Cuti ends Sunday. The bugs come Monday.

"Doctor, what should I be worried about when school restarts?"

I got this question four times last week. Different parents, different words, same worry. So let me answer it properly · before Monday.

The first two weeks back from school holidays are a viral free-for-all. Not because schools are dirty. Because your child just spent two weeks at malls, kampung gatherings, and open houses · then walks back into a classroom of thirty kids who did the exact same thing. Whatever was going around one household last week is in your child’s nose on Monday.

This is normal. Annoying, but normal.

Here’s what I usually see in clinic the first week back.

🦶 Hand, foot and mouth disease (HFMD)

The big one in Malaysia right now · peaks March through July. Starts with low fever and a sore throat, then small blisters on the hands, feet, and inside the mouth. MoH protocol is home isolation for at least 10 days. Paracetamol for fever and pain. Cold drinks, soft food. Most cases are mild and self-limiting.

🚩 Watch for: high fever past day 3, refusal to drink, drowsiness, or twitching. Those are the EV71 red flags. Come and see me.

👁️ Conjunctivitis (mata merah)

Red, watery, crusty in the morning. Spreads fast in classrooms because kids touch everything then their face. Most cases are viral and clear in 5 to 7 days. Bacterial ones (thick yellow discharge, one eye worse than the other) usually need antibiotic drops.

🚩 Watch for: eye pain, blurred vision, or sensitivity to light. Bring them in.

🤧 The common cold and cough

Runny nose, sore throat, mild cough, sometimes a low fever. Usually 5 to 7 days. Don’t reach for over-the-counter cough mixtures for kids under 6 · they don’t help and aren’t recommended. Saline drops, honey (only over age 1), fluids, rest.

🚩 Watch for: fast breathing, wheeze, chest pulling in with each breath, or fever past day 3. That’s when a viral cold becomes something else.

🤢 Gastro (vomiting and diarrhoea)

Rotavirus, norovirus, or a viral combo. Spreads through hands and shared snacks. The danger here isn’t the bug itself · it’s dehydration.

🚩 Watch for: no urine for 6 to 8 hours, dry mouth, sunken eyes, lethargy. Start oral rehydration salts early. If your child can’t keep anything down, come and see me.

🧼 The boring stuff that actually prevents this

Handwashing before snacks. A small hand sanitiser in the school bag. No sharing water bottles. Own utensils where possible. And · I know this one is hard · keep them home if there’s a fever or any active rash. One day at home now saves five at home next week.

🌡️ A note on fever

Fever itself is not the enemy. It’s the body doing its job. The number on the thermometer matters less than how your child looks and behaves. A child with 39°C who is drinking, alert and playing is doing better than a child with 38°C who is floppy and not responsive. Treat the child, not the number.

👩🏻‍⚕️ When to come and see me

• Fever past 3 days, or any fever in a baby under 3 months

• Fast or laboured breathing

• Persistent vomiting, or any sign of dehydration

• Rash with fever (we always want to rule out dengue and measles)

• Drowsiness, neck stiffness, or "just not themselves"

If you’re unsure · earlier is always better. Come and see me at PMC, or book an appointment here.

With lots of love and a warm hug,
Dr. Nisa Khalil

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