Fever, Cough & Runny Nose in Kids: Red Flags vs. Wait andWatch

1) Go to A&E RED FLAGS

Very hard to wake, floppy, or looks seriously unwell; weak/high-pitched continuous cry.
Breathing danger signs: grunting, severe chest indrawing, or very fast breathing (see table). Stridor/noisy breathing at rest.
Blue/grey/pale skin or lips.
Non-blanching purplish rash (pressing a glass does not make it fade).
Seizure or confusion.
Infants < 3 months with temperature more than or equal to 38.0 °C (any fever in this age group).

2) See a clinic the same day AMBER

Breathing concerns without the red-flag features: nasal flaring, crackles, or fast breathing above age thresholds; home pulse oximeter less than 95% on room air.
Age 3–6 months with temperature more than or equal to 39.0 °C.
Signs of dehydration: very dry mouth, fewer wet nappies/urine, poor drinking, capillary refill more than or equal to 3 s.
Fever persisting > 3 days (older infants/children), or fever that improves then returns.
Ear pain with fever, ear discharge, or symptoms lasting > 48–72 hours.
Fever for 5 days or more (your doctor may consider Kawasaki disease, especially with red eyes, cracked lips/strawberry tongue, swollen hands/feet or rash).

3) Safe to “wait & watch” at home GREEN

Child is alert, breathing comfortably, drinking and urinating normally, and has no red/amber signs.

What helps

Fluids & rest; light clothing. Check through the night.
Paracetamol or ibuprofen for discomfort (weight-based dosing; ibuprofen usually for children older than 6 months). Use only while the child appears distressed—don’t alternate routinely.
Honey ½–1 tsp at bedtime may ease cough in children aged 1 year and up.
Saline nose drops/spray for congestion; cool-mist humidifier if helpful.

What to avoid

OTC cough/cold syrups in very young children (limited benefit, potential harms). Seek professional advice for < 2 years; avoid products containing codeine in children.
Tepid sponging (not recommended for fever management).
Honey in infants < 1 year (risk of infant botulism).

Age-specific breathing thresholds

Age	“Fast” breathing	Action
< 6 months	> 60 breaths/min	RED (seek urgent care)
6–12 months	> 50 breaths/min	AMBER (same-day clinic)
> 12 months	> 40 breaths/min	AMBER (same-day clinic)

Count for 60 seconds while the child is calm. If you use a home oximeter, SpO2 less than 95% on room air is concerning—seek same-day care.

Runny nose: myth-busting

Green/yellow snot is not equal to automatic antibiotics. Colour alone cannot distinguish viral from bacterial infection. Seek care if symptoms are severe, worsening, or persist > 10 days (or “double-sickening”).

How long should a cough last?

A typical viral cough can linger for 2–3 weeks. See your doctor if cough lasts > 4 weeks, or earlier if breathing becomes hard, there is stridor, wheeze, or the child looks unwell.

Quick medication notes (Singapore-relevant)

Paracetamol: dose by weight (commonly 10–15 mg/kg per dose every 4–6 hours; max 4 doses/day). Follow your product’s label.
Ibuprofen: generally for children older than 6 months; dose by weight as per label. Avoid if dehydrated or if advised by a doctor.

Always read the label; check with your GP/pharmacist for age/weight-specific dosing and if your child has chronic conditions.