A baby with a cold needs three things above all: a clear nose, milk and sleep. Saline drops and a nasal aspirator before feeds and before bedtime make the biggest difference. An ordinary cold lasts one to two weeks. Call 1177 (the national healthcare helpline) if your baby is under three months and has a fever, if they are working hard to breathe, or if they are drinking noticeably less than usual.
It is four in the morning in Hammarby sjöstad. A four-month-old is snuffling, lets go of the breast after three sucks and screams because she cannot get air through her nose. You have been up three times. It is not dangerous, but it is exhausting, and it will be roughly like this six to ten times in the first year if the baby has a sibling at förskola (municipal preschool, from age one).
Why a cold is worse for a baby
Babies breathe almost entirely through their noses in the first months. A blocked nose therefore means it is hard to feed and hard to sleep, not just irritating. The nasal passages are also so narrow that a little mucus is enough to block them. That is why a cold a five-year-old barely notices can turn a baby into a grizzly bundle for a week. The immune system has never met these viruses before either, so every cold in the first year is a new one.
A blocked nose: what actually works
- Saline drops. Available at the pharmacy. Lay the baby on their back, a few drops in each nostril, wait half a minute. The mucus loosens and runs out, or is swallowed. Completely harmless, can be used often.
- A nasal aspirator afterwards. The simple one with a tube, or the pump kind. Suck gently, one nostril at a time. Before feeds and before bedtime, that is when it counts.
- Upright when the baby is awake. Against your shoulder, in a carrier, on your lap. The mucus drains backwards instead of collecting.
- A steamy bathroom. Run a hot shower, shut the door and sit with the baby in the steam for ten minutes. Many babies' mucus loosens.
- Feed more often, less at a time. A baby with a blocked nose cannot manage a long feed. Offer more often and accept shorter feeds.
- Greasy cream under the nose. The skin quickly turns red from snot and wiping. Apply after every wipe.
Decongestant nasal spray for adults must not be given to babies. There are nasal sprays made for children from a certain age, but ask the pharmacy, and never give anything to a child under one without checking first. Cough medicine has no place with small children: it does not help, and some kinds are downright unsuitable.
Sleep during a cold
Expect more wake-ups for a week. Clear the nose right before bedtime, not half an hour before. Put the baby down on their back as usual; do not put anything under the head or the mattress, babies should sleep flat. During the day, naps can happen in a carrier on a walk, where many babies sleep better. Split the nights if there are two of you: one takes it until two o'clock, the other the rest. It is a week, not a new habit, so whatever you do to get the baby to sleep now, you do not have to keep doing once she is well.
Fever in babies: different rules by age
| Age | What applies |
|---|---|
| Under 3 months | Fever, 38 degrees or more: contact a doctor the same day, even if the baby seems bright. Small babies can become seriously ill quickly and show it late. |
| 3 to 6 months | Call 1177 for advice, especially if the fever lasts more than a day, the baby is drowsy or does not want to feed. |
| Over 6 months | The fever itself is not dangerous. Judge the general condition: drinking, weeing, can be comforted. Call if the fever lasts more than four days. |
| All ages | Always call for laboured breathing, drowsiness that does not lift, a rash that does not fade when you press on it, or if the baby is not drinking. |
When to call 1177
- The baby is under three months and has a fever
- Breathing fast, pulling in between the ribs or at the base of the throat, nostrils flaring, grunting on the out-breath
- Drinking less than half the usual amount, or has noticeably fewer wet nappies than usual
- Drowsy, hard to wake, crying in a whiny or plaintive way you do not recognise
- Fever for more than four days, or fever that comes back after fever-free days
- Pulling at the ear, screaming at night, seems to be in pain
- A cough that has not cleared up after three weeks, or a cough with whooping
- You are worried. That is reason enough, every time.
Call 112 if the baby has blue lips or blue skin around the mouth, pauses in breathing, cannot be woken or has a seizure. Do not wait for it to pass.
RSV: the cold that can become more for the smallest babies
RSV (respiratory syncytial virus) is a common cause of colds that for most people is just a runny nose, but in the smallest babies it can cause inflammation of the small airways, with laboured breathing as a result. It peaks in winter. Babies under six months, babies born prematurely and children with heart or lung conditions are the most vulnerable. The signs are fast breathing, pulling in of the chest, wheezing on the out-breath and not having the energy to feed. That needs to be assessed the same day. Some regions offer protection against RSV to the smallest babies; ask BVC (the child health clinic every family is enrolled in) what applies where you live.
Colds and a sibling at preschool
With a sibling at preschool it is realistic to expect one cold a month through the winter half of the year. What you can do: wash hands when the older sibling comes home, do not share dummies, spoons or cups, and keep coughing visitors away from the baby in the first months. It cannot be avoided entirely, and it is not your failing when it comes. A baby with six colds in the first year has a perfectly normal immune system that is doing its job.
How we do it with our families
Sanna looks after a seven-month-old in Bromma on Tuesdays and Thursdays while his mum works from home. When the baby has a cold, the shift starts with saline drops and the nasal aspirator before the bottle, and the lunchtime nap happens in the carrier on a walk around the block instead of in the cot. She counts wet nappies and writes the number on the note, along with how much he has drunk and whether his breathing was any different. Those are the things 1177 asks about first, and they are hard to answer if nobody has been counting.
This text is general information and does not replace advice from BVC, your vårdcentral (local health centre) or 1177. If you are worried about your child, call 1177. In an emergency, call 112.
Would you like a nanny who knows your child, knows how they usually are and notices when something is different? Book a free first meeting with the nanny in your home.
Read more: Fever in children · Laboured breathing while your child sleeps · Colds in children · FAQ
Frequently asked questions
Can a baby have cough medicine or nasal spray?
Cough medicine should not be given to small children, it does not help and can do harm. Decongestant nasal spray for adults must not be used on babies. Saline drops are fine from day one. Always ask the pharmacy or 1177 before giving anything else to a child under one.
How long does a cold last in a baby?
The runny nose and fever usually last about a week, the cough can linger for two to three weeks. If the baby gets worse after starting to get better, or gets a fever again after a few fever-free days, call 1177. It could be an ear infection or something else that needs to be assessed.
Can the baby go outside with a cold?
Yes, if the baby is fever-free and up to it. Fresh air often makes the nose run more, which is good, and many babies sleep best in the pram even when snuffly. Dress the baby as usual and avoid wind straight in the face.
How often can I use the nasal aspirator?
Before feeds and before sleep, that is when it does some good. More often than that and the lining gets irritated and swells more. Always use saline drops first so the mucus loosens, otherwise you are sucking at empty nasal passages.
How do I know if my baby is working hard to breathe?
Look at the baby undressed. If the skin pulls in between the ribs, under the ribcage or at the base of the throat with every breath, if the nostrils flare, if the baby grunts on the out-breath or breathes much faster than usual, call 1177 straight away. Blue lips or pauses in breathing: call 112.