Conjunctivitis in children
Advice for professionals
Conjunctivitis ("red eye" or "pink eye") is a common eye condition that affects children, especially under 5 years of age. It can either be caused by an infection or by an allergy. Infectious conjunctivitis is contagious and may spread to other household members. Allergic conjunctivitis is more common in children with allergies such as hay fever.
Symptoms of conjunctivitis include:
- A red or pink eye (or both eyes)
- Redness behind the eyelid
- Swelling of the eyelids, making them appear puffy
- Excessive tears
- Either a watery discharge or a yellow-green discharge from the eye which dries when your child sleeps, causing crusting around the eyelids
- A dislike of bright lights (photophobia)
- A gritty feeling (like there is sand in the eye)
- Itchiness of the eyes and eye rubbing
- Children with allergic conjunctivitis almost always rub their eyes excessively. They may also have an itchy or runny nose and sneezing
When should you worry?
If your child has any of the following:
- Becomes pale, mottled and feels abnormally cold to touch
- Is going blue around the lips
- Has a fit/seizure
- Becomes extremely agitated (crying inconsolably despite distraction), confused or very lethargic (difficult to wake)
- Develops a rash that does not disappear with pressure (the 'Glass Test')
- Is under 3 months of age with a temperature of 38°C / 100.4°F or above (unless fever in the 48 hours following vaccinations and no other red or amber features)
You need urgent help
Go to the nearest Hospital Emergency (A&E) Department or phone 999
If your child has any of the following:
- Severe pain in eyes
- Extreme sensitivity to light (photophobia)
- Changes in vision including flashing lights (vision can appear blurred or misted because of discharge smeared over the surface of the eye, but this will usually clear on blinking or wiping the eyes)
- Severe headache
- Persistent vomiting
- Babies under 28 days with a red eye(s) or lots of thick pus from their eye(s). A sticky eye(s) without redness or swelling is quite common in babies due to blocked tear ducts - this does not require review by a doctor
- Blisters develop on the skin next to the eye
- Redness and swelling of the skin around the eye
- Is finding it hard to breath
- Seems dehydrated (dry mouth, sunken eyes, no tears, drowsy or passing less urine than usual)
- Is becoming drowsy (excessively sleepy) or irritable (unable to settle down with toys, TV, food or picking up) - especially if they remain drowsy or irritable despite their fever coming down
- Has extreme shivering or complains of muscle pain
- Is 3-6 months of age with a temperature of 39°C / 102.2°F or above (but fever is common in babies up to 2 days after they receive vaccinations)
- Continues to have a fever above 38.0°C for more than 5 days
- Is getting worse if you are worried
You need to contact a doctor or nurse today
Please ring your GP surgery or call NHS 111 - dial 111
If none of the above features are present
Self care
Continue providing your child’s care at home. If you are still concerned about your child, call NHS 111 – dial 111
This content has been developed by healthcare professionals from across the UK in collaboration with the RCPCH.
Sticky eye in a baby/blocked tear duct - no treatment required (green)
Mild conjunctivitis - no treatment required (green)
Peri-orbital cellulitis - needs same day review (amber)
Causes of conjunctivitis
Most cases of conjunctivitis in children are caused by an infection; your child may also have a runny nose, cough or earache.
Treatment
Most children with conjunctivitis do not need treatment with antibiotics - it takes the same amount of time to get better whether an antibiotic is used or not.
If your child has any features of infection (amber or red features above), they will need to be urgently seen by a healthcare professional who may decide that your child may benefit from antibiotic treatment. If your child is under 28 days of age and has a red eye(s) or large amounts of pus discharging from their eye(s), they need to be seen by a healthcare professional.
You can help relieve symptoms by gently cleaning the eye(s) with cotton balls soaked in warm water.
- Clean in one direction only, outwards from the inside (nose side) of the eye. This prevents the other eye becoming infected if only one eye is affected
- Discard the cotton ball each time to prevent reinfection
- Do not try to clean inside the eyelids as this may cause damage to the inside of the eye. Lubricating eye drops such as 'artificial tears' may give some relief
- If your child wears contact lenses, make sure they stop using them until their symptoms have completely gone
It can take up to 2 weeks for a child to fully recover from conjunctivitis . If your child is not improving after 2 weeks, you should take your child to see their GP.
Prevention
- To avoid conjunctivitis spreading to other family members, make sure all family members (and your children) wash hands regularly with warm soapy water and wash your child's pillows and face cloths in hot water and detergent. Avoid sharing towels and pillows
Your child does not need to be excluded from school or childcare if they have conjunctivitis.
There are many sensory issues associated with sleep including:
- Sensitivity to sound, touch, and visual stimuli which can be distracting and distressing and can affect the process of falling asleep.
