Winter creates the ideal conditions for respiratory illness in children to spread due to increased time spent indoors. Common infections like respiratory syncytial virus (RSV), influenza and pneumonia can place significant strain on young, still-developing lungs.

The good news is that with a little awareness and a few simple, daily habits, parents and caregivers can give their children the best chance of staying well throughout winter.

Why children's lungs are more vulnerable in winter 

Children are more susceptible to respiratory infections because their immune systems are still developing. This means that inflammation and mucus can more easily lead to breathing difficulties.

Winter adds to this risk. Increased time indoors, closer contact with others and dry, heated air can irritate sensitive airways. “Children’s airways are smaller than adults and still developing, so in colder, drier winter conditions they become irritated and blocked more easily. This means even mild infections can make symptoms escalate faster than they would in adults,” explains Dr Pierre Breedt-Kriek, paediatrician at Life Groenkloof Hospital.

RSV, flu and pneumonia: how to tell the difference 

Respiratory illnesses often start with similar symptoms, but they can progress differently:

• Influenza or flu usually to comes on suddenly, with fever, body aches, fatigue and a persistent cough. Children may also feel more tired than usual and lose their appetite. A lot of times, children do not know how to describe body aches and can present with just general irritability.
• Respiratory syncytial virus (RSV) is just that, a virus, and one of the most common causes of lower respiratory infections in young children, particularly babies. While it often starts with mild cold-like symptoms, it can progress to bronchiolitis or even pneumonia. In severe cases, breathing may become fast, laboured or accompanied by wheezing. Look out for the skin pulling in under the ribs or in the middle of the neck when your child breathes in. This is a sign they are struggling to breathe and need medical attention.
• Pneumonia is a lung infection that can be caused by viruses (including RSV), bacteria or other organisms. It is generally more serious, affecting the air sacs in the lungs, which can fill with fluid or pus. Symptoms may include rapid breathing, chest discomfort, fever and a persistent cough.

For caregivers, it can be difficult to know when a child’s symptoms are a common cold or a sign that further care is needed. Dr Breedt-Kriek adds, “Most childhood respiratory illnesses start off mildly, with symptoms like a runny nose or light cough. However, parents should become concerned if a child is breathing faster than usual, working hard to breathe, struggling to feed, or if symptoms don’t improve after a few days. These are signs that medical attention may be needed.”

He emphasises that it is important to avoid using cough syrups in children without medical guidance. “Because children have limited capacity to clear their lungs, cough syrups can lead to build up of secretions and pus which can worsen their outcome. Measures like corticosteroid use (prednisone) also limits the body’s natural defence systems and can cause severe complications if not used correctly.

Five everyday habits that help protect children 

There is no single way to prevention of respiratory illness, but small, consistent actions can make a meaningful difference. Encourage your family to adopt these five habits to help reduce the risk of infection:

• Wash hands regularly with soap and water, especially before meals, after school and after play.
• Cover coughs and sneezes using tissues or elbows, not your hands. If family and friends want to visit small babies, ask them to wear a mask, not kiss the baby and to avoid visiting when they feel sick.
• Improve ventilation. Fresh air and ventilation reduce the concentration of viruses indoors. Open windows when possible and encourage time outdoors.
• Avoid smoke exposure. Tobacco smoke and indoor air pollution can irritate the airways and increase the risk of respiratory illness in children.
• Support overall health and immunity Ensure they get enough sleep, eat a balanced diet, and stay well hydrated to support their body’s natural defences. Make sure you keep up with your child’s immunisation schedule, enquire about flu vaccines, and make sure close contacts in the home are immunised against influenza.

Dr Breedt-Kriek emphasises that these habits may seem simple, but they are among the most effective ways to reduce the spread of infection.

“Parents play a critical role in early prevention because small, consistent actions can significantly reduce a child’s risk of infection. Being aware of hygiene practices and environmental triggers allows them to intervene early, limit exposure and recognise when something isn’t right,” he says. “In children, respiratory symptoms can progress quickly, so this awareness can make the difference between managing a mild illness at home and preventing a more serious complication.”

 

Vaccinations are an important part of protection

The annual flu vaccine is one of the most effective ways to reduce the risk of severe illness in people of all ages (especially children), particularly those with underlying conditions. Staying up to date with routine immunisation is equally important.

Dr Breedt-Kriek recommends that all children, particularly those under five, or those with underlying conditions such as asthma or prematurity, should receive the annual flu vaccine.

Staying up to date with routine immunisations is important. For some high-risk infants, RSV preventive options may also be recommended. “RSV is a common cause of respiratory illness in young children; however, routine childhood vaccination is not yet widely available, and parents should speak to their healthcare provider about current and appropriate prevention options. Some children might benefit from receiving RSV antibodies, especially those at high risk for severe disease. Maternal RSV vaccination is widely available in South Africa, and all pregnant women should enquire about the vaccine – it can offer valuable protection in your child’s first six months of life.”

When to seek medical care

Most childhood respiratory illnesses improve with rest, fluids and supportive care. However, seek medical attention urgently if your child shows any of the following symptoms:

• Breathing that is fast, laboured or noisy
• A child struggling to speak or feed due to breathlessness
• Pale or blue lips
• A high (above 38.3°C) or persistent fever
• Unusual sleepiness or difficulty waking
• Persistent vomiting, especially vomiting preceded by severe coughing episodes
• Signs of dehydration (such as fewer wet nappies or dry lips)

“Often, it is not just one symptom, but rather how your child seems overall. If they look unwell or if you feel uneasy, make an appointment with your doctor immediately.” “Parents should trust their instincts. If a child’s breathing becomes rapid or laboured, if you notice the chest pulling in with each breath, any bluish colour around the lips, or the child is unusually drowsy or difficult to wake, these are red‑flag symptoms that require urgent medical attention.

He further highlights that signs like a high fever that persists, poor feeding, or dehydration should also prompt a same‑day review by a doctor. “In young children, respiratory illnesses can deteriorate quickly, so early assessment is always the safest approach.”

Why paediatric care makes a difference for respiratory illness

Children have distinct medical needs. Their symptoms can change quickly and t and they require specialised care tailored to their needs.

Paediatric-focused teams are trained to assess and manage respiratory illness in children, providing appropriate support such as oxygen therapy, nebulisation or careful monitoring when needed.

Equally important is the care environment. Child-friendly spaces and experienced healthcare teams can reduce anxiety and support a smoother recovery for both children and their families

“Parents can support recovery by encouraging rest, giving medication as prescribed and watching closely for any changes in symptoms.”

Paired with the right treatment and clear information, caregivers can be empowered to act with confidence, whether that means managing mild symptoms at home or knowing when to seek help.

 

Speak to your GP or paediatrician if you are concerned about your child's symptoms or risk of respiratory illness. Visit our website to find a paediatrician near you.