Nursery bugs & childhood illnesses
Slapped cheek, threadworms, ringworm. Some of the names on the nursery noticeboard can leave you with more questions than answers. Find out what parents might notice, what usually helps and who to ask for advice.
When to get help now
Call 999 or go to A&E for difficulty breathing, blue or grey skin or lips, a child who is difficult to wake, a seizure, or a rash that does not fade under pressure. Do not wait for a rash if your child seems seriously ill.
A temperature of 38°C or higher under 3 months, or 39°C or higher at 3 to 6 months, needs immediate medical advice, as does suspected fever in a baby under 6 months even without a thermometer reading. Contact an urgent GP or call 111 now; if your baby seems seriously unwell, call 999 or go to A&E. Do not wait for a rash or for medicine to work.
Call 111 for a child under 5 if you are worried or unsure. This guide is not a diagnosis.
Before giving medicine
Ask a pharmacist about the right product for your child’s age and weight, and follow its label. Do not give aspirin to children under 16 or paracetamol to babies under 2 months. Do not give ibuprofen under 3 months or 5kg, with dehydration or chickenpox, or for asthma unless a doctor recommends it. Do not alternate paracetamol and ibuprofen unless a healthcare professional advises you to.
Chickenpox
Medicine: Symptom relief, not a cure: children’s paracetamol (such as Calpol) may ease discomfort when suitable for age. Ask about itch relief. Avoid ibuprofen unless a doctor advises it.
Symptoms: Itchy spots become fluid filled blisters, then scabs. New spots can appear alongside older ones. Fever and reduced appetite are common.
What helps: Offer fluids, cool baths and loose clothes. Keep nails short. Age appropriate paracetamol may ease discomfort. Do not give ibuprofen unless a doctor advises it.
Pharmacist: Ask about cooling products and age suitable itch relief.
GP: Contact your GP if you are unsure it is chickenpox. Phone before attending.
Urgent help: Call 111 for worsening symptoms, hot or painful skin around spots, fewer wet nappies, or newborn exposure or symptoms. Pregnant or immunocompromised contacts should also seek urgent advice.
Nursery guidance (check your nursery’s own policy): Stay home until every spot has scabbed over, usually about 5 days after the rash starts. Avoid newborns, pregnant people and those with weakened immunity.
Usually 1 to 2 weeks.
Conjunctivitis
Medicine: Treatment depends on the cause. Drops may be recommended; antibiotics do not treat viral or allergic conjunctivitis. Children under 2 need a GP prescription if treatment is needed.
Symptoms: Red, gritty, itchy or watery eyes, sometimes with sticky lashes. Infection and allergies can look similar.
What helps: Gently clean crusts with cooled, boiled water and a separate clean cotton pad for each eye. Wash hands and avoid sharing towels.
Pharmacist: A pharmacist can advise about drops. Treatment for children under 2 needs a GP prescription; antibiotics do not help every cause.
GP: See a GP for a baby with red, sticky eyes, or if symptoms have not cleared within 7 days.
Urgent help: A baby under 30 days with red, sticky eyes needs an urgent GP appointment or 111. Seek urgent help for eye pain, light sensitivity, vision changes or very red eyes.
Nursery guidance (check your nursery’s own policy): NHS guidance does not usually require exclusion if your child feels well enough. Your nursery may have additional requirements; check with them.
Often settles within a couple of weeks.
Hand, foot and mouth
Medicine: Symptom relief only: suitable pain relief can help a sore mouth. There is no medicine or antibiotic that cures the virus.
Symptoms: A sore throat, fever and reduced appetite may come first, followed by painful mouth ulcers and spots or blisters on hands, feet and sometimes the bottom.
What helps: Offer cool fluids and soft foods if eating solids. Avoid acidic drinks and hot, salty or spicy foods. Antibiotics do not cure it.
Pharmacist: Ask which pain relief or mouth ulcer treatments are suitable for your child’s age.
GP: Contact your GP if symptoms are not improving after 7 to 10 days.
Urgent help: Ask for an urgent GP appointment or call 111 for a very high temperature, reduced peeing or any symptoms that worry you.
Nursery guidance (check your nursery’s own policy): NHS guidance does not require waiting for all blisters to heal once a child feels well. Confirm the nursery’s own requirements before returning.
Usually 7 to 10 days.
Impetigo
Medicine: Specific treatment: a pharmacist or GP may prescribe hydrogen peroxide cream or antibiotics. Pain relief alone does not treat the skin infection.
Symptoms: Sores or blisters that burst and leave golden brown crusts, often around the nose, mouth or hands. It spreads easily.
What helps: Keep affected areas clean and dry, wash hands and avoid sharing towels. Finish prescribed treatment even when the skin improves.
Pharmacist: For children aged 12 months and over, a pharmacist can assess and may provide treatment. This can include a prescribed antiseptic or antibiotic.
GP: See a GP for children under 12 months, weakened immunity, recurrence within a year, or symptoms that change or worsen after treatment. Phone before attending.
Nursery guidance (check your nursery’s own policy): Stay home until 48 hours after starting prescribed hydrogen peroxide cream or antibiotics, or until untreated patches have healed, dried and crusted over.
Often improves within a few days of treatment.
Molluscum contagiosum
Medicine: Usually no infection treatment: spots generally clear on their own. Moisturiser may soothe the skin; a GP may treat eczema or an infection around the spots.
Symptoms: Clusters of small, raised, dome shaped spots, often with a shiny central dimple. They commonly appear on the body or in skin folds.
