COVID-19, RSV, influenza, and other respiratory illnesses: What’s the difference?

Your child has symptoms of congestion, cough, and fever. Is it influenza or influenza? Is it COVID-19? Or are they symptoms of respiratory syncytial virus (RSV)?

Let’s focus on four common childhood illnesses caused by viruses: COVID-19, influenza, the common cold, and respiratory syncytial virus (RSV). They all have some similar symptoms. Here are some clues to help you tell them apart.

Symptoms of RSV may include fever, cough, fatigue, nasal congestion, difficulty breathing, sneezing, rapid/short breathing, flaring nose, wheezing and grunting, poor eating/loss of appetite. You may also notice that your head bobs up and down with each breath, or that your chest sinks between and under your ribs. Symptoms are usually worst on the third to fifth days and last 7 to 14 days.

Watch this video to spot the signs of RSV:

  • flu symptoms They may include fever, chills, headache, body aches, dry cough, fatigue, stuffy nose and sore throat. Some children may experience vomiting and diarrhea. Symptoms appear approximately one to four days after exposure to a sick person.

  • coronavirus disease symptoms They may include fever, cough, fatigue, muscle or body aches, congestion, difficulty breathing, sore throat, headache, sneezing, vomiting/diarrhea, or loss of taste/smell. Symptoms appear on days 2 to 14 after infection.

  • cold symptoms They may include fever, cough, fatigue, nasal congestion, sore throat, sneezing, and mild swollen glands. A cold is an upper respiratory tract infection that can be caused by a variety of viruses. Healthy children get 6 to 10 colds per year.

If your child has any of the following symptoms, call your pediatrician:

  • Shortness of breath, nose flaring, wheezing, and grunting

  • Chest sinking with every breath

  • Shortness of breath/difficulty breathing

  • Vomiting for more than 24 hours

  • bloody diarrhea

  • The child looks very sick or sleepy

  • Loss of appetite

  • dehydration

  • Any child with a fever above 104°F (40°C); a child under 2 months with a fever above 100.4°F (38°C); a fever above 103°F (39.5°C) for more than 24 hours.

Is it possible to be infected with two viruses at the same time?

Yes. For example, children can be infected with the flu and COVID-19 at the same time. It is not uncommon for children to develop secondary illnesses. For example, they may have bronchiolitis or pneumonia as well as other health problems such as ear infections or sinusitis.

Some symptoms of the flu, COVID-19, and other respiratory illnesses are similar. Your child’s pediatrician may order tests if needed to confirm the diagnosis.

How to avoid getting sick when these viruses spread

Vaccines are an effective tool against serious illness caused by many preventable diseases. Staying up to date on routine vaccinations can also help others, including people who are at high risk if infected.

  • Annual influenza vaccination is recommended for everyone 6 months of age and older. Get your children vaccinated as soon as the vaccine becomes available so they are protected during flu season, which can last until the end of May.

  • The updated COVID-19 vaccine is recommended for everyone over 6 months of age. Ask your pediatrician when your child should get the newer COVID-19 vaccine.

  • Nirsevimab is an RSV vaccine recommended for use in infants younger than 8 months of age in their first RSV season, and in some children 8 to 19 months of age who are entering their second RSV season and are at high risk for severe illness from VRS.

  • RSVpreF is a vaccine for pregnant women designed to protect babies from RSV infection.

Remind your child of other ways to avoid illness. Children should learn to cover their mouth and nose with a tissue when they cough or sneeze (and then immediately throw the tissue in the trash). They can wear masks in public to prevent the spread of germs to others. Everyone should be encouraged to wash their hands with soap and water or use alcohol-based hand sanitizer.


If your child is sick and you have any questions or concerns about his or her symptoms, call your pediatrician immediately. It is important for all children to stay up to date on immunizations, physical activity and daily care.

More information:

The information contained on this website should not be used as a substitute for medical advice and care from your pediatrician. Your pediatrician may recommend a variety of treatments based on individual facts and circumstances.

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