Being a parent these days means constantly second-guessing every sniffle or sneeze, cough or hint of congestion — because, let’s face it, the chance of being exposed to Covid-19 is still very real. Just type “does my child have a co…” into google and the proof is in the algorithm. (The rest of that inquiry, of course, is “does my child have a cold or Covid.”) Add in flu season, a surge in respiratory syncytial virus (RSV) cases — and the fact that our kids are being exposed to viruses they might not have had contact with since the start of the pandemic — and the illness options seem endless.
But how might caregivers know if a child has a cold, Covid, the flu, or RSV? “Unfortunately, there really isn't a great single answer to this,” pediatrician Dr. Krupa Playforth, M.D., FAAP tells Romper. “At this time, given the Covid-19 infection numbers, any symptoms could be a marker of Covid-19, and likely warrant a test.” But while a test is the only way to be positive (pun obviously intended) as to what virus your child has or doesn’t have, there might be some symptoms (or timing of symptoms) that could be more prevalent in certain situations than in others.
Common cold symptoms in children
Even the “common cold” isn’t one-size-fits-all when it comes to what symptoms a child might present. Why? Playforth explains that “the ‘common cold’ is caused by multiple different viruses, and the specifics may depend on the type of virus that is the cause.”
According to the experts, common cold symptoms in kids often include:
- A runny nose or nasal congestion
- A sore throat
- Possible headaches, fatigue, poor sleep and/or appetite, and dehydration
- Sometimes fever
Dr. Rebekah Diamond, M.D., pediatrician and author of Parent Like a Pediatrician, tells Romper that children “tend to get sicker with some of the common colds when they are younger, but if that’s not happening, then [symptoms are] pretty much the same as adults.” She adds, though, that children do get fevers more often (and at higher temperatures) than adults do, so it’s not uncommon for kids to run a fever with a cold.
The American Academy of Pediatrics (AAP) notes that a rectal thermometer reading of 100.4 degrees Fahrenheit and above is considered a fever in children. The fever temperature, along with the accompanying symptoms (how long it lasts and the child’s age) often dictates the course of action and when to call the doctor:
- For fever in babies under 8 weeks old, seek immediate medical attention.
- For fever in babies under 12 weeks old, contact the pediatrician right away. Never give babies under 12 weeks Tylenol (or any medication) unless told to by the pediatrician. (The AAP actually recommends calling a health care provider before administering fever reducers for all children under 2 years.)
- Guidance varies, but in babies 3-6 months, the general thought is to call a medical provider for fever within 24 hours — and more urgently if the fever is above 102 or accompanied by other symptoms, such as cough, dehydration, vomiting, or diarrhea.
- Contact a child’s doctor for any fever lasting longer than 24 hours in children younger than 2 years (or sooner if accompanied by other symptoms) and any fever lasting longer than three days in children 2 years and older. And for fever in all babies and children, call a medical provider immediately if it is repeatedly above 104 degrees Fahrenheit
Of course, you should always reach out to your child’s primary care provider or seek immediate medical attention if you are ever concerned about your child’s symptoms or suspect an emergency.
Common Covid-19 symptoms in children
Just as there are many different viruses that can cause the “common cold,” the changing nature of the Covid-19 virus makes it difficult to pinpoint specific symptoms that can define a child’s illness as a classic case or make it much different from other viruses. “It’s been an evolving situation with variants,” explains Diamond. “At first [kids were] mostly asymptomatic, and then with [the] Delta [variant], kids were getting a little sicker, still primarily with respiratory symptoms or sometimes with more of the inflammatory type of Covid — high fevers, feeling sick.” She says now with Omicron, a sore throat and gastrointestinal symptoms have been common in kids (along with breathing issues that she sees as a pediatric hospitalist) — although it can, of course, still look like a cold.
