What You Should Know About the Flu, RSV, and COVID-19 This Season, According to Physicians

As parents, it can be nerve-wracking to see your child get sick at any time of the year, but during flu season, when upper respiratory colds and symptoms circulate, those feelings can be more intense. If you have young children who can’t communicate how or what they’re feeling, or children with preexisting health conditions like asthma, it can be an even more difficult time of year. Trying to determine what’s wrong, how long they might be sick, and, most importantly, how to get them healthy again can be tricky if you don’t know what to look for.

Common diagnoses, like influenza (the flu), RSV (respiratory syncytial virus), and COVID-19 can look alike, so the expertise of a doctor is valuable to distinguish between them. Dr. Matthew Stewart, a pediatric physician at Nemours Children’s Health, sees symptoms like congestion, cough, fever, reduced appetite and runny nose spike during flu season. These symptoms can indicate viral infections, which can cause other reactions, too, like asthma flares and hives. And though many of Dr. Stewart’s patients display a common set of symptoms and may have viral infections, two patients with similar symptoms won’t necessarily have the same illness.

“There are some subtler symptoms that can be tough for families to pick up on,” says Dr. Stewart. “That’s why we can make a better impact if we see kids sooner than later, so we can prevent those symptoms from worsening.”

As a parent, you can help by keeping track of your child’s symptoms and experiences. Factors like how long your child has felt sick, their temperature, their breathing patterns, their pain and more are helpful for doctors to know as they figure out a diagnosis and care plan for your child. That’s not to say your child will always need to be treated in a doctor’s office, but having the advice of a doctor means you can make more informed choices about at-home care to ensure you’re doing everything you can to help them feel better faster.

With the right at-home remedies, you’ll be better equipped to take care of your child. And with the right knowledge and communication with pediatricians, you’ll know what you’re dealing with, and if and when you should bring your child to a doctor’s office or hospital. Here’s how to provide supportive care to your child at home, and a deeper look at the differences between the flu, RSV, and COVID-19.

At-Home Remedies

According to Dr. Catharine Eleey, a pediatrician at Nemours Children’s, at-home remedies are often the first level of defense against the common symptoms of the season. They can make your child more comfortable throughout the duration of their illness, and in many cases, these remedies might be all a child needs while their body heals itself.

“A lot of the counseling I give parents can be very applicable across the board, regardless of which virus is causing the symptoms,” agrees Dr. Stewart. But there’s also some nuance to the advice a pediatrician will give parents, depending on whether the kid is suffering from the flu, RSV, COVID-19 or something else. With respect to those differences, a pediatrician can provide some guidance as to what to expect, what to be concerned about and, should it be relevant, when to take your child to an emergency room.

“Across the board, it’s important to keep kids hydrated and encourage fluids. We also recommend nasal saline drops or sprays and humidifiers,” says Dr. Eleey. Hydration is crucial to support your child’s body as they fight their illness, and saline and steam can help relieve congestion to keep your child more comfortable. There’s also a recent study suggesting that making saltwater drops at home and administering them to your child’s nose can help them get better faster.

Those recommendations are useful for kids of all ages, but some care techniques are more relevant for specific age groups. For example, a NoseFrida or bulb syringe can alleviate congestion for younger kids, and kids over age one can benefit from honey for coughs. Over-the-counter medications can also be used for kids over the age of six, although most pediatricians recommend focusing more on the home treatments discussed above.

These options can make your child more comfortable as they fight their viruses, but they shouldn’t stop you from seeking advice from a doctor if you have additional concerns. “Parents should never hesitate to call us if they’re worried about their kids,” says Dr. Judy Larkin, a pediatrician at Nemours Children’s.

The Flu

It can cause common cold symptoms, but the flu has distinct characteristics (one of which is that it’s no fun).

“The typical flu triad is fever, muscle aches and headaches,” says Dr. Eleey—and she’s noticed some of the common language that kids with the flu will use to describe those feelings. Complaints of leg-aches can be signs that a kid has inflammation in their legs, which might indicate the flu. Many kids will also complain that their eyes hurt, which raises concern for a flu-induced headache. Most people with the flu will also develop cold symptoms like a cough, a runny nose and a sore throat.

There are other distinctions to the flu as it progresses—mainly, that the flu is typically a heavy-hitter from the beginning, rather than developing and getting worse over time. According to Dr. Eleey, the flu typically begins to improve in three to five days. Because it can naturally improve quickly, medication isn’t always necessary for the flu, but a medication called oseltamivir can be effective in shortening the virus’s duration and reducing the severity of symptoms if it’s given within the first 48 hours.

“If we are going to medicate, it’s a pretty narrow window of opportunity,” explains Dr. Larkin. For parents, that means it’s beneficial to catch the flu earlier on, so that your child can access medication to make the experience easier. And for children who have other conditions like asthma or immune system issues, there’s still an opportunity to take oseltamivir outside of that 48-hour timespan, though it might be less effective.

RSV

Though RSV can be one of the more concerning diagnoses for a child to receive, it’s also common. It’s most identifiable, according to Dr. Stewart, through its impact on a child’s lungs and breathing.

“Kids two and under with RSV can get some pulling or tugging of the muscles of their ribcage, which makes it difficult to get air in,” he explains. “That can cause really fast breathing and scare parents.” Because of those risks, younger children are more likely to need hospitalization from RSV, so that they can be given breathing support.

For children with asthma, those same symptoms—scary-sounding breaths and difficulty breathing—are also common, which can make RSV a particularly concerning virus for those children as well. But it’s something parents can monitor: As a parent of an asthmatic child, if you notice them struggling to get through sentences without stopping for breath or having any other breathing changes, it’s important to seek care. According to Dr. Stewart, even though it can be frightening, there’s a thorough protocol for treating RSV in children with asthma, which can involve oxygen, steroids and closer monitoring. If your child has asthma and displays signs of RSV, it’s important to see a doctor sooner rather than later. With earlier intervention, doctors can prevent RSV from escalating.

“With RSV, I’ll be able to alleviate fears by telling parents whether or not I have concern about this progressing,” says Dr. Stewart. “And if it is a more concerning case, I can equip them with what to look out for and what to pay attention to.”

For kids who don’t have asthma and are older than two, RSV might not look or sound as frightening. Often, Dr. Eleey says, RSV might take the shape of a bad cough, accompanied by other symptoms like a runny nose and fever—but still, there aren’t any medications specifically designed to treat RSV, so the best thing to do is monitor your child and use home remedies to keep them comfortable while they fight the virus. You can do that with over-the-counter medications like acetaminophen (if they’re under six months old) and ibuprofen (if they’re older than six months) or receiving oxygen at a hospital.

COVID-19

Where the flu and RSV can have some identifying features, COVID-19 can act like a chameleon and be hard to classify.

“COVID can present with mild symptoms, but it can also present with more flu-like symptoms or more severe symptoms,” says Dr. Larkin. According to her, for younger kids who don’t have the words to explain their discomforts, things like severe fussiness and changes in activity level and appetite can be indicators of COVID-19—but some children might not show symptoms at all. And though it is variable, even children who are symptomatic are often able to get over this virus relatively quickly.

“If kids are symptomatic and having a severe cough or prolonged fevers, they should be seen in the office,” says Dr. Eleey. “But most of the time, if kids are handling it okay, there’s no intervention needed beyond home care.”

Ultimately, though concern for your children is inevitable (and though they might never listen to you when you tell them to wash their hands), pediatricians want you to know that you don’t have to feel afraid or helpless this flu season. With the right knowledge, care and treatments, you can feel confident that your children will bounce back.

To learn more about Nemours Children’s Health, click here.