As temperatures begin to drop, a handful of respiratory viruses are spreading at unusually high levels in the U.S. and sending children to hospital, and doctors are urging parents to be aware of what symptoms indicate serious illness.
Pediatric cases of flu and RSV, or respiratory syncytial virus, are on the rise. The number of covid cases in children is decreasing, but the coronavirus is also circulating at a high level.
Most children should recover from infections with Covid, RSV or the flu on their own, especially with rest and plenty of fluids, said Dr. Paul Offit, a pediatrician and vaccine expert at the Children’s Hospital in Philadelphia. But some, including very young children and those with underlying lung problems, may need extra care.
Here are the signs and symptoms to look out for if your child has a respiratory virus.
Does my child have RSV, Covid or the flu?
Because any virus usually starts out as an upper respiratory infection, it can be difficult — if not impossible — for parents to know early on which one they’re dealing with, said Dr. Kristin Moffitt, an infectious disease specialist at Boston Children’s Hospital. . Even for doctors, the only way to determine which virus is causing an infection is through a test.
Early symptoms of Covid, RSV, and the flu can be similar for many children, including:
- Running nose
- muscle strain
- A fever
Less common symptoms include:
- Stomach ache
A sore throat, Moffitt said, could be a sign of Covid, as doctors have noticed that infections with omicron subvariants often start with a sore throat.
Covid home testing can help parents determine if Covid is the cause of their child’s illness, although negative test results on rapid tests don’t always mean someone is clear.
Kids can also be tested for RSV or the flu at the doctor’s office, usually with what’s called a multiplex test, Moffitt said.
It’s also possible, she said, for a child to be infected with more than one virus at the same time, known as a co-infection.
Why are respiratory viruses dangerous for very young children?
It all comes down to anatomy: Babies and toddlers have much smaller airways than older children and adolescents. That means when they get sick from respiratory viruses, their airways can quickly fill with mucus, leading to breathing problems, said Dr. Deanna Behrens, a pediatric intensive care physician at Advocate Children’s Hospital in Chicago.
Children with underlying health conditions, such as chronic lung disease or heart problems, may also be at higher risk for serious illness from respiratory viruses, said Dr. Nusheen Ameenuddin, a pediatrician at the Mayo Clinic in Rochester, Minnesota.
Moffitt said if parents are unsure if their children need more help recovering from infections, they should call their pediatrician.
“The offices of pediatricians are now very responsive and trying to relieve the pressure that the emergency care and pediatric emergency department feel,” she said. They “often open “hospitals and things like that to be able to assess children who aren’t improving and whose parents are concerned, but don’t quite meet the criteria for an emergency department evaluation.”
When should a child go to the emergency room?
Symptoms that warrant an immediate trip to the emergency room include a child refusing to eat, having trouble urinating or breathing abnormally, Behrens said.
That’s especially important, she said, for “babies and maybe even the toddlers who can’t tell the parents what’s going on with them.”
Abnormal breathing can show up as rapid breaths, loud wheezing or a struggle to suck in air, Behrens said.
Respiratory problems can also manifest when the lips turn blue or the muscles between the ribs pull in with each breath, said Ameenuddin of the Mayo Clinic.
Parents should also seek emergency care if their child has a fever for more than 4 days, said Dr. Sunitha Kaiser, a pediatrician at UCSF Benioff Children’s Hospitals in San Francisco.
If left untreated, severe cases of Covid, RSV or the flu can develop into pneumonia, an infection of the lungs, said Dr. Peter Hotez, co-director of the Center for Vaccine Development at Texas Children’s Hospital.
RSV, Hotez said, is also known to cause bronchiolitis, an inflammation of the small airways in the lungs. Both conditions can be fatal, especially in children with underlying health conditions.
Is there a treatment for RSV?
A child who is sick with Covid may be given steroids or the antiviral drug remdesivir, Moffitt said. Likewise, a handful of antivirals can be given for the flu, including Tamiflu.
However, there is no treatment for RSV, so a child who becomes infected with the virus and is sick enough to go to the hospital will usually only be offered supportive care, including oxygen, Moffitt said.
There is also no vaccine for RSV, Hotez said. A handful is in development, one from Pfizer.
And certain children with underlying health conditions may qualify for monoclonal antibody injections to prevent severe RSV.
Hotez also urged parents to have their children vaccinated against Covid and flu.
“There are three viruses in circulation,” he said, “and if you can get one or two off the table by getting your child vaccinated, that makes things much easier.”
Ameenuddin said parents can protect their children who are too young to be vaccinated by creating a “cocoon” in which everyone around the children is vaccinated, reducing the chances of transmission and serious illness.
Follow NBC HEALTH On Twitter & Facebook.