What helps: Do not squeeze or scratch. An unperfumed moisturiser or cool bath may soothe dry, itchy skin. Cover affected areas and avoid sharing towels or baths.
Pharmacist: Ask about a gentle moisturiser for discomfort. Products to remove the spots are not usually needed.
GP: See your GP if unsure of the diagnosis, spots are painful, swollen, crusted or very itchy, near the eyes or genitals, or your child has weakened immunity.
Nursery guidance (check your nursery’s own policy): NHS guidance usually allows normal activities. Check the nursery’s policy; cover spots with waterproof dressings for swimming.
Can take up to 18 months to clear.
Ringworm
Medicine: Specific treatment: an antifungal, chosen with a pharmacist. Scalp infection usually needs GP prescribed tablets and shampoo. Paracetamol does not clear ringworm.
Symptoms: A dry, scaly or itchy patch, often ring shaped. Colour varies with skin tone. Scalp infection can cause patchy hair loss.
What helps: Use the recommended antifungal for the full course, even if the rash fades. Keep skin clean and do not share towels, combs or bedding.
Pharmacist: A pharmacist can check the rash and recommend age appropriate antifungal treatment or refer you.
GP: See a GP for scalp ringworm, weakened immunity, or no improvement after pharmacy treatment. Scalp infection usually needs prescription tablets and shampoo.
Nursery guidance (check your nursery’s own policy): NHS guidance does not usually require exclusion once treatment has started. Check your nursery’s own policy before returning.
Antifungal treatment may be needed daily for up to 4 weeks.
Roseola
Medicine: Symptom relief only: suitable children’s paracetamol may help discomfort. It does not cure the virus. A young baby’s fever still needs urgent advice.
Symptoms: A sudden fever with symptoms similar to a cold may be followed by a rash on the chest, tummy and back. The rash is usually not itchy and can be harder to see on darker skin.
What helps: Offer rest and fluids. Use age suitable pain relief for discomfort, following the label. Do not overwrap your child.
Pharmacist: Ask about suitable pain relief, but do not delay urgent assessment of a young baby’s fever.
GP: Speak to a GP if your child has weakened immunity and has been exposed.
Urgent help: Call 111 or seek an urgent GP appointment for poor feeding, dehydration, fever lasting 5 days, or a child who is not themselves and worries you. Follow the young baby fever advice above. A first seizure needs emergency help.
Nursery guidance (check your nursery’s own policy): NHS guidance says to stay home with a fever, but not to wait for the rash to fade once well. Check your nursery’s requirements.
Usually within a week; the rash often fades within 2 days.
Scarlet fever
Medicine: Specific treatment: a GP prescribes antibiotics. Children’s paracetamol may help discomfort but cannot replace antibiotics.
Symptoms: Fever, sore throat and swollen neck glands, followed by a rough, sandpaper textured rash. The tongue may develop a red, bumpy appearance. Rash colour may be harder to see on darker skin.
What helps: A GP usually prescribes antibiotics. Complete the course. Cool fluids, soft food and suitable pain relief can help with discomfort.
Pharmacist: A pharmacist can advise about symptom relief, but suspected scarlet fever needs GP assessment.
GP: Contact your GP if you suspect scarlet fever, feel unwell after contact, have chickenpox as well, do not improve within a week after assessment, or become ill again later. Phone before attending.
Nursery guidance (check your nursery’s own policy): Stay home for at least 24 hours after the first antibiotic dose and until well enough to attend. Without antibiotics, infection can spread for 2 to 3 weeks; ask your GP about return.
Usually around a week with appropriate treatment.
Slapped cheek syndrome
Medicine: Usually symptom relief only: rest, fluids and suitable pain relief for discomfort. It normally clears without specific treatment.
Symptoms: Feeling unwell, fever or a sore throat can come before a cheek rash, followed by a body rash. Changes can be less obvious on brown or black skin.
What helps: Rest and fluids usually help. Continue usual baby feeds. Age appropriate pain relief can ease discomfort.
Pharmacist: Ask about suitable symptom relief for your child’s age.
GP: Contact a GP after exposure if your child has a blood disorder or weakened immunity, even without symptoms. Pregnant contacts should tell their midwife or GP, even without symptoms.
Urgent help: Seek an urgent GP appointment or call 111 for marked paleness, breathlessness, extreme tiredness or fainting.
Nursery guidance (check your nursery’s own policy): NHS guidance does not usually require exclusion once the rash appears and the child feels well. Tell the nursery and check its policy; infection spreads before the rash.
The rash usually fades within 1 to 3 weeks.
Threadworms
Medicine: Specific treatment: a pharmacist usually recommends mebendazole, plus household hygiene. Paracetamol does not treat worms. Children under 2 need individual advice; hygiene alone may be advised.
Symptoms: An itchy bottom, especially at night, disturbed sleep, or tiny white worms that look like threads in poo or around the bottom.
What helps: Wash hands and under nails, keep nails short, shower each morning and wash bedding and nightwear. Hygiene measures last 2 weeks with medicine, or 6 weeks without it.
Pharmacist: A pharmacist can recommend mebendazole. Household members aged 2 and over usually need treatment together, even without symptoms. Tell the pharmacist about younger children and anyone pregnant or breastfeeding.
GP: For a child under 2, treatment may not be suitable and the pharmacist may refer to a GP. Do not give an older child’s medicine to a baby.
Nursery guidance (check your nursery’s own policy): NHS guidance does not routinely require exclusion. Check your nursery’s policy and keep up careful handwashing.
Medicine kills worms, not eggs; keep up the hygiene routine.