Differences Between COVID-19, RSV, Flu and Other Bugs Affecting Kids

Note: This chart should only be used as a starting point. Symptoms can vary from person-to-person. If your child is sick, talk with their pediatrician about testing and treatment.

While terms like “the common cold,” “the flu,” “colds” and “cold viruses” are frequently used like they mean the same thing, there are many different viruses that cause respiratory symptoms in children. The severity of and treatments for these illnesses vary, which is why asking an expert is always recommended.

It can be challenging to identify the cause of symptoms, especially in younger kids. We’ve included additional information about each condition below, signs and symptoms to look for and why testing matters.

*Less than half of children who are diagnosed with COVID-19 will have a fever. Even if your child does not have a fever, it is possible that they could have COVID-19.

Because COVID-19 is highly contagious and it can take longer for people to develop symptoms, a COVID-19 test can alert you as soon as possible if you have the virus — even if you were infected but don’t have symptoms.

“Knowing if you have the virus sooner means you can isolate and take other precautions sooner,” says Dr. Dominguez. “Getting or taking a COVID test is one of the best things you can do to help control the spread of the virus.”

Knowing if your child has COVID will also help your pediatrician provide appropriate care. For example, we now have treatments for COVID-19 that may be recommended for some patients, just like we have treatments that can help ease the symptoms or lower the risk of the flu.

While many pediatricians offer COVID testing in their offices, at-home tests are now widely available, and most are recommended for children over 2 years old. Children under the age of 2 can be tested in their pediatrician’s office. If your child tests positive for COVID-19, it’s important to then follow the CDC’s guidance on isolation measures.

If your child is feeling sick, it’s best to call their pediatrician for recommendations. (If you don’t have a pediatrician, you can call our ParentSmart Healthline.) They can help assess your child’s symptoms and determine if COVID-19 testing — or a test for multiple viruses — is an appropriate next step.

The CDC recommends that anyone with symptoms of COVID-19 be tested as soon as possible, mask up and stay away from others. If you have been exposed but don’t have symptoms, you should wear a mask for 10 days and test on day 5.

At-home COVID-19 tests are widely available at most pharmacies and are generally considered accurate for detecting the presence of the coronavirus. These tests provide results in about 10 minutes, which means you can take precautions sooner and help prevent others in your circle from getting sick, too.

You should use an at-home COVID-19 test if:

• The person being tested is at least 2 years old. Currently, there are no home tests approved for kids under 2.
• You have COVID-19 symptoms. A positive test shows that you have the virus and should take the recommended precautions. If the test is negative, consider retesting in 1 to2 days, or requesting a PCR test, which is more sensitive, from your primary care doctor.
• You were exposed to someone who has COVID-19. In this case, test 5 days after exposure. Positive results indicate that you have the virus and should take the recommended precautions. If the test is negative, test again in 1 to2 days.
• You are attending an event or large gathering where people from different households are mingling, especially when people at the event are at risk of severe complications from COVID-19. It’s recommended to test immediately prior to the event, and to skip the event if you get a positive result.

COVID-19 affects people differently. Coronavirus symptoms range from mild to severe, and not everyone will have every symptom. In general, symptoms in kids and teens may include:

• Fever/chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• New loss of taste or smell
• Sore throat
• Runny or stuffy nose
• Nausea or vomiting
• Diarrhea
• Abdominal pain
• Poor appetite (or poor feeding)

Influenza symptoms include:

• Fever/chills
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Tiredness
• Nausea or vomiting
• Diarrhea

Yes. Experts predict that the 2022 to 2023 flu season could hit earlier and be more severe, due in part to eased COVID-19 restrictions after years of precautions. The best way to prevent the flu is to get the influenza vaccine for everyone in your family as soon as possible.

“Everyone should get a flu shot every year, but especially during the pandemic,” says Dr. Dominguez. “Not only does it reduce your chances of getting the flu, but if you do get it, your symptoms will likely be less severe.” The flu shot is also very effective in preventing severe disease, hospitalization and death, Dr. Dominguez adds.

