Quick answer: a run of illnesses in the first year of preschool is normal and is not a sign of a weak child or a dirty school. Most of it is viral and self-limiting. The important decisions are when to see a doctor, when to keep your child home, and how to reduce spread at home. Your doctor is the authority on your child; this is general guidance only.

Almost every family has the same experience. The child starts preschool, and the next six months seem to be one long cycle of runny noses, fevers and messages from the school.

It is exhausting, especially for working parents with limited leave. It is also expected, and it does end.

Why it happens

A young child arriving at preschool is meeting a large number of common viruses for the first time. There are hundreds of them, immunity to each has to be built individually, and a room full of preschoolers is an efficient sharing system. Children this age touch everything, put things near their mouths and have not yet mastered a tissue.

Six to twelve colds a year is within the normal range for a preschooler in their first year of group care. Most families notice a clear improvement in the second year, and by the time these children reach primary school they are often ill less often than classmates who stayed home.

The common ones

Hand, foot and mouth disease. Very common in Singapore and mostly affects under-fives. Usually starts with fever, poor appetite and a sore throat, followed by mouth ulcers and a rash or small blisters on the hands, feet and sometimes the bottom. It is usually mild and clears in about a week. The mouth ulcers are the miserable part, and the main risk is dehydration because drinking hurts. Cold drinks, ice lollies, yoghurt and soft bland food help. See a doctor for diagnosis, and go back promptly if your child will not drink, has a high fever that persists, is unusually drowsy or is not improving.

Colds and coughs. Runny nose, cough, mild fever. Antibiotics do nothing for these. Fluids, rest and time are the treatment.

Stomach bugs. Vomiting and diarrhoea, usually short-lived. Fluids are the priority. Watch for signs of dehydration: fewer wet nappies, no tears, a dry mouth, unusual sleepiness.

Conjunctivitis. Red, sticky eyes. Spreads easily and usually needs a doctor's look.

Chickenpox. Less common now with vaccination, but still circulating.

When to keep your child at home

The general principle: home if they are infectious, feverish, or too unwell to take part in an ordinary day.

Keep them home for a fever, for vomiting or diarrhoea, for a suspected or confirmed case of HFMD until your doctor says they may return, for conjunctivitis until treated, for an undiagnosed rash, and for any day when they are simply too miserable to cope.

Please also tell the school. Preschools are required to track and report certain illnesses, and early notice is what stops a small cluster becoming a large one. Nobody minds the call.

Why schools close rooms sometimes

If HFMD cases pass a threshold, a preschool may need to close a class or the centre for a period on health authority guidance. It is disruptive and we know how hard it is for working families. It is also the single most effective way to break a chain of transmission, and it is done to get everyone back to normal faster.

A centre that reports promptly and communicates clearly is doing exactly the right thing. Treat that transparency as a good sign rather than a bad one.

Reducing the spread at home

  • Handwashing, properly and often. Soap, running water, twenty seconds. Before eating, after the toilet, after coming home. Sing something to make the time pass.
  • Do not share cups, cutlery, towels or bedding during an illness.
  • Wipe the high-touch things. Door handles, taps, light switches, toys that have been in mouths.
  • Cover coughs with an elbow and get tissues into a bin immediately.
  • Wash hands after nappy changes. HFMD in particular can be passed on in stools for weeks after the child seems better.

Building a child who copes well

There is no supplement that will prevent this, and claims to the contrary should be treated with suspicion. What genuinely supports a young immune system is unglamorous: enough sleep, a varied diet, plenty of outdoor time and physical activity, keeping up with the national vaccination schedule, and not too much stress.

That is most of the list. It is not exciting, and it works.

What we do

We are strict about handwashing, we screen at the door, we clean and disinfect on a daily schedule, and we tell families quickly when something is going around, because information lets you make good decisions.

And we try to say the reassuring part out loud, because the first year can feel relentless: this phase is normal, it is temporary, and your child is not fragile. They are building an immune system, and that work has to happen somewhere.

Shaws Preschool has cared for children across the East Coast and Serangoon since 1989, with health and hygiene routines built into every day. Come and see how we run a morning: book a tour. For any concern about your own child's health, please speak to your doctor.