My Kid Is Sick: Is It RSV, Flu, COVID-19, or a Cold?

If it feels like your child has been sickconstantlythis fall, you are far from alone. This has been a particularly challenging season for respiratory viruses. The director of the Centers for Disease Control and Prevention (CDC) Rochelle Walensky stressed in a call with journalists on December 5th, the U.S. is facing a “tripledemic” of viruses.

RSV and flu levels are higher than they are in most typical years, Dr. Walensky said, and hospitals continue to be overburdened with patients. Of course, COVID-19 continues to loom in the background, with cases beginning to rise again as theholiday seasonramps up and people gather indoors with family and friends, according to Dr. Walensky.

作为一个家长,它可以be difficult to know what virus your child has brought home, especially as so many respiratory viruses are circulating at once, and many share similar symptoms. While you can’t know for sure what your child has without getting tested, there are some symptoms that set these viruses apart from one another.

The RSV Surge

This year’s RSV season has come early and is particularly intense, saysMuzna Atif, M.D. FAAP, a pediatric hospitalist, and the medical director at Pomona Valley Hospital Medical Center. “Viral bronchiolitis from RSV usually peaks yearly in December to January, making this early surge in cases unusual with a large number of cases needing medical attention,” says Dr. Atif.

According to the CDC,RSV casesbegan to surge in the summer and early fall this year. RSV cases appear to have peaked or at least leveled out in most parts of the U.S., but it is still causing significant problems.

RSV hits young children under 6 months particularly hard, and emergency departments have been full of young patients for weeks now.In her December 5th call to reporters, Dr. Walensky said RSV hospitalizations continue to be higher than they typically are this time of year.

RSV Symptoms

For many of us, RSV presents like atypical cold, with a sore throat, congestion, and coughing. But young children can have a much tougher time with RSV and can develop serious breathing issues. Babies and toddlers can develop a condition from an RSV infection called bronchiolitis, saysZachary Hoy, MD, a pediatric infectious disease specialist at Pediatrix Nashville Pediatric Infectious Disease.

“The most affected pediatric patients are those younger than 6 months,” Dr. Hoy says. “Bronchiolitis from RSV can cause trouble breathing where patients need oxygen support, IV fluids or close monitoring in the hospital.”

Although RSV often resembles common colds, there are some distinguishing characteristics, says Dr. Hoy. “One of the hallmarks of RSV is the significant amount of mucus it produces,” he says. “The extra mucus can cause stopped up noses and sometimes younger infant patients need bulb suctioning to help clear their noses.”

Another way to tell the difference between RSV from something like the flu is the way the symptoms come on, says Dr. Atif. RSV symptoms usually have a gradual onset, as opposed to the flu, which has a shorter exposure period and is usually associated with rapidly progressing symptoms like fever and body aches, she describes.

COVID-19 Cases Are Rising

Early in the fall, we got a bit of a respite from COVID, with cases leveling off around the country. Unfortunately, cases appear to be rising again. “Since the start of the holiday season, COVID cases are again starting to rise slowly,” says Dr. Atif.

According to the CDC, for the week ending November 29, 2022, hospitalizations (which usually spike after cases rise) have increased almost 17%.With at-home testing, it can be difficult to get a true picture of caseloads, but COVID wastewater readings are currently rising all over the country.

COVID-19 Symptoms

COVID symptoms includesore throat, headaches, fever, chills, fatigue, nausea, and diarrhea.Symptoms can vary significantly from one child to another “Sometimes symptoms may be very mild to asymptomatic, especially in vaccinated children,” she describes.

In other words, it can be tough to distinguish COVID symptoms from symptoms of other common viruses like the flu or even the common cold. As such, the best way to know if you have COVID or something else is to test for it, Dr. Atif says.

In terms of distinguishing characteristics of COVID vs. other respiratory viruses, the loss of taste and smell that often comes with a COVID infection is a telltale sign, says Dr. Atif. But not all kids experience this, so again, it’s best to visit your healthcare provider and/or get your child tested for COVID.

Flu Cases Continue to Rise

In her recent call to reporters, Dr. Walensky said the U.S. is seeing the highest number of flu cases in a decade, especially for this time of year.So far, the U.S. has recorded over 8.7 million flu cases and 78,000 hospitalizations. Tragically, 4,500 people have died this season so far.

Flu Symptoms

The recent surgeis attributed to the influenza A variant, says Dr. Atif.“Children are coming for medical attention and some are being hospitalized with symptoms like high-grade fever, body aches, weakness, poor appetite, sore throat, and croup-like symptoms,” she describes.

Most of the very sick children areunvaccinated, Dr. Atif says, and are being admitted to pediatric hospitals with severe respiratory distress, requiring large amounts of oxygen and sometimes ventilation. The highest rates of hospitalization for flu this season have been among children under 4 years old.

Telling the difference between the flu and other common respiratory viruses can be difficult at times. Again, the rapid onset of symptoms is one of the flu’s defining characteristics. “As opposed to other viral infections like COVID, symptoms onset is rapid usually within a day or two of exposure to a sick contact, and more severe in presentation,” Dr. Atif explains.

Symptom Check: Is it RSV, Flu, Or COVID?

	RSV	Flu	COVID-19
Sore Throat	Sometimes	Common	Common
Congestion	Common	Sometimes	Sometimes
Nausea/Diahrrea	Rare	Sometimes	Sometimes
Taste/Smell Loss	Rare	Rare	Sometimes
Rapid Onset	Gradual	Rapid	Sometimes
Difficulty Breathing	Sometimes	Uncommon	Sometimes
Fever	Sometimes	Common	Common
Cough	Common	Common	Common

Is It Just a Cold?

当然,COVID、流感和RSV并不是唯一梵uses currently making the rounds. The common cold is still here, and many kids are catching that too. How to tell the difference between it and others?

“The common cold is generally self-limited and associated with much milder symptoms, most of the time easily managed at home and not requiring medical attention,” Dr. Atif describes.

But again, there is often overlap between cold symptoms and COVID and RSV symptoms, Dr. Hoy reminds. “The main way to tell if it is a common cold virus is by getting your child tested,” he says. “Because RSV, COVID and influenza can all cause cough, malaise,intermittent feverand other respiratory symptoms, it is difficult to predict which one based on symptoms alone.”