As we move deeper into fall and get closer to the holidays, your child might start having symptoms like a runny nose, cough, or fever. With the common cold, the flu, RSV, and COVID-19 all spreading at the same time, it can be hard to know which illness they have and how to care for them.
The Centers for Disease Control and Prevention (CDC) says the combined number of hospitalizations from RSV, the flu, and COVID-19 will be about the same as last year. For kids, RSV is expected to cause the most hospitalizations, especially in babies under 6 months old.
Melissa Wallach, MD, a pediatrician at K. Hovnanian Children’s Hospital at Hackensack Meridian Jersey Shore University Medical Center, explains what parents need to know this virus season.
How can I tell if my child has a cold, the flu, RSV, or COVID-19?
These illnesses share many symptoms, which can make things confusing. The only sure way to know is with a test, but here are some general patterns doctors often see:
Common cold:
A cold is usually mild. Symptoms come on slowly and often include a runny or stuffy nose, sneezing, sore throat, and cough. Your child might have a low fever, but not always. They usually still have energy to play and eat.
Flu:
The flu comes on suddenly. A child who felt fine in the morning may feel very sick by the afternoon. Signs include a high fever, body aches (kids may say their legs hurt or seem extra fussy), headache, sore throat, and major tiredness. They look much sicker than they would with a cold. Vomiting and diarrhea can also happen, especially in younger kids.
RSV:
RSV can cause swelling in the lungs and airways. Symptoms include a runny nose, coughing or wheezing, and working harder to breathe. In serious cases, kids may get pneumonia, low oxygen levels, or take long pauses (10 seconds or more) between breaths. Babies may be fussy and may eat or drink less.
COVID-19:
COVID-19 can look like a mild cold, be as strong as the flu, or show different symptoms. Kids may have the same breathing problems as with other viruses, but vomiting and diarrhea are more common. Loss of taste or smell happens less in young children.
Are some children at higher risk of severe illness?
Yes. Babies under 6 months are at high risk because their immune systems are still developing and they are too young for flu or COVID vaccines. Children with health problems like asthma, diabetes, heart conditions, weak immune systems, or a history of premature birth are also more likely to get very sick.
What is one big misunderstanding parents have about these illnesses?
Many parents think fever is always a dangerous sign. While a fever can be scary, it simply means the body is fighting an infection. What matters more is how your child is acting. A child with a fever who is still playful is usually less concerning than one with a fever who is weak, very tired, or not drinking.
The one major exception: Any fever in a baby under 3 months old needs an immediate call to your pediatrician.
How can I protect my child? When should I call the pediatrician?
Prevention is key.
Vaccinate:
The best way to prevent severe illness is to vaccinate your child against the flu (ages 6 months and up), RSV (for certain infants under 8 months if their mother did not get the shot while pregnant), and COVID-19 (for eligible ages). Ask your pediatrician about the right schedule. Last year’s data showed RSV vaccines for pregnant people and infants reduced RSV hospitalizations by 43% to 52% in babies up to 7 months old.
Practice good hygiene:
Teach kids to cover coughs and sneezes and to wash their hands often, especially after coughing, sneezing, or using the bathroom.
Keep them home when sick:
If your child is ill, keep them home from school or daycare so they don’t spread germs and can rest.
Call your pediatrician if:
- Your baby under 3 months has a fever
- Your child is breathing fast, flaring their nostrils, or struggling to breathe
- They show signs of dehydration (no urine or wet diapers for 6–8 hours, crying without tears, vomiting everything, or refusing to drink)
- They are unusually fussy, very tired, or hard to wake
- They have a fever for several days or seem to be getting worse
Caring for a sick child can be stressful, but your pediatrician is there to help. Never hesitate to reach out, especially during cold and flu season.