- Interoception difficulties, particularly recognising when hungry, full or thirsty or when the person is tired.
- Some children are more sensitive to foods like sugar, caffeine and additives which keep people awake.
Look at the bedroom environment to see what may be affecting their ability to go to sleep and stay asleep. Do their pyjamas and bedclothes feel comfortable, are they too hot or cold? Is it too light or too dark, too noisy or too quiet? Perhaps it is too cluttered and stimulating. Think about your child’s diet. Are they eating too early or not having enough to eat? Are they eating food that can stimulate them close to bedtime. There can be added difficulties where children have restrictive diets but some simple adjustments of what is eaten and when can make a big difference.
Sticking to the same routine helps your child to know what to expect at bedtime and helps them feel secure. It also helps to support your child’s internal body clock and keep it on track. The age related sleep advice and information on this website can help with establishing routines. Some children will benefit from using picture timetables, timers or social stories to help them understand their bed-time routine. More information about visual supports can be found on these websites
Visual Resources | Autism West Midlands
Visual Supports | Autism Toolbox Autism Toolbox
Your child may be feeling overstimulated after a busy day and needs help to wind down, or their environment may be overstimulating with lots of toys, TVs and computers within reach. Avoiding TV and computers or hand-held devices an hour before bedtime can help your child to wind down. Activities that are good for the wind down period are jigsaws and colouring. Having a relaxing bath and milky drink can help some children, but for some children having a bath can over-excite them so they may need to have their bath earlier in the day.
Children who wake to use the toilet, wet the bed, or who wear nappies or pull-ups at night that need changing may have disturbed sleep. Eric, the children’s bowel and bladder charity are a good source of advice on this topic.
What might help
Keeping a sleep diary
A sleep diary can help you understand what may be causing difficulties with sleep. Fill it out every evening and record as much as you can. You can use it to spot patterns and make changes that may help.
The Sleep Charity have templates you can download; one for teenagers and one for younger children.
Seeking advice and help from sleep services
There are organisations that can help you if you are having difficulties with your child’s sleep. There are many national organisations, including those who specialise in sleep for SEND families, and there are also community-based services in Shropshire, Telford and Wrekin. Click the link at the bottom of page to visit our support services page.
Understanding sleep cycles
The circadian sleep cycle is a 24-hour cycle that helps govern essential bodily functions especially the sleep-wake cycle. It plays a vital role in a person’s ability to sleep in one consolidated block of time at night and to stay awake during the day. As the sun sets in the evening, the brain begins producing melatonin, a hormone that induces sleepiness. Core body temperature also drops.
As melatonin and tryptophan (an amino acid which helps produce melatonin) are naturally produced in the body, there are things you can do to help their production. Darkness helps to promote the production of melatonin which is why it is a good idea to put your child to sleep in a darkened room, and light emitting devices such as tablets and phones also can destroy Melatonin so should not be used for at least an hour before bed. New research shows that limiting exposure to screens and increasing physical activity levels during the day has a positive effect on children's overall physical, mental health and wellbeing, including sleep.
Setting a waking time consistently even in holiday times, called ‘anchoring’ the wake time, can help to reset the body clock over time. This should be accompanied with exposure to lots of light on waking to support circadian rhythm.
Melatonin and tryptophan occur naturally in some foods and drinks such as milky drinks and cereals which is why having a milky drink before bed can help settling to sleep. For more information visit Diet & Sleep - The Sleep Charity
Prescriptions of melatonin
Behavioural strategies and practical solutions are the best way to address sleep difficulties, but if they are having a significant impact on your child’s ability to function, a drug form of melatonin is sometimes prescribed for neurodivergent children. As the drug’s function is to re-set sleep and wake cycles, it works best combined with good sleep hygiene practices. It is important that is it taken under medical supervision and not purchased on-line so that it is closely monitored for dosage and side effects. It should be prescribed for the shortest period necessary as the long-term effects of the drug on children’s development are not yet known.
In Shropshire, Telford and Wrekin the Community Paediatric Service and the BeeU Service (CAMHS) can prescribe Melatonin for children and young people who meet ALL of the following criteria.
- the child/young person must be open to and being treated by the service due to a neurodevelopmental/mental health need (diagnosis not required)
- sleep issues are causing significant impact on the child/ young person, for example due to daytime sleeping or behavioural problems that are impacting daily functioning or educational attendance
- behavioural approaches have been tried and failed. These may have been offered by the service (where available) or by community sleep support services.
GPs are unable to prescribe Melatonin although they sometimes issue repeat prescriptions when prescribing has been started by a specialist (such as a paediatrician or child psychiatrist).
Further support
Click on the link below to visit a page with information about
- national websites and sleep organisations
- local community services in Shropshire, Telford and Wrekin.