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For parents, the fall and winter may seem like an endless barrage of coughing, sneezing, fevers, and runny noses in their children. Respiratory viruses like the common cold, influenza (flu), COVID-19, and respiratory syncytial virus (RSV) are circulating widely this time of year. And attending school or day care may make your child more susceptible to respiratory illnesses.

Pediatric respiratory illnesses can cause a range of similar symptoms. It’s even possible, though rare, to get more than one respiratory infection at once. This can make knowing what your child has challenging.

“As we go into the back-to-school and wintertime season, a lot of parents are curious about how to tell between these sorts of pathogens,” says Megan Culler Freeman, MD, pediatric infectious diseases specialist, UPMC Children’s Hospital of Pittsburgh. “It can be tough to figure that out on your own at home.”

Here’s what parents need to know about respiratory illness symptoms in kids, when to seek care, and how to prevent infection.

What Are the Symptoms of Respiratory Illnesses in Children?

The early signs of respiratory illness in children are often very similar.

Cold symptoms in children

Common symptoms of a cold include:

• Cough.
• Fussiness or irritability.
• Loss of appetite.
• Low-grade fever.
• Runny nose.
• Sneezing.
• Sore throat.
• Swollen neck glands.

Colds are typically the most common respiratory illness in children. According to the American Academy of Pediatrics (AAP), most children will get eight to 10 colds in their first two years of life.

Flu symptoms in children

Flu symptoms are similar to those of the common cold, but they’re typically more severe. Common symptoms include:

• Cough.
• Diarrhea or loose stools.
• Fatigue.
• Fever or chills.
• Headache.
• Muscle or body aches.
• Nasal congestion.
• Runny nose.
• Vomiting.

Children under 5 years of age are at higher risk of flu complications, especially children under 2.

COVID-19 symptoms in children

Signs of COVID-19 in kids include:

• Body/muscle aches.
• Chills.
• Coughing.
• Diarrhea.
• Difficulty breathing.
• Fatigue.
• Fever.
• Headache.
• Loss of taste and smell.
• Nausea or vomiting.
• Nasal congestion.
• Runny nose.
• Shortness of breath.
• Sore throat.

Children often have mild symptoms or are asymptomatic from COVID-19. However, it can progress to more severe illness. Children with underlying medical conditions face a higher risk of COVID-19 complications.

RSV symptoms in children

RSV symptoms in toddlers and infants are similar to those of a cold, including:

• Coughing.
• Fever.
• Fussiness.
• Hoarse crying or voice.
• Loss of appetite/poor feeding.
• Nasal congestion.
• Runny nose.
• Sneezing.

Infants under 6 months of age may experience:

• Apnea (breathing pauses of over 10 seconds).
• Decreased activity.
• Irritability.
• Loss of appetite/poor feeding.

RSV cases are typically mild. Most children get RSV for the first time by the time they’re 2 years old.

However, RSV can progress to a more serious lung infection like bronchiolitis or pneumonia. RSV is the most common cause of hospitalization in children under age 1.

“It tends to be the younger the patient, the more trouble they might have with RSV,” Dr. Freeman says. “And when I say trouble, it’s mostly difficulty breathing, hard work of breathing, and sometimes refusal to eat and drink.”

Symptoms of croup in children

Croup is another common respiratory illness in young children, often caused by a parainfluenza virus. It causes swelling of the voice box and windpipe, which narrows the vocal cords.

Common symptoms include:

• A barky cough.
• Fever.
• Hoarseness.
• Musical sound when breathing in (stridor).
• Noisy breathing.
• Trouble breathing.

When should I worry about my child’s respiratory illness symptoms?

Dr. Freeman says calling your child’s pediatrician if you’re worried about their symptoms is always OK. However, the two symptoms that cause the most concern are breathing problems and dehydration.

“If you notice at any point in the winter that your toddler or your infant is breathing fast, breathing hard, can’t catch their breath, or is turning blue, those would all be reasons to go to the emergency department,” Dr. Freeman says.

The same is true for signs of croup, Dr. Freeman adds.

“If you’re worried about your kid’s breathing, you should take them to be evaluated, even if it’s in the middle of the night,” she says. “Because those things can be really scary.”

Signs of dehydration can include:

• Crying with fewer or no tears.
• Decreased urination (fewer than six wet diapers per day in babies).
• Dry mouth.
• Loose stools.
• Playing less often.
• Sunken fontanelle (soft spot in the head).

“Hydration is often overlooked,” Dr. Freeman says. “And when kids have fevers or lots of nasal drainage, or if a kid has vomiting and diarrhea, these are all ways that the body loses fluid. And they feel crummy and don’t want to drink.”

