Does my kid have COVID-19 or just a cold? A pediatric nurse explains how to tell – and why it matters

Fall and winter are peak seasons for respiratory infections like COVID-19, RSV (respiratory syncytial virus), influenza (the flu), and the common cold. These illnesses often start with similar symptoms such as coughing, runny nose, or sore throat, which can make it difficult to tell them apart. This confusion is compounded at the start of cold and flu season, as it overlaps with summer seasonal allergies. Each of these infections spreads easily, so keeping sick children home helps protect classmates and school staff, especially those with underlying health conditions that increase their risk of complications. For example, RSV can lead to serious lung infections in infants and young children, while COVID-19 and the flu may cause severe illness in children with chronic health conditions like obesity or diabetes.

While all these illnesses share symptoms like cough, runny nose, and sore throat, there are key differences that can help identify them. Colds, caused by various viruses, typically have mild symptoms that last about 7 to 10 days. COVID-19, caused by the SARS-CoV-2 virus, often lasts longer—7 to 14 days, sometimes up to three to four weeks—and may include body aches, shortness of breath, fatigue, fever, and loss of taste or smell. A distinctive feature of COVID-19 in some children is stomach symptoms like abdominal pain, vomiting, or diarrhea, which are not linked to colds. The flu, caused by the influenza A or B virus, comes on suddenly and lasts about 3 to 7 days, with symptoms similar to COVID-19 but without loss of taste or smell. RSV symptoms resemble a cold but may include decreased appetite and can lead to serious lung infections, particularly in infants and toddlers, with symptoms lasting three to four weeks.

If your child shows symptoms of a respiratory infection, keeping them home from school is generally recommended to prevent spreading the illness to others. A good rule to follow is whether your child can comfortably participate in classroom activities. If they have had a fever in the past 24 hours or symptoms like diarrhea, nausea, or vomiting, they should stay home and rest. The American Academy of Pediatrics highlights that children with certain medical conditions, such as obesity, diabetes, or immune system deficiencies, are at higher risk of severe illness if they contract COVID-19, RSV, or the flu. Keeping sick children home not only aids their recovery but also protects vulnerable individuals in the school community.

Determining whether your child has COVID-19 based on symptoms alone is often impossible, so testing can be useful. A home COVID-19 test is recommended if your child has symptoms or has been exposed to someone with COVID-19, or if they have a chronic medical condition that increases their risk of complications. A positive test result is reliable, but a negative result does not completely rule out COVID-19. This could happen due to errors in following testing instructions or because the virus levels are too low to detect. If symptoms persist after a negative test, the CDC advises retesting in 48 hours or having a healthcare provider perform a PCR test, which is more accurate.

The American Academy of Pediatrics recommends vaccinations for COVID-19 and the flu for all children over 6 months, unless there is a medical reason not to. A study published in December 2025 supports this recommendation, showing that vaccinated children are less likely to become severely ill or hospitalized if infected. The CDC also recommends vaccinating infants against RSV based on specific criteria. While vaccines do not guarantee complete protection, they help the immune system recognize and respond more effectively to these viruses. Vaccination reduces the risk of severe illness and the number of school days missed due to illness, benefiting both the child and the broader community.