Both conditions can be very serious in kids. When we compare the numbers year by year in people younger than 18, it’s clear that COVID-19 has caused more cases, hospitalizations and deaths than the flu does in a typical year. Though COVID-19 has not been as serious in children compared to adults, proportionally speaking, claims that COVID isn’t as serious as the flu in kids are not accurate.

Read what we know about the burden of COVID-19 in children and adolescents.

Yes. For the past 15 years, flu-related deaths in children reported to CDC during regular flu seasons have ranged from 37 to 199 deaths each year.

During the first two years of the pandemic, more than 1,000 children died from COVID-19. That averages to more than 500 each year, far more than a bad year of the flu. This means that COVID-19 has caused more than double the number of annual child deaths compared to the flu, and more deaths continue to occur.

Death isn’t the only risk associated with COVID-19. Some people who’ve been infected with the virus experience long COVID, in which symptoms linger for months after the initial infection. While the risk of long COVID appears to be lower in kids than adults, children can experience unique concerns, such as myocarditis, multisystem inflammatory syndrome (MIS-C), abnormal liver enzymes, fatigue, hair loss and skin rashes.

Most children who are infected by COVID-19 are asymptomatic, meaning they don’t have any symptoms, or they have mild symptoms. In rare cases, though, there are two reasons some children get very sick.

“One is just a really bad COVID-19 infection that occurs during what we call an acute — or sudden — infection,” says Dr. Dominguez. “The other is a new condition called multisystem inflammatory syndrome in children, or MIS-C, which usually occurs 2 to 6 weeks after the infection.”

Cases of COVID-19 continue to ebb and flow. But when COVID-19 case counts increase, experts expect an increase in MIS-C, Dr. Dominguez says. Although MIS-C is rare, parents should be aware of the symptoms. The best way to prevent MIS-C is to take recommended precautions against COVID-19.

Symptoms of MIS-C can include:

• Fever
• Severe abdominal pain
• Vomiting
• Diarrhea
• Rash
• Red eyes or red lips
• Trouble breathing
• Seeming confused/sleepy
• Persistent pain or pressure in the chest
• Pale, gray or blue-colored skin, lips or nail beds, depending on skin tone

If your child is showing these symptoms, you should call your primary care provider. In a life-threatening emergency, you should always call 911.

Medical experts suspect a connection between MIS-C and COVID-19, and most experts think that MIS-C is caused by the body’s immune response to a COVID-19 infection. Read what we know about MIS-C and its link to COVID-19.

Much remains unknown about MIS-C, and Children’s Colorado is involved in several national research studies to learn more. A team of our multidisciplinary specialists developed comprehensive guidelines to effectively diagnose and treat children with MIS-C, including nearly 200 who’ve been treated at Children’s Colorado. The guidelines are now nationally recognized and shared with hospitals across the country.

Call your pediatrician when you notice these symptoms of RSV:

• High fever and ill appearance (though not all children with RSV experience fever)
• Thick nasal discharge
• Worsening cough
• A cough with discolored mucus
• Signs of dehydration
• Signs they’re having trouble breathing: Look for short, rapid and shallow breaths or retractions, where the chest caves in and the belly expands with each breath
• Unusual irritability or inactivity
• Refusing to nurse or bottle feed

If your child is struggling to breathe, seek out emergency care.

Most kids get RSV before they turn 2, and most recover quickly. But RSV can cause serious complications for infants, preemies, and babies and young children with underlying medical conditions. RSV can lead to pneumonia and bronchiolitis, when the small airways in the lungs become inflamed and clogged with mucus. Even kids without underlying conditions can get very sick with RSV. Kids and babies with more severe cases of RSV often require a trip to the emergency department or care in the hospital so they can receive breathing support, like oxygen.

RSV can cause re-hospitalization for babies who have been in the neonatal intensive care unit (the NICU) due to prematurity or other medical conditions. Some NICU babies that require oxygen are eligible for an antibody that treats RSV, which the care team would recommend along with other vaccines for babies with medical conditions.