How Can I Tell the Difference Between Flu, Cold, RSV, and COVID-19 in Kids?

The flu, the common cold, RSV, and COVID-19 have very similar symptoms. So, knowing whether your child has RSV versus a cold, COVID-19, or the flu by symptoms alone can prove difficult. However, RSV, the flu, and COVID-19 do tend to cause more severe symptoms than the common cold.

“If you’re noticing that your child is having multiple days of fever (over 100.4 F), significant cough, or seems to be really low energy, then that might be an indication that they might have one of those more significant viral illnesses of the winter,” Dr. Freeman says.

Dr. Freeman offers a couple of other potential ways of knowing what your child has:

1. Many day cares and schools report when a child is sick with a specific respiratory illness. “They’ll say something like, ‘Oh, one of the classmates had the flu,’” Dr. Freeman says. “So, then you would know if your child got sick around that time, you would be more concerned for the flu.”
2. Tests for the flu and COVID-19 are available over the counter. If your child is showing symptoms of a respiratory illness, you can purchase an at-home flu or COVID-19 test — or even a combination test.

Getting tested for COVID-19 or the flu within two days of symptoms appearing is best, Dr. Freeman says. Antiviral medications are available for those illnesses. They’re most effective within 48 hours of symptoms appearing.

What Are the Treatment Options for Childhood Respiratory Illnesses?

Treatment for common childhood respiratory illnesses ranges from medications to managing symptoms, including:

• Antiviral medications — Antiviral medications are available for the flu and COVID-19. Call your child’s pediatrician within 48 hours of your child showing symptoms to get them evaluated and ask about a prescription antiviral medication.
• Cough medicines — These can help relieve coughs. However, you shouldn’t give cough medicine to any child younger than 7 years of age.
• Fever relievers — To treat fevers, you can use acetaminophen (Tylenol®) dosed appropriately for your child’s weight. If they’re over 6 months of age, you can give your child ibuprofen (Advil® or Motrin®). Don’t give your child aspirin.
• Fluids — Dehydration is a potential complication for many childhood respiratory illnesses. Make sure your child is receiving plenty of fluids, such as water or Pedialyte, to prevent dehydration.
• Nasal saline sprays — If your child has a runny or stuffy nose, a nasal saline spray can help relieve it.

It’s also important that your child rests.

You should also keep your child home from school or day care if they have symptoms like fever, vomiting, or diarrhea, or if they’re still infectious.

“Staying away from other people when they’re sick, staying home from work or school when you’re sick, canceling the play dates until they’re feeling a little bit better are ways that we can prevent spread in the community,” Dr. Freeman says. “And lots of handwashing!”

How Can I Protect My Child from Respiratory Viruses?

You can help protect your kids from respiratory viruses with a combination of vaccines and other preventive measures.

Vaccines

Common vaccines against childhood respiratory illnesses include:

• COVID-19 — Whether or not your child is eligible for the COVID-19 vaccine depends on your state of residence. Contact their pediatrician for more information.
• Flu — Children 6 months and older should receive an annual flu shot. They receive two shots for their first flu season and one shot each year afterward.
• RSV — Pregnant women should get an RSV vaccine while they’re 32 to 36 weeks pregnant from September to January. Infants whose mothers didn’t receive a vaccine while pregnant should get a monoclonal antibody immunization before their first RSV season. Some infants and young children who are at greater risk of RSV complications are eligible for another monoclonal antibody immunization before their second RSV season. Talk to their pediatrician for more information.

Hand hygiene

Respiratory viruses often spread through respiratory droplets. When someone who is sick coughs, sneezes, or talks, it releases droplets that can infect nearby people. The droplets can also land on nearby surfaces; if a child then touches that surface and then touches their eyes, nose, or mouth, they can become infected.

Hand hygiene can help prevent those second types of infections. Frequent handwashing with soap and water can help kill many respiratory viruses. Scrub with soap and water for 20 seconds before rinsing, or use hand sanitizer with at least 60% alcohol.

Parents should also stay mindful of their own hand hygiene to prevent the spread of disease.

“It’s important to try to increase the number of handwashings,” Dr. Freeman says. “Definitely after every bathroom use, but also if you blow your nose, if you cough into your hand, if you are playing with stuff outside, if you come in from running an errand, those are all great times to remember your hand hygiene.”

Covering coughs or sneezes with tissues or the crook of the elbow also helps prevent disease spread.

UPMC Children’s and UPMC Children’s Community Pediatrics (CCP) are here for you and your children this respiratory virus season. From flu shots to treating illnesses, we’re here to help.