As per the experts, kids might experience:
- Symptoms similar to a common cold (nasal congestion/runny nose, coughing, sore throat, headache, fatigue and decreased appetite, and fever)
- Gastrointestinal symptoms, like vomiting, diarrhea, and/or abdominal pain
- Loss of taste or smell
- Chest pain
- Body aches and muscle cramping
- Difficulty breathing or shortness of breath
While some children do, of course, develop severe breathing issues, Playforth notes that the “most recent variant typically causes fairly mild symptoms in children and adults.”
Common flu symptoms in children
The good news with the flu is that it is typically not common during roughly half the year. The bad news is that everything has seemingly changed since Covid, meaning that it is now difficult to predict when flu season will begin and end — and what other viruses will be on the rise. “Influenza virus causes the flu in children and adults, and is usually seasonal during the late fall and winter months,” pediatrician Dr. Sara Siddiqui, M.D., FAAP, tells Romper. But, of course, like other viruses, it can change depending on the year, says Diamond, who also adds that there is usually an influenza type A and type B each season.
In general, though, Siddiqui notes, that symptoms of the flu might include:
- High fever, often greater than 102 degrees Fahrenheit, within the first 48 hours
- Muscle aches and pains
- Possible gastrointestinal problems
- Cold symptoms, including a cough and congestion
Of course, “reports of increased cases occur when an outbreak is in progress,” explains Siddiqui, adding that the “flu vaccination helps to prevent severity and hospitalization secondary to flu and also can impact the spread of the flu virus.”
Common RSV symptoms in children
RSV is a respiratory illness that is so common that the Center for Disease Control (CDC) suggests that practically all children contract the virus at some point before they turn 2. Premature infants (whose lungs may not yet be fully developed), babies (especially those 6 months and younger), children with underlying conditions (such as congenital heart disease, chronic lung disease, neuromuscular disorders, or weakened immune systems), and older adults are at the greatest risk for more serious illness.
“For many children, RSV will look like a severe cold,” notes Playforth. “However, for some, it will go on to cause bronchiolitis.” Diamond explains that RSV isn’t the only virus that can cause bronchiolitis (“when the lower airways get inflamed and filled with mucus”) — but RSV is kind of famous for it, especially in kids under 3. Treatment is often supportive, but she says to look for signs of respiratory distress (meaning breathing fast, retraction of the muscles around the ribs, nose flaring, and skin tugging in at the neck) that indicate the need for emergency care.
“As kids get older RSV gets less severe,” reassures Diamond. “You can get it again in the upcoming years, but being bigger and older means it’s less severe even if you haven’t had an infection already.”
In general, symptoms — which Playforth states usually worsen on days three to five of illness — may include:
- Congestion and/or runny nose
- Sore throat
- Wheezing, difficulty breathing, and low oxygen (which can be signs of bronchiolitis)
- Poor appetite and dehydration
- Pneumonia (an infection of the lungs in the lower respiratory tract)
Playforth notes that while “some children will develop dehydration or fatigue and may need to be admitted for IV fluids or oxygen,” most children fully recover within one to two weeks. Adds Siddiqui, “Yes, RSV is dangerous for small and premature babies and young infants. But most older kids and adults will do fine."
How to know if a child has a common cold, Covid, the flu, or RSV
Many of these viruses can look similar from one person to the next, so there is no definitive way to determine if your child has Covid, the flu, or RSV without testing (there is a test for each) — or simply a common cold. There can, though, be some helpful situational factors that come into play.
Assess what’s going around in your community
“If something is very contagious and going around, that’s the most likely thing to be causing it,” says Diamond. “So if there is a Covid exposure and then a few days later [your child has] these symptoms, it’s more likely to be Covid than in another situation. But could your kid have had another virus, like adenovirus for example, that can make you look very sick similar to Covid? Sure, it can certainly be that, too.”