Yes, adults and older children can and do get RSV, but they typically don’t get as sick as young children or seniors. Dr. Dominguez puts it this way: If you think you or a child in your home has a cold, consider that it might be RSV, and act accordingly. Wash your hands, cover your cough, stay home when you’re sick — and don’t kiss any babies until you feel better.

Common cold symptoms include:

• Runny or stuffy nose
• Sneezing
• Sore throat
• Gray, yellow or green nasal discharge
• Cough
• Scratchy voice

It can be difficult to tell the difference between COVID-19 and a cold. The likelihood that it’s the new coronavirus versus another virus greatly depends on what is circulating in your community, which varies. This is another reason getting tested for COVID is important.

A cold is generally milder than the flu, and symptoms appear gradually. Flu symptoms are usually more sudden and severe. With the flu, your child will likely have a high fever, a headache, severe tiredness, achy muscles and chills. For a common cold, they may have a low fever to start, but they won’t have a headache or muscle aches, and they won’t have chills. In very young children, fever may be the only symptom of flu infection.

Learn more about how to tell the difference between a cold and the flu.

Ear infections are common, and about 85% of children experience at least one during childhood. Some ear infections can resolve without antibiotics. But Dr. Gitomer says parents should call their child’s primary care provider if they see a combination of the following symptoms:

• Ear pain
• Drainage of fluid from the ear
• Tugging or pulling at an ear
• Fussiness or crying more than usual
• Trouble hearing sounds
• Loss of balance
• Headache

When kids have multiple ear infections in a matter of months, it may be time to meet with one of our ear, nose and throat specialists to discuss ENT surgery.

The sinuses are the system of nasal cavities in the skull. These cavities are usually empty, but they can become blocked with fluid and germs when you have a viral infection like a common cold. The blockage causes the tissue along these cavities to become inflamed, and that’s when a sinus infection can occur.

Sinus infection symptoms are similar to a cold but may also include pain and tenderness in the face and a fever. A sinus infection typically resolves on its own with over-the-counter medications and does not require parents to seek medical care for their child.

Occasionally, you can get a bacterial infection in your sinuses; the most common sign is when your symptoms last more than 10 days. If your child’s sinus symptoms have not improved in this time period, it’s time to call a doctor.

“It’s important to treat these longer infections with antibiotics because, in rare cases, untreated sinus infections can spread to areas around the sinuses,” says Dr. Gitomer. “When this happens, symptoms can include a red, puffy or bulging eye, decreased or painful movement of the eye or vision loss, or severe headaches.”

In these cases, Gitomer says it’s important to contact your primary care provider. Your child will likely need antibiotics and may need to be seen by a pediatric otolaryngologist: an ear, nose and throat surgeon.

“A sore throat is a common symptom of the flu and a cold, so there’s always a question of how to tell when it’s something more,” says Dr. Gitomer. “A sore throat with a cough, runny nose or raspy voice indicates that your child likely has a viral infection, not a bacterial infection like strep throat.”

Strep throat symptoms can include:

• A sore throat that comes on rapidly
• Painful swallowing
• Fever
• Headache
• Swollen tonsils
• Red spots on the roof of the mouth or tonsils
• Swollen lymph nodes in the neck
• White streaks of pus on the tonsils

If your child is experiencing these symptoms, call their pediatrician and tell them you suspect your child may have strep throat so they can be tested.

An EV-D68 infection can look a lot like the common cold, but some patients also have asthma-like symptoms, including shortness of breath and wheezing.  Some cases can require hospitalization, especially for kids with asthma. If your child has been sick, keep an eye out for AFM, which tends to occur about one week after their respiratory infection.

Primary symptoms of AFM include sudden onset of:

• Arm or leg weakness
• Loss of muscle tone and reflexes

Additional symptoms of AFM may include:

• Difficulty moving the eyes or drooping eyelids
• Facial droop or weakness
• Difficulty with swallowing or slurred speech
• Pain in arms or legs
• Pain in neck or back

In extremely rare cases, additional complications and injury to the nervous system may occur. If your child is showing signs of this rare condition, seek medical care immediately.