Is It a Cold, the Flu, an RSV Infection, or COVID-19?

Your child has a sore throat, cough, and a high fever. Is it just a cold? Or could it be the flu or an RSV infection? Is it COVID-19?

All these illnesses are caused by viruses that infect the respiratory tract. All are contagious and can spread easily from person to person. And they cause some similar symptoms. So it can be hard to tell them apart.

Here are some things to look for if your child gets sick.

The Common Cold (Caused by Many Different Viruses)

Symptoms

Cold symptoms usually are mild. They often include a tickly throat, a runny or stuffy nose, and sneezing. If there's a fever, it is not high. A child with a cold usually feels quite well and has a good appetite and normal energy levels.

Tests & Treatment

There is no test for the common cold, and no specific treatment. It just needs to run its course.

Prevention

Because so many viruses cause colds, there's no vaccine that can prevent them. But it's always a good idea to wash hands well and often, cover coughs and sneezes, and avoid people who are sick.

The Flu (Caused by the Influenza Virus)

Symptoms

The flu can also be mild. Usually, though, kids with the flu feel worse than if they have a cold. They might have a fever that comes on suddenly, with chills, a headache, and body aches. They can have a sore throat, runny nose, and cough. And they feel generally miserable and tired and don't have much of an appetite. Some kids even have belly pain, nausea, vomiting, or diarrhea.

Tests & Treatment

A doctor can check if someone has the flu by doing a test that looks for the flu virus.

Most kids with flu get better at home with plenty of liquids, rest, and comfort. In some cases, a doctor might prescribe an antiviral medicine to ease symptoms and shorten the illness. Someone who gets very ill might need treatment in the hospital.

Prevention

Many cases of the flu can be prevented by getting a flu vaccine every year.

RSV Infection (Caused by Respiratory Syncytial Virus)

Symptoms

RSV — respiratory syncytial (sin-SISH-ul) virus — usually causes cold symptoms. But in some infants and young children, it can lead to a more serious infection, such as bronchiolitis or pneumonia. Babies with an RSV infection might have fever, cough, wheezing, and trouble breathing. They might breathe very fast, grunt with the effort, or have retractions (when the skin between and below the ribs pulls in during breathing). They might feed poorly or seem very sleepy.

Tests & Treatment

Often, doctors can diagnose an infection by asking about symptoms and doing an exam. Sometimes they might do a test to look for the virus in nasal fluids.

Most kids with an RSV infection get better on their own. But if it's more serious, they may need care in the hospital to get oxygen and intravenous (IV) fluids if it’s hard for them to eat.

Prevention

Pregnant women can get an RSV vaccine at 32–36 weeks of their pregnancy. Babies younger than 8 months old whose mothers didn't get the vaccine can get an RSV antibody shot during or right before RSV season. Some babies 8–19 months old who are at risk for getting very sick from RSV can get a second shot as they enter their second RSV season.

COVID-19 (Caused by a Type of Coronavirus)

Symptoms

Kids with COVID-19 may not have any symptoms, or their symptoms can be mild, like those of a common cold. Some can have more severe flu-like symptoms. So COVID-19 symptoms can look very much like those from a cold, RSV infection, or the flu. But they can also look different. For example, they can include a loss of taste or smell, or a variety of rashes.

Sometimes kids have symptoms several weeks after being infected with the virus, as part of a condition called multisystem inflammatory in children (MIS-C). And rarely, they might have symptoms that last for a long time, a condition known as long COVID or post-COVID-19 condition.

Tests & Treatment

To see if someone has COVID-19, doctors can do a test that looks for a piece of the virus in the respiratory tract. They also can check for a past infection by doing a blood test that looks for antibodies.

Most people with a mild illness, including kids, don’t need any specific treatment, and they get better with plenty of liquids, rest, and fever-reducing medicine. A very few kids who are at higher risk for severe COVID-19 can get antiviral medicine to keep them from getting very sick and needing hospital care.

Some people who get very sick from COVID-19 will need hospital care, possibly in the ICU. Doctors can watch them closely, give oxygen or IV fluids if needed, and treat any problems. Rarely, they will also give medicines such as antiviral drugs or steroids. Someone who needs it can get extra help to breathe from a ventilator (breathing machine).

Prevention

Everyone age 6 months or older should stay up to date on their COVID-19 vaccines. They protect against common variants and work well to prevent serious illness, hospitalization, and death due to COVID-19.

When Should I Call the Doctor?

If you have any doubts or questions, it's best to call your doctor. An illness that seems like a cold can turn out to be the flu, RSV, or COVID-19. And other illnesses, like strep throat or pneumonia, can cause similar symptoms but need different treatment.

Sometimes it's hard to know for sure which germ is causing the problem. Then, doctors might do some tests to find out. Sometimes a person can be infected with two viruses at once or get one after the other.

Get medical care right away if your child:

• seems to be getting worse
• has trouble breathing
• has a high fever
• has a bad headache
• has a sore throat
• seems confused
• has severe belly pain
• has pain or pressure in the chest
• has trouble staying awake
• looks bluish in the lips or face

Call your doctor right away if your child has asthma or another illness and starts to feel sick with symptoms that might be the flu or COVID-19. The doctor might want to do some tests or start a specific medicine.

What Else Should I Know?

Common steps that help prevent the spread of germs work well against these viruses. It's always wise to:

• Wash hands well and often. Wash for at least 20 seconds with soap and water or use hand sanitizer with at least 60% alcohol.
• Avoid people who appear sick.
• Clean surfaces that get touched a lot (like doorknobs, counters, phones, etc.).