Differences Between RSV, COVID-19, and Flu

Does your child keep getting colds? Runny noses? A cough that just won’t go away? How can you tell if it’s COVID-19, the flu, or RSV? According to the American Academy of Pediatrics, even healthy kids get about 6–10 colds each year. There are a number of different viruses that make the rounds, especially during fall and winter months, and here are some things to watch for when it comes to making decisions about diagnosis, home care, and potential visits to the doctor.

What are flu symptoms, COVID symptoms, and RSV symptoms?

There is a lot of overlap between symptoms. This means some of the symptoms of flu, COVID, and RSV can appear similar to other respiratory illnesses, up to and including the common cold. It would require a test to confirm a diagnosis for flu, COVID, or RSV. Plus, it’s also possible to have more than one of the viruses at the same time!

The chart below shows the likelihood and severity that each symptom brings to each virus. That’s why which illness your child has can be difficult to determine based on symptoms alone!

Chart showing the likelihood and severity that each symptom brings to each virus including the flu, COVID, and RSV

Does it matter which virus is causing these symptoms?

It doesn’t really make a difference which virus your child has. What matters is how sick the virus is making them. Another thing to keep in mind is that these viruses can make children seem sicker the younger they are. That’s because young kids (especially those under 2 years old) have small airways. This is normal for their age! Therefore, they usually look much sicker than adults do when they have a common cold.

What is RSV? This is a question parents are asking more the last few years as it has become more topical. RSV stands for “respiratory syncytial virus.” With RSV, you can usually tell the difference from other illnesses because symptoms are usually the worst on days 3 through 5 and last about 7 to 14 days.

When should I call my pediatrician?

Here are a few guidelines to help you decide when to call your child’s pediatrician:

When your child is struggling to breathe. This may look like:
- Breathing quickly (i.e., belly is moving fast).
- Noisy breathing (i.e., grunting noises, wheezing).
- Can’t catch their breath.
- Retractions: You can see the skin between and under their ribs sucking in when they breathe, nasal flaring.
If you are concerned about dehydration:
- Vomiting and diarrhea with fewer number of wet diapers or peeing less than normal.
If your child has bloody diarrhea.
If your child is very drowsy and cannot stay awake to eat, drink, or play.
If your child has a fever:
- >104 °F in any child (> means greater than or higher than)
- >100.4° F in any child younger than 2 months of age. Call your pediatrician immediately and do not give them any medications until you speak with your child’s doctor.
- >103° F in any child for more than 24 hours and that will not improve with acetaminophen (Tylenol) or ibuprofen (Motrin).

Bottom line: If your child has a runny nose but they are eating well, drinking a lot, peeing a normal amount, and are still playful, there is no need to worry! Stay on top of their symptoms and monitor for any worsening, but you most likely do not need to rush to the emergency room.

Young boy lying on the couch covered in a blanket, looking sad while recovering from illness in the living room.

When should I go to the emergency room (ER)?

The most important thing to remember is that your pediatrician is always a resource. Most clinics have a phone line that is managed 24/7 with nurses or other providers who can help you decide if you should wait until you can schedule a pediatrician appointment or if you should go to the ER. If you are worried and feel like you can’t wait, trust your gut and go to the ER!

Can these viruses be treated at home?

Remedies you can do at home include:

Suction your child’s nostrils with saline water. This helps to make the mucus thinner, and suctioning helps clear mucus which young children can’t always do on their own.
Give acetaminophen (Tylenol) or ibuprofen (Motrin) to make them more comfortable if they are older than 2 months old. Ask your pediatrician about correct dosing.

If your child is not getting better despite your efforts, call your pediatrician or go the ER.

How do I protect my other children from getting sick?

Just like adults, children should be shown how to cover their mouths and noses when they cough or sneeze when they’re sick (and how put the tissue in the trash right away and wash their hands). When someone is sick, everyone in the home should wash their hands frequently with soap and water for at least 20 seconds. And surfaces that are touched frequently should be cleaned (e.g., doorknobs, phones, toys).

These viruses have options for seasonal vaccines and scheduled shots. Talk to your child’s pediatrician about vaccines for respiratory viruses and children.

A preschool teacher knees down with a small group of children as they gather around an activity table filled with rice. They are each dressed casually and are smiling as they enjoy playing together.

When can my child return to daycare or school?

Here are a few guidelines to help you decide when to send kids back to regular activities:

When they’ve been fever free for at least 24 hours.
When they are drinking a normal amount.
When they are awake and alert enough to participate.
When they no longer appear sick.

Learn More and Find Pediatric Care

To find out more about these viruses and keeping your child safe, talk with your doctor or learn more from the experts at Nemours® KidsHealth about colds, flu, RSV, and COVID differences. If you need care or diagnosis testing, Nemours Children’s offers pediatric urgent care and emergency care.

Written by: Daphna Varadi, MD a second-year pediatric resident at Nemours Children’s Hospital, Delaware.

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