Parents sending their children to nursery for the first time can expect a challenging year of illness, but new research offers a reassuring perspective: this early exposure builds crucial resilience for school.
A collaborative study by experts from UCL, the University of Cambridge, Cornell University, and North Middlesex University Hospital, which analysed immunology, infectious disease genomics, and epidemiology data, indicates that toddlers and pre-schoolers are likely to encounter 15 illnesses in their initial year of formal childcare.
The research suggests that during this period, children can anticipate an average of 12 respiratory illnesses, such as coughs and colds, two episodes of diarrhoea or vomiting, and at least one illness presenting with a rash.
Dr Arindam Das, a Doctify-rated consultant paediatrician, confirms that frequent illness is a normal part of early childhood development. "It’s very normal, especially in the first year of nursery, for children to be unwell pretty frequently," he reassures. "When young children pick up these minor infections, their immune system is learning how to fight infections, so catching these bugs is a normal part of childhood."
Dr Das highlights six common ailments children frequently pick up in nursery settings:
Coughs and Colds
These are the most prevalent infections. "The most common infections that children pick up at nursery are coughs, colds, and fever," says Dr Das. Most colds in younger children typically resolve within two weeks.
The NHS advises ensuring children drink plenty of fluids and suggests saline nose drops to alleviate stuffy noses.
Dr Das stresses the importance of hygiene: "Good hand hygiene is the most effective measure to prevent lot of these infections because they spread via droplets and touch. So, teaching children to wash their hands and to cover their mouth and nose when they’re coughing and sneezing is really important."
Fever
While often a concern for parents, Dr Das explains that a fever itself is not necessarily a red flag. "You need to look at the whole picture. A fever is a sign or a symptom that the child is fighting a bug." High temperatures usually return to normal within one to four days and can often be managed at home. However, parents should contact NHS 111 or their GP if the child has other symptoms like a rash, if the fever persists for five days or more, or if they are not eating or appear dehydrated.
Tummy Bugs
Gastrointestinal infections are also common. "We also see a lot of tummy bugs in nursery school-age children," Dr Das notes. He describes a typical progression: "For a tummy bug, the most common scenario is vomiting and then after a few days diarrhoea usually starts. This is a natural progression, and parents shouldn’t be alarmed." Most tummy bugs can be managed at home with adequate hydration, and paracetamol or ibuprofen can be used for comfort.
However, parents should seek medical help if their child becomes very drowsy or lethargic, is not drinking enough, or is passing very little urine. The NHS advises calling 111 for children under five with signs of dehydration (e.g., fewer wet nappies), persistent vomiting, bloody diarrhoea, or diarrhoea lasting over seven days or vomiting over two days.
Conjunctivitis
This eye inflammation can be viral, bacterial, or allergic. "If your child has reddening of the eyes and has some watery discharge, then this is most likely to be a viral infection," Dr Das explains. Allergic conjunctivitis primarily causes itching, while bacterial forms present with more purulent, thick, yellowy discharge and the child may appear generally unwell.
For minor or viral cases, frequent eye watering and paracetamol for discomfort are recommended. Over-the-counter eye drops are also an option. A GP should be consulted if symptoms do not clear within seven days or if a baby has red, sticky eyes.
Hand, Foot and Mouth Disease
This viral illness typically presents with a mild to moderate temperature and characteristic rashes. "The other hallmark symptom is rashes on the hand, foot or mouth. There doesn’t necessarily have to be rashes on all three places, but is usually on at least two of these areas," says Dr Das.
The rashes are blanching, meaning they fade when pressed, and the child usually feels well between fever episodes. Mouth ulcers, loss of appetite, and a sore throat are also common. The NHS recommends cool fluids and soft foods, avoiding hot, salty, or spicy items. Parents should contact their GP if symptoms do not improve after seven to ten days.
Dr Das observes an increase in younger children contracting chickenpox. The main symptom is an itchy, spotty rash. "One typical character of a chickenpox rash is that they come out in different times and they look different – we call it ‘pleomorphic’, which means they come out in crops," he explains.
The rash often starts on the face, with new spots appearing on the body while older ones on the face are already changing. Chickenpox is usually self-resolving, but the intense itch can be distressing. Paracetamol or age-appropriate antihistamines can help. Medical attention is needed if the rash becomes yellowy, shows pus, or bleeds. NHS 111 should be contacted if a child with chickenpox shows signs of dehydration.
When to Keep Children Home Regarding when to keep children home from nursery or school, Dr Das advises: "The standard guidelines for vomiting or diarrhoea advises parents to not send their child to school or nursery until 48 hours after the symptoms have stopped." He also suggests keeping children home if they are actively coughing and sneezing, not only for their own well-being but to prevent wider transmission. The NHS also recommends keeping children with a high temperature off school until it subsides. Dr Das concludes: "I fully understand that the logistics around keeping children at home, so I would just advise parents to use their common sense to judge whether the child is safe and whether they are following the official guidelines or school guidelines."
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