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RSV, Flu & COVID: How Are These Respiratory Illnesses Different?

​Your child has a stuffy nose, cough and fever. Is it the flu? COVID? Or are they symptoms of respiratory syncytial virus (RSV)?

Let's look at four common childhood illnesses caused by viruses—COVID, flu, the common cold and respiratory syncytial virus (RSV). All of them share some similar symptoms. Here are some clues to help tell them apart.

RSV symptoms may include fever, cough, fatigue, stuffy nose, shortness of breath, sneezing, fast/short breaths, flaring nostrils, wheezing and grunting, poor feeding/no appetite. You may also notice their 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.

Watch this video for signs of RSV:
  • 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.

  • Cold symptoms may include fever, cough, fatigue, stuffy nose, sore throat, sneezing, slightly swollen glands. Colds are upper respiratory infections that can be caused by many viruses. Healthy children get about 6-10 colds a year.

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 °F in any child; fever above 100.4 °F in a child under 2 months old; fever above 103 °F for more than 24 hours.

Is it possible to be infected by two viruses at once?

Yes. For example, children can be infected by the flu and COVID at the same time. And it is not unusual for children to develop a secondary illness. For example, they may have bronchiolitis or pneumonia and other health problems like an ear infection or sinus infection.

Some of the symptoms of flu, COVID and other respiratory illnesses are similar. Your child's pediatrician may order a test if it is necessary to confirm a diagnosis.

How to avoid getting sick when these viruses are spreading

Immunizations are an effective tool to prevent serious illness from numerous preventable diseases. Staying up to date on routine immunizations also helps others—including people at high risk if they get infected.

  • Flu vaccines are recommended for everyone 6 months and older each year. Get your child vaccinated as soon as the vaccine is available so they are protected throughout flu season, which can last until the end of May.

  • The updated COVID vaccine is recommended for everyone 6 months and older. Ask your pediatrician when your child should receive an updated COVID vaccine.

  • Nirsevimab is an RSV immunization recommended for babies younger than 8 months of age in their first RSV season and some children age 8 to 19 months who are entering their second RSV season and are at high risk of getting very sick from RSV.

  • RSVpreF is a vaccine for pregnant people​ to protect their infants from RSV.

Remind your child about other ways to avoid illness. Children should learn to cover their mouths and noses with a tissue when they cough or sneeze (and then put the tissue in the trash right away). They can wear a mask in public to avoid the spread of germs to and from others. Everyone should be encouraged to wash their hands with soap and water or use an alcohol-based hand sanitizer.


If your child is sick and you have any questions or concerns about their symptoms, don't hesitate to call your pediatrician. And, it is important for all children to stay up to date on immunizations, sports physical examinations and routine care.

More information

Last Updated
American Academy of Pediatrics (Copyright © 2022)
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
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