Track the symptoms and their behavior
Sometimes the onset of symptoms — both the proximity to exposure and the initial severity — can also help indicate if a child has a cold, Covid, the flu, or RSV. “In most cases, flu starts very abruptly, and most children will experience fever, body aches, and fatigue,” explains Playforth. “The common cold and sometimes Covid-19 tend to begin more insidiously, and the symptoms may be quite minor in many children.” Siddiqui adds that with Covid, though, there may be a loss of taste or smell, along with a high fever that may last from 24 to 72 hours in infants and young children.
As for RSV, Siddiqui says that it can be difficult to tell exactly what the virus is during the initial presentation of symptoms — but RSV usually gets worse within a few days. “Chest congestion, cough, and nasal discharge can increase during day three to five, especially worsening at night,” she explains, adding that infants, particularly those under 3 months, “may present with rapid breathing, persistent cough, or fever during this time.”
Consider their vaccination status
Children’s level of protection — meaning whether or not they have had this year’s flu vaccine or if they are up-to-date with available Covid vaccinations — might also help determine what virus (and the severity of it) is causing these common symptoms, explains Diamond, as exposure presents a greater risk for the unvaccinated. They are not fail proof, but these vaccines are designed to protect people from many short and long term effects. “Flu and Covid both can have really serious long term effects. And so I hope parents will find the right information that makes them feel really comfortable getting their kids protected.” While there is currently no protection against RSV, recent trials show promising results for several RSV vaccines — one which would be administered to pregnant women, who would then pass along antibodies to the fetus through the placenta.
How to treat the cold, Covid, the flu, and RSV in children
Oftentimes there isn’t much that can be done to actually treat these viruses in children, especially when it comes to the common cold — but focusing on your child’s comfort (after checking in with your medical provider regarding any concerns) is key.
Siddiqui says that means nursing with fluids, rest, pain and fever-reducing medication like Tylenol (after consulting with your pediatrician), saline drops, and the use of a cool-mist humidifier or sitting in a steamy bathroom to break up mucus. She also reminds parents that babies under 3 months of age should be examined by a medical professional for a fever of 100.4 degrees Fahrenheit or more, as well as any type of congestion, cough, or difficulty breathing, and before any at-home treatments — and that all infants and children should be evaluated if symptoms persist or worsen or are accompanied by a fever. Also, remember that decongestants and cough medicines are not safe for babies and young children and age requirements for fever reducers — acetaminophen or ibuprofen (for babies over 6 months), but never aspirin — vary depending on the type of medication and age of baby.
While at-home treatments may be similar for these viruses, Siddiqui adds that “checking for worsening symptoms, breathing issues, or respiratory distress” when dealing with Covid and “checking for pneumonia and dehydration” in cases of influenza are an important part of the evaluation and diagnosis process. Playforth adds, “There are antiviral medications that can be used for influenza and Covid-19 if given early in the course, although these have their pros and cons and not all are approved for all ages.” Of course, medications used to treat Covid are usually reserved for more extreme cases, says Diamond.
Siddiqui also notes that when dealing with a suspected or confirmed case of RSV, “checking for signs of bronchiolitis and pneumonia is important in monitoring the progression of the virus — and measuring a baby's respiratory rate, in addition to measuring other vital signs like pulse and oxygenation, is important, too.” For a select high-risk population of babies, there is a monoclonal antibody called Synagis available, but Playforth notes that “it needs to be given monthly throughout RSV season and requires pre-approval.”
What should be reassuring, says Playforth, is that “for all four, the vast majority of children will recover fully, although some symptoms may linger after the acute phase of illness, especially for influenza, Covid-19, and RSV.” And, while it is helpful and often logistically important to know what exactly your kid is brewing for a variety of reasons, she explains that “hydration, comfort, and watching for signs of worsening are the key elements” to helping kids get through it. Parents can get through it by taking comfort in knowing that they certainly won’t be alone in dealing with a range of viruses for the foreseeable future.
Dr. Sara Siddiqui, M.D., FAAP, pediatrician at the NYU Langone Huntington Medical Group and clinical assistant professor in the Department of Pediatrics at NYU Langone Hassenfeld Children’s Hospital in New York