RSV, Flu and COVID-19: Symptoms and When to See a Doctor

Kaitlin Cockerell, M.D., a general pediatrician at Arkansas Children's Hospital in Little Rock and assistant professor of Pediatrics at the University of Arkansas for Medical Sciences (UAMS), explained a respiratory illness is any illness caused by a virus that can affect the respiratory tract — lungs, upper and lower airways. Even the common cold can turn into a respiratory virus.

"Viruses' are spread by secretions, like if a person coughs or sneezes on someone or out into the air. It can also be spread by saliva, for example, if someone shares a drink or kiss," Cockerell said. "Someone must be in close contact with another person to spread it. It is not spread by just touching someone who has the virus."

However, Cockerell noted if a person with a virus sneezes or coughs, it can linger in the air or on a surface for hours.

Breaking it down: RSV, Flu and COVID

No medication can treat a virus. Some medicines control symptoms caused by a virus, like coughing or fever, and can lessen the length of symptoms. For example, Tamiflu or Xofluza (for ages 12 and up), if taken within the first 48 hours of flu symptoms, can help shorten flu symptoms. A person who starts the medication in that window may experience symptoms for five days instead of seven.

The most common respiratory illnesses are RSV, flu and COVID:

• RSV, Respiratory Syncytial Virus. It causes common cold symptoms in older children and adults. Infants and children under two are at risk for severe wheezing and respiratory distress, requiring oxygen and hospitalization. A hallmark symptom is trouble breathing. Dehydration can also occur. RSV is the most common cause of pneumonia and bronchiolitis in children under 1.
• Flu, caused by the influenza virus. The most common strands are Influenza A and Influenza B. People can experience fever, muscle aches, congestion, coughing and vomiting.
• COVID-19, caused by the SARS-CoV-2 virus. Subtypes cause various symptoms, including cough, congestion, a runny nose, fever, body aches, sore throat and loss of taste and smell. Most children who contract COVID-19 experience cold symptoms, but children with underlying conditions are most at risk.

Children who contract a respiratory illness can see a primary care doctor if they have the following symptoms:

• Mild cough
• Runny nose
• Sore throat
• Fever at or less than 100.4
• Mild fatigue

If a child has a fever of 100.4 for more than 24 to 48 hours or their symptoms are not improving within five to seven days, parents should make an appointment with their primary care doctor.

Emergency care is vital if a child has:

• Trouble breathing
• Changes in alertness
• Bluish lips or face
• Persistent chest pain/pressure
  
  

When to see a doctor or go to ER

"The biggest reason you'd want to go to the ER is for a child's respiratory status. They need a more critical evaluation if they're visibly struggling to breathe or saying their chest hurts," Cockerell said.

Parents may notice fast or hard breathing when a child sleeps, indicating they're struggling to breathe. Lethargy is different from fatigue. Cockerell explained fatigue can be if a child has low energy "and just wants to lay around on the couch" but is still eating and drinking.

"If a parent is having a hard time waking their child up, it's lethargy. They need to go to the emergency room," she said.

Parents need to immediately take a baby under six weeks with a fever to an emergency room because their immune systems are weak.

Comfort at home & prevention

There are many ways a parent can keep their child comfortable at home as they recuperate from a respiratory illness.

• Lots of rest
• Alternate Tylenol and Ibuprofen for pain relief, even if a child does not have a fever.
• Drink fluids to stay hydrated. If a child won't drink, popsicles help with hydration.
  
  

Several things can prevent or lessen the chance a child will contract a respiratory virus. Children six months and older should receive flu and COVID vaccines. Cockerell said every relative in close contact with children younger than six months should ensure their vaccines are up-to-date. Other tips include:

• Good hand hygiene, like scrubbing hands for at least 20 seconds. Children can sing or hum “Happy Birthday” twice to remember how long it takes to wash their hands.
• Cough into their elbow instead of their hand.
• Wear a mask in crowded public places.
• If one child has a virus in the home and another is healthy, using Lysol in their sitting areas and hand-washing can limit the spread.
• Do not allow sick relatives in contact with infants. Relatives need to wash their hands and avoid touching a baby's face.
  
  

"It's up to the parent and their discretion, but it's a good conversation to have with your family members. Ask them if they're coughing, have a runny nose or any respiratory illness symptoms," Cockerell said.

Where to find vaccines, treatment

Arkansas Children’s hospitals and clinics provide COVID-19 and flu vaccines, along with other immunizations. Arkansas Children’s Hospital in Little Rock and Arkansas Children’s Northwest in Springdale deliver high-quality care in their emergency departments.

Primary care services are available at the following:

• General Pediatric Clinic, ACH
• Primary Care Clinic, ACNW
• ACH Southwest Little Rock Clinic
• ACH Pine Bluff Clinic
• Arkansas Children's Hospital - After-Hours Clinic
• Harvey Pediatrics, Operated by Arkansas Children's