickening of the valve between the tummy and intestines that keeps the stomach contents from emptying. Some babies and preschoolers gag easily while eating or having their teeth brushed, causing them to vomit.

Other preschoolers (and elementary school kids) could have cyclic vomiting syndrome. This condition involves intense vomiting for several hours or even days, followed by weeks or months of peace.

Advice for Parents

If your pediatrician can't diagnose the cause of your child's vomiting, consider consulting a pediatric gastroenterologist.

Strep Throat

Strep throat can affect people of all ages, but it's most common in children ages 5 to 15. It causes inflammation and pain in the throat, and symptoms can include sudden high fever, sore throat with red or white patches, headache, chills, and swollen lymph nodes in the neck.

Strep throat can spread from one person to another by sneezing, coughing, sharing utensils, or by close contact with someone who had an infection, says Dr. Madhankumar.

What's Normal

One episode a year.

What's Not Normal

Drooling or great difficulty swallowing.

Why Your Child Might Be Vulnerable to Strep Throat

As many as one in 10 kids with strep—a bacterial infection of the tonsils caused by highly contagious Streptococcus pyogenes bugs—don't respond to the first course of antibiotics prescribed by a doctor. So even though these kids have been treated, the infection never gets knocked out. Some children need longer treatment to get rid of the strep bacteria; others, a different antibiotic.

Sometimes kids come in close contact with a carrier who has no symptoms but can pass the infection along. And if your child gets their first infection during peak strep season (spring and fall), they're more likely to become reinfected, because bacteria thrive during those months, causing infections to be three times more prevalent than in winter or summer.

Parents may contribute to repeat infections, too. Strep symptoms heal quickly with treatment, leading many parents to stop giving medication early: One study found that while 80% of families claimed they'd administered every dose of antibiotics, 50% had stopped after just three days. Full treatment is necessary to wipe out all of the strep bacteria.

Doctors are swift to treat strep throat in order to prevent rare yet serious complications such as heart-damaging rheumatic fever. But the most accurate test—a throat culture—takes two days to yield results. A rapid antigen test offers results in minutes but can fail to detect strep about 20% of the time. For these reasons, doctors may overdiagnose and overprescribe antibiotics to be on the safe side. Bottom line? Your child may not have strep at all. The symptoms of strep throat can mimic other common illnesses, like COVID-19, a cold, or even the flu.

Advice for Parents

If your child is diagnosed with strep throat, ask for a 10-day course of antibiotics, and make sure they take all of it. "Studies have shown that a seven-day course of penicillin is much less likely to eradicate the strep germ than is a 10-day course," says Richard J. Schmidt, M.D., a fellow in pediatric otolaryngology at the Nemours/Alfred I. duPont Hospital for Children in Wilmington, Delaware.

When strep keeps coming back with a vengeance, some doctors are suggesting an old standby: tonsillectomy. Repeat infections can create pockets of hard-to-kill bacteria on the tonsils.

Pneumonia

Pneumonia is the inflammation of the lung sacs caused by a bacterial or viral infection. "In a pneumonia infection, the air sacs become filled with pus and may become solid," says Dr. Madhankumar. Pneumonia is spread by droplets of infected fluid, and it can be contagious before symptoms begin.

The most common symptoms of pneumonia include aches and pain in the chest when coughing or inhaling air, chills and fever, and a cough that produces phlegm.

What's Normal

Getting it once.

What's Not Normal

Two bouts in one year, or three or more during childhood.

Why Your Child Might Be Vulnerable to Pneumonia

Recurring pneumonia could be a sign of an underlying illness such as asthma, gastroesophageal reflux, cystic fibrosis, neurological problems, or an immune deficiency, says Raj Padman, M.D., chief of the division of pulmonology at the Nemours/Alfred I. duPont Hospital for Children.

Sometimes, the cause is just a tiny item—a candy or a bead—that has been accidentally breathed into the lungs and remains lodged there. (Canadian doctors have reported on the case of a 2.5-year-old whose recurrent pneumonia was apparently caused by a tiny bit of greenery from a Christmas tree that he had inhaled into his lungs as a baby.) But about 10% of repeat pneumonia has no known cause, researchers say.

Advice for Parents

Ask your pediatrician or a family doctor for a referral to a pediatric pulmonologist. This specialist can perform lung-function tests and lung scans to help detect and solve your child's problem.

Was this page helpful?
Related Articles