UNC Health Talk

A Parent’s Guide to Treating Cold, Flu and COVID-19

Aaahh-choo! Sniff! These are sounds that can cause dread for any parent. No one wants to see their child infected with a cold, the flu or COVID-19.

Unfortunately, you can’t avoid every runny nose or sore throat. Viral illnesses are common among healthy children throughout the year, especially during cold and flu season (generally the fall and winter months).

“Children may catch as many as 12 colds or viral infections in the first two years of life,” says Cheryl Lynn Jackson, MD, chief of the Division of Pediatric Emergency Medicine at the UNC School of Medicine. Older children can experience several colds a year, too.

Here’s what parents need to know to help their children feel better.

Know the Symptoms of Colds, the Flu and COVID-19 in Children

Determining whether your child is suffering from a cold, the flu or COVID-19 can be tricky. The symptoms of all three are similar and can include a runny, stuffy nose and sore throat. (Sore throat is a tough symptom to spot in children too young to talk, but fussiness, a reduced appetite and drooling are potential signs.)

Both COVID-19 and the flu can cause fever, cough, shortness of breath, fatigue, body aches, muscle pain and vomiting and diarrhea. Loss of taste and smell is sometimes one of the first symptoms of COVID-19, whereas it usually comes later in the course of a cold or flu.

Cold symptoms are typically less severe than flu symptoms, but some colds are caused by RSV, which can be dangerous in babies. COVID-19 in young children is typically mild but in some cases results in serious illness.

“Most colds last about a week, but it’s not unusual for cold symptoms to last as long as 10 to 14 days,” Dr. Jackson says. “And because viruses mutate, there are multiple strains of the same virus, and you might get infected by a different strain right after you recover from the last.”

The only way to know for sure what virus is at work is to get tested. This is especially important in the midst of the COVID-19 pandemic, because a positive COVID-19 test means your child will need to quarantine before returning to school or socializing.

How to Help Your Child Feel Better

Much of treating a cold, the flu or COVID-19 in young children is about monitoring their symptoms and keeping them as comfortable as possible.

“We don’t recommend over-the-counter cough and cold medicines for children younger than 4 years of age,” Dr. Jackson says, because the drugs in these products can have serious and even life-threatening side effects if dosed incorrectly. “It’s difficult to assure that the smallest children don’t get more than recommended for their weight, particularly if given too frequently.”

For children 4 or older, your pediatrician can recommend cough and cold medicines to manage cold symptoms.

Fever-reducing drugs can be taken by babies, toddlers and children. Sometimes, doctors prescribe antiviral medications for children with the flu.

Here’s what parents can do at home:

  • For nasal congestion, run a cool mist humidifier to fill the air with moisture, which helps loosen mucus and moisten your child’s airways. Saline drops and sprays can help, too. Older children can be reminded to blow their nose often; parents can use nasal suction devices—gently—on babies and toddlers.
  • For a fever of 100.4 degrees or more, you can give acetaminophen (Tylenol) or ibuprofen to children 6 months or older. Babies younger than 6 months cannot take ibuprofen, only Tylenol. Make sure you understand the correct dosage based on your child’s age and weight. A newborn in the first month of life with a fever of 100.4 or greater needs to go to the emergency department and may require hospitalization. For older babies, contact your pediatrician immediately for advice.
  • For a cough, children over age 1 can try honey, Dr. Jackson says: ½ to 1 teaspoon before bed can help. Warm, decaffeinated tea with honey can help too. (Remember that babies younger than 1 cannot have honey in any form.) Popsicles are often a kid-favorite remedy for coughs and sort throats. Mentholated rubs can be used on children ages 2 and older; cough drops can be used starting at age 4. Elevating your child’s head at rest can help prevent postnasal drip, which exacerbates coughing. Finally, if your child is having coughing spasms, call your doctor to check for croup, which causes a barking cough.
  • To prevent dehydration, encourage your child to drink a lot of fluids. Breast milk and formula are best for babies, but Pedialyte can help if they’re not feeding enough. Pedialyte is a good choice for toddlers, too; older children can drink Pedialyte or Gatorade to replace electrolytes.

Know When to Seek Emergency Care

Dr. Jackson says that you should take your child to the emergency department if they are experiencing labored breathing (working hard to breathe or struggling to breathe), they appear to be dehydrated, they’re experiencing uncontrollable pain or their fever is getting worse and lasting more than two or three days.

For infants and toddlers, if they are not drinking fluids or wetting two or fewer diapers a day, it’s time to get immediate medical care. Again, a newborn in the first month of life with a fever is also an emergency.

“If you are concerned with how your child looks and you’re not clear if this can wait until morning, take them to the emergency room,” Dr. Jackson says. “If that’s your perception, it needs to be acted on.”

If your child has been sick for more than a week and symptoms are not improving, call your pediatrician, Dr. Jackson says.

Ways to Prevent Cold and Flu in Children

Flu symptoms will develop one to four days after exposure, cold symptoms show up one to three days after exposure, and COVID-19’s incubation period is typically two to 14 days after exposure, Dr. Jackson says.

“Fun fact about viruses: You’re most contagious 24 to 48 hours before symptoms are at their greatest and you notice them,” Dr. Jackson says.

With so many illnesses circulating, preventive steps are critical:

  • Keep your children at home if they’re sick.
  • Teach children to wear masks and practice physical distancing.
  • Vaccinate children 6 months and older for the flu and 5 years and older for COVID-19. Make sure all adults in the family receive these vaccines.
  • Encourage frequent and thorough hand-washing and teach children how to cover their coughs and sneezes. Use alcohol-based hand sanitizer when hand-washing isn’t possible, and remind your children not to touch their eyes, nose and mouth with unwashed hands.
  • Disinfect frequently touched surfaces and objects, including toys, doorknobs, phones and tablets.
  • Don’t share silverware, plates or cups, especially if someone is ill.

If your child has symptoms of a cold, the flu or COVID-19, talk with your pediatrician. If you don’t have a pediatrician, find one near you.