🤒 Parents’ guide to virus triple-threat: Flu, COVID and RSV

It’s the winter “sick season” and pediatricians’ offices, urgent care centers, and pediatric hospitals are packed.

Respiratory syncytial virus (RSV), which causes colds and sometimes serious respiratory problems in babies and older adults, “is really surging at a time it doesn’t normally surge,” says Tina Tan, MD, a pediatric infectious disease specialist and professor of pediatrics at Northwestern University in Chicago. “There have been a lot of young infants that have required hospital care, and in multiple states there has been a high level of influenza activity that is occurring.”

The combination of flu arriving early while RSV is surging and COVID-19 is still circulating threatens to overwhelm the healthcare system, says Elizabeth Murray, DO, a pediatrician specializing in emergency medicine at the University of Rochester Medical Center and a spokesperson for the American Academy of Pediatrics.

Still, though it might seem like everyone is getting sick, there are some steps parents can take.

Staying Healthy

There’s no magic way to ensure your kids won’t get sick, but there are a number of strategies to reduce the likelihood of infection and limit the severity of some of the more dangerous viruses.

Keep kids up to date on vaccines. While there is no RSV vaccine yet, they should get their flu vaccine, their COVID-19 vaccines, and when eligible, their COVID-19 booster shots. “Protect yourself against what you can protect yourself against,” Tan says. “We have tools.”

With the flu already spreading, there’s no reason to delay getting a flu shot. And kids can get both their flu and COVID-19 shots at the same time, Keren says.

Wash hands thoroughly and regularly. Make sure your children learn to do so properly when arriving home, after using the bathroom, and before eating a meal or snack, Murray says.

Wear masks when needed. As we have learned during the ongoing COVID-19 pandemic, mask-wearing on certain occasions can help reduce exposure to a number of infections. That’s especially the case when you know you have certain bugs going around a classroom, Tan says—if one kid in a class tested positive for COVID-19, for example. You also may want to consider using masks more often when you know you have an event you don’t want to be sick for, like a performance, track meet, or family holiday celebration, Murray says. Older kids especially can understand that masks are most helpful when in crowded indoor spaces and can often be removed in less crowded or outdoor settings, she says.

Treating COVID-19, Flu, and RSV

No matter what you try, at some point your child’s temperature will rise or he or she will start to cough. Sickness happens, and younger kids typically get eight to 10 colds a year, according to Keren.

Focus on comfort. For viral infections, which include the illnesses mentioned above and other common respiratory bugs, kids generally just need time to heal, Tan says. But you want them to be as comfortable as possible throughout the process. “It’s all about comfort,” Murray says. “Let your child rest, watch movies—screen time rules don’t apply.”

Hydrate, hydrate, hydrate. Hydration is one of the most important things to focus on because dehydration is often what can eventually send a kid to the hospital. This happens particularly frequently with younger kids dealing with RSV, said Katie Lockwood, MD, an attending physician at Children’s Hospital of Philadelphia, at an October press briefing. If necessary, “this is the time to bribe them with sugary beverages like juice or ice pops,” she said. For children over age 1, some honey mixed with warm apple juice or decaffeinated tea can soothe throats, but never give honey to a child under 1 year of age.

Steam up the bathroom. Steam can help break up mucus, Lockwood says. Steam up a bathroom by running the hot shower and then let your child read a book as they breathe the steamy air, not in the tub, just sitting in the room. A cool mist humidifier at night can help, too, as long as you keep it clean and mold-free.

If a child has croup, characterized by a barking cough, taking them outside into the cool air at night can also help relax the throat, Tan says.

Be careful with meds. When it comes to medication, as long as your pediatrician has given the okay, it’s fine to use children’s ibuprofen or children’s acetaminophen to make kids more comfortable or treat a fever. Don’t give cough medicine to kids though, Murray says, because it doesn’t work well for them and can even be dangerous.

Keep kids home when sick. “In the past, we didn’t do things as well as we should have when it comes to appreciating illness and keeping people home,” Murray says. It’s especially important when kids have a fever or a strong cough, so try to have a plan in place to keep them home when they need to be.

When to Go to a Doctor or an ER

Whenever your child is sick or you have a question about their health, it’s worth giving your pediatrician a call just to check in. Right now, with emergency rooms so busy dealing with severe and urgent cases, it’s best to go to your pediatrician or an urgent care center first if you can, Keren says. Many pediatricians can run a quick test to see if an illness is caused by COVID-19, flu, or RSV, for example.

But if you see real emergency signs, you should go to a hospital, Tan says. If your child is very sick, they’ll be prioritized. Here’s what to know about when you should seek care.

Fever: For infants under 60 days old, any fever is an emergency, Murray says. A fever of 105° F is also a medical emergency for any child. Call your doctor about fevers that don’t go down with medicine or that last for longer than a day, and call if a fever goes away for a day or more and then returns.

Dehydration: If your child starts to show signs of dehydration, call your doctor. These signs include a lack of tears while crying and fewer than six wet diapers a day for infants or no urination for 8 hours in toddlers or older kids. If your child seems very sleepy or lethargic along with these signs, go directly to an ER.

Breathing trouble: Signs include breathing much faster than normal and using abdominal muscles to breathe. Other emergency signs include your child’s chest appearing to be sinking under their collarbone or ribs or your child being unable to catch their breath enough to talk. Some kids with breathing trouble may also appear bluish or purplish around the mouth or fingernails. Grunting, nose flaring, and chest pain, which is very uncommon in children, are also signs you should go to an ER, according to Murray.

Trust your gut: If your child is truly in an emergency situation, “you are not going to miss it,” Murray says. “None of these symptoms are subtle; you’re going to know if your child is struggling.” It’s understandable that kids would become more lethargic and easily upset when sick, but you should be able to see when their behavior is significantly different or doesn’t seem proportionate to the symptoms they’re experiencing.

When Does This End?

This crush of illnesses appears to be happening now because a lot of children weren’t exposed to much COVID-19, flu, and RSV for a year or two and are now being exposed again, Murray says.

That’s changing the timing of these illnesses, and it also means that some kids appear to be struggling a bit more than would have been expected. Murray says she’s seen some kids ages 3 and 4 struggling more than expected with RSV, for example, which is usually a simple cold in kids that age but more of a serious issue for infants.

But we don’t yet know the outlook for the full winter cold and flu season, or the role that new COVID-19 variants will or won’t play. “It’s hard to know,” Murray says. “Are we going to peak early and be done, or is it going to be continuously bad?”

In the south and south-central regions of the U.S., where rates of the flu have started to tick up, RSV rates are actually decreasing, said José Romeno, MD, director of the Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, on a press call.

In the meantime, “we need to tip the odds in favor of health and success,” Murray says. That means getting kids vaccinated against the illnesses we can protect them from, and keeping them home when they’re sick to stop illnesses from spreading further.