Pediatricians see a rise in respiratory infections this time of year, and it can be hard to tell them apart. “COVID, RSV, influenza A and B—all of these are respiratory viruses, and the symptoms overlap a lot,” says Dr. Pilar Bradshaw with Eugene Pediatric Associates.

So, how can you tell what’s making your child sick? And when should you call your doctor?

How to differentiate illnesses
Flu, COVID and RSV share many common symptoms. The American Academy of Pediatrics offers this guide to help identify them:

  • Flu symptoms may include fever, chills, headache, body aches, dry cough, fatigue, stuffy nose and sore throat. Some children may throw up and have diarrhea. Symptoms show up about 1 to 4 days after being exposed to a sick person.
  • COVID symptoms may include fever, cough, fatigue, muscle or body aches, congestion, shortness of breath, sore throat, headache, sneezing, vomiting/diarrhea or loss of taste/smell. Symptoms show up 2 to 14 days after infection.
  • RSV symptoms may include fever, cough, fatigue, stuffy nose, shortness of breath, sneezing, fast/short breaths, flaring nostrils, wheezing and grunting, poor feeding or no appetite. You may also notice head bobbing or chest caving in between and under their ribs with each breath. Symptoms are usually the worst on days 3 through 5 and last about 7 to 14 days. RSV is considered to be the most contagious of these respiratory illnesses.

In addition, colds are another common respiratory illness that may include fever, cough, fatigue, stuffy nose, sore throat, sneezing and slightly swollen glands. Colds are less contagious than the others and can be caused by many viruses. Colds are also usually less severe and healthy children can get about 6-10 colds a year. And unlike the others, there is no immunization available to prevent colds.

All of the illnesses can be serious and widespread, but the flu is often most prevalent. “Influenza hospitalizes more babies than any of those other viruses do every year,” Dr. Bradshaw says.

When to see a doctor
How do you know when to take your kids to a doctor? Dr. Bradshaw says prolonged lethargy and difficulty breathing are key warning signs.

“Things that tell me that you should see your pediatrician for your kid’s respiratory illness include very high fever accompanied by lethargy, days and days of fever that aren’t getting better; after three or four days, we really should be talking with you about seeing your child,” Dr. Bradshaw says. “Any time a cough is accompanied by difficulty breathing or very loud, wheezing, musical sounding breaths; any time that your kid is so sick that they can’t stay hydrated, they’re not drinking much, they’re not making much urine. Those are really important signs to see your doctor.”

The AAP recommends you call your pediatrician if your child has any of the following symptoms:

  • Rapid breathing, flaring nostrils, wheezing and grunting
  • Chest caving in with each breath
  • Shortness of breath/difficulty breathing
  • Vomiting for more than 24 hours
  • Bloody diarrhea
  • Very ill or drowsy
  • Poor feeding
  • Dehydration
  • Fever above 104 degrees Fahrenheit in any child; fever above 100.4 degrees Fahrenheit in a child under 2 months old; fever above 103 degrees Fahrenheit for more than 24 hours.

Testing can identify if your child has RSV, COVID or the flu. Unfortunately, a child can get more than one virus at a time, and what can be even more concerning about these illnesses, Dr. Bradshaw says, is the risk for a secondary bacterial infection.

“For example, if your child gets a cold and it seems like a couple days later it’s gone, but then—bam!—my kid is tanking,  that may be a sign of a secondary bacterial infection that can be serious. You should see your doctor; it might be something like pneumonia.”

How to prevent illnesses
What can you do to decrease the risk of a serious illness? Staying up to date on immunizations can be very effective. Flu shots greatly reduce the risk of being hospitalized from influenza, especially for young children and older adults. COVID shots are still recommended by the American Academy of Pediatrics for all kids 6 months and older. There’s also an RSV antibody injection available to protect newborns and toddlers at high risk from RSV.

To guard against catching or spreading contagious illnesses, families should take some precautions.

“We can help to prevent the spread of respiratory viruses in our home by doing really good handwashing,” Dr. Bradshaw says. “Every time we come in from a super germy place, change our clothes, wash hands and faces and all exposed skin, so those droplets of germs get off the skin and off the clothing. It’s also important to remember if our kid has a fever or we have a fever, stay home. If your child has difficulty containing their coughing, or if they’re vomiting or having diarrhea, they should not be out in the community.”

As always, if you have any questions or concerns about your child’s illness, don’t hesitate to call your pediatrician.