Unfortunately, it is a given that babies and toddlers are going to constantly get sick. And while it would be crazy to expect every child with a runny nose to be ‘quarantined’, where should parents draw the line when letting them play with other children or pregnant women?

There is a lot of folk wisdom floating around such as, ‘If you have symptoms you are no longer contagious,’ or, ‘After a fever keep kids away from others for 48 hours.’ ‘Bugs are good for children’s immune system,’ is another popular one. Unless you have a medical degree it’s hard to know what separates fact from fiction.

Barry Duffy is an award-winning paediatrician at Prince of Wales Private and Sydney Children’s Hospital. He has some rules of thumb for parents to use when keeping their families safe.

Coughs and runny noses

It’s not uncommon for parents to be scolded by others for taking a child with a cough or runny nose to the park. But do they have a point?

“We are becoming too germaphobic,” says Duffy. “If there are kids with a cough or runny nose it means it’s a virus in the community and it’s going to spread. So you might as well just do your normal activities.”

If you have a child who gets reoccurring middle ear infections they might need antibiotics if they are exposed to certain viruses. “But to say you have to protect that group of children by limiting everyone else is a big ask,” says Duffy.

Duffy says most paediatricians will say a cough or a runny nose is not a problem. Children are more likely to pick up a cold from a bus trip to the doctor than they will from playing in the park.


Fevers, mostly due to viral infection, probably instil the most fear into parents but it turns out they are not as dangerous as we may have first thought. If your child has had a fever recently (even within 12 hours) and then is acting happy and wanting to play, chances are they are fine to go out and do so.

“The concept of keeping kids away from other kids because they have a fever doesn’t make sense to me,” Duffy explains. However, check what other symptoms they have which might indicate if the fever is related to something more sinister.

Vomiting and diarrhoea 

Another two scary symptoms for parents are vomiting and diarrhoea. Duffy stresses we should exercise caution when it comes to these two because they are potentially more contagious.

Besides keeping kids at home, parents need to make sure to wash their hands carefully with an alcoholic-based handwash. “You need to have access to soap and water but also alcoholic handwashing because we know it is a very effective way to stop spreading viruses.”

Duffy says the rule of thumb in hospital is if you have a decent volume and frequency of fluid motions you are still a potential spreader. Children need to stay away from others until the diarrhoea is thicker and less frequent. “If your motions are 2-3 times a day and not runny, your risk of being contagious is much less.”

Duffy says there is one nasty virus lurking around that parents should be aware of. Norovirus has diarrhoea as a symptom and spreads by respiratory route. “It spreads by droplets, gets on surfaces like doorknobs and survives well. It is a bad one. In that instance you want the stools as close to normal, probably 1-2 times a day before going out.”

Children with immunosuppression 

Children who are immunosuppressed because they have leukaemia or are born with a poor defence against infection are at greater risk. “Usually their parents will let people know because their doctors would encourage them to do so,” says Duffy. “So if you have children in that circumstance then yes, you have to be careful to minimise their exposure.”

Viruses help kids build a good immune system

“Most of the viral illnesses around are not so debilitating and devastating that you ought to avoid them,” he says. “And there are many viruses that kids are going to get that help with their immunity. This is because if you have exposure and immunity to individual viruses it means you will have some immunity to those viruses of the same family that you might meet later on.”

What viruses should we worry about?

Thanks to vaccinations, viruses with potential serious consequences such as chickenpox, measles, mumps, rubella and rotavirus have become less frequent. The rubella vaccine was mainly created to protect pregnant women. But unfortunately not all dangerous viruses have been eradicated.

“Parvovirus and hand, foot and mouth disease are commonly spread around young children. Both of those can be devastating to a foetus if the mother gets it during pregnancy for the first time. “Women in their first half of pregnancy need to be careful, especially those who already have small children,” he says. “Toddlers go to preschool and preschools have parvovirus and hand, foot and mouth disease. The majority of women won’t get in to trouble but some may lose their babies. It’s impossible to say anything that makes sense that doesn’t frighten the hell out of people.”

Sadly, there has also been a revival of pertussis (whooping cough). Before the 1980s people were immunised against pertussis with a whole-cell vaccination, but in some cases the vaccinations caused local reactions and fevers. In the 80s and 90s a new a-cellular vaccination was used that we now know does not have the same longevity.

“[The whooping cough epidemic] is now a worldwide phenomenon in first world countries that used that vaccine. Now young adults are getting that illness and spreading it back to kids because their immunity didn’t last like the immunity did from the old vaccine. Most children are okay because they are all immunised, but we have to protect the babies under the age of four months.”

The best way to protect newborns from this potentially fatal illness is to make sure everyone who will come in contact with them such as grandparents, aunties, uncles and carers, receives a free booster shot from their GP.

Published in Essential Baby on December 12, 2013. 


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