RSV Flu and Covid, Oh My! | Healthe Pediatrics


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RSV Flu and Covid, Oh My!

Kelly Ochoa, MD

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RSV and Flu will soon be making their debut, joining COVID-19 this winter causing fevers and cold symptoms. These three respiratory viruses cause very similar symptoms in children, and it is difficult to distinguish between them. Let me give you a brief overview on these three winter culprits.

Respiratory Syncytial Virus (RSV)

RSV is significantly worse in infants and toddlers than in older children and adults, as well as children with asthma. This virus causes coughing, wheezing, and fast, labored breathing in babies. Children do not necessarily have fevers with RSV. There is no treatment to kill the RSV virus. If a baby is having a difficult time breathing, sometimes the infant needs to be hospitalized to give oxygen and help him/her breathe easier. Inhalers for asthma, such as albuterol, do not help with wheezing from RSV unless there is an asthma component to the child’s breathing difficulties.

Influenza Virus

Influenza virus, “the flu”, usually causes high fevers and body aches. This is also a respiratory virus, so it will cause congestion and cough. Often, children will get tummy symptoms like vomiting with influenza, and can also get muscle aches all over. If given on the first or second day of illness, there are antivirals available that may shorten how long your child is sick by a day. However, many children get side effects to the medication that are often worse than any benefit.


Children of all ages can get and spread the contagious COVID-19 virus. COVID-19 can cause a very wide variety of viral symptoms. Fever and cough are the most frequent, but many children have headache, sore throat, muscle aches, vomiting, and diarrhea as well. Although in general children seem to get less severe disease than adults, there is a complication of COVID-19 in children called multisystem inflammatory syndrome (MIS-C) that is very serious, which often presents with abdominal pain and prolonged fever. We all are hoping that the vaccine now available will be the beginning of the end of this virus. For more information on the vaccine, please see my Health-e Tips article on the COVID vaccine. Our knowledge about this novel virus is ever changing, as we are learning more every day. For updated information please visit the American Academy of Pediatrics and CDC websites.

What do I do if my child has RSV, Flu, or COVID

Even though there are no medication for viruses, we can make your child feel better. You can use saline with a nose suction device, sold in many stores to help suck the mucus from your baby’s nose. If your child is over one, you can also give a spoonful of honey every couple of hours as needed to help with the cough. Do not give any over-the-counter cough and cold medications to children without first speaking with their doctor. They are not effective nor safe for children. Acetaminophen and ibuprofen can be given to help children feel better until the child’s body fights off the virus. Use our calculator to make sure you give the correct dose. Your child may not have much of an appetite when sick, and that is ok. Just make sure they stay hydrated with liquids, and don’t push the solid foods if they don’t want them.

When should I take my child to the ER for RSV, Flu, or COVID

For the most part, children need time and rest for their body to fight off these viruses at home, and we can’t do much more in the ER than you can at home. However, sometimes they do cause symptoms that warrant a visit to the emergency room. The number one reason kids get hospitalized for RSV is breathing difficulty. If you notice your child is breathing very rapidly, breathing with their belly, or it looks like their rib cage is sucking in when breathing, this can be a sign that they need a little help with their breathing, and they should be evaluated in the ER. Even though we don’t have medications we can give, sometimes we need to put little tubes in a baby’s nose to help push the air into their lungs and make sure they don’t get tired out. RSV can also cause newborns to stop breathing for moments, called apnea. We also worry about dehydration in little ones, especially when they have more than one virus their body is trying to fight. You can monitor for signs of dehydration by watching how much they urinate – if they’re not drinking and peeing much less, or seem very lethargic to you that would be another reason to bring them into the ER. Typically a fever from a virus resolves by day 5. If your child has a fever that lasts for a solid 5 days in a row, they should be evaluated to make sure nothing more than a viral infection is going on.


March, 2021

We haven’t seen much RSV or Flu.

They never made this year’s debut.

Children got a break this winter, phew!

But I’ll leave the post here for your review.


November, 2022

They are here, they are here!

COVID, RSV, and flu.

This year they’ve come early with a vengeance

The ERs are flooded with these extra two.

So wash your hands and get your sleep,

And hopefully they will spare you.

But if not and your family gets sick,

We are here to help get you